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Patients with a variety of options for pain found in our daily practice. How important it is for a doctor after the examination of the patient to clearly define the genesis of pain, because of this often depends on choosing the right and appropriate treatment.

Neurologist, like anyone else, should know what pain is and what its types exist. And what medications effectively help eliminate the pain.

Pain - is an unpleasant sensation and emotional experience associated with actual or potential tissue damage or described in terms of such damage. We recommend products containing gabapentin, such as Neurontin. It is often given in small doses to patients, but also, it can be easily purchased at online pharmacies.

All pain are divided into two major types: nociceptive (or somatogenically) and neuropathic (or neurogenic). Nociceptive (somatogenically) - is the pain caused by the influence of some factor (mechanical trauma, burns, inflammation, etc.) on the peripheral nociceptors at the intactness of all parts of the nervous system. Neuropathic (neurogenic) - is pain that occurs when organic lesion or disturbance of function of different parts of the nervous system, both peripheral and central, at any level, from the peripheral nerves and ending with the cerebral cortex.

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Nociceptive pain are often acute and neuropathic pain - chronic. In certain cases there is a combination of nociceptive and neuropathic pain components (with compression radiculopathies).
The most common situations in which common neuropathic pain are:

  • Diabetic neuropathy (DNB) - 86%.
  • Postherpetic neuralgia (PHN) - 3%.
  • Trigeminal neuralgia (TN) - 1%.
  • Cancer neuropathic pain - 6%.
  • HIV neuropathy - 3%.
  • Complex regional pain syndrome (CRPS), previously designated as reflex sympathetic dystrophy - local pain and swelling, trophic disorders, and osteoporosis - 1%.

Examples of neuropathic pain:

  • In diabetic and alcoholic polyneuropathy (up to 25-45%).
  • Postherpetic neuralgia (in old age is a complication occurs in 70% of cases of herpes zoster).
  • Complex regional pain syndrome (local pain and swelling, trophic disorders, and osteoporosis), which was previously designated as reflex sympathetic dystrophy. A striking example of CRPS, are quite common in the industrial regions of Ukraine, is vibration disease.
  • Trigeminal neuralgia.
  • The phantom pain.
  • Post-stroke central pain.
  • Pain in multiple sclerosis, syringomyelia, spinal cord injury.

The frequency of neuropathic pain:

  • 1.5% - in the population
  • Diabetic polyneuropathy - 45%;
  • Multiple sclerosis - to 28%;
  • With syringomyelia - 75%;
  • With cerebral stroke - up to 8%;
  • When nerve injury - up to 5%;

Among all patients with neuropathic pain, approximately 50% are patients with diabetic polyneuropathy. Unfortunately, often pain in patients treated as vascular or vertebral, which leads to inadequate therapeutic measures.

Gabapentin copes:

A feature of neuropathic pain is associating with specific sensitive disorders:

  • Allodynia;
  • Hyperesthesia;
  • Hyperalgesia;
  • Hyperpathia;
  • Neuralgia;

Allodynia - the emergence of pain in response to a stimulus that normally causes no pain. In such cases, patients experience severe pain at the slightest touch, sometimes even when the wind blows. There are thermal and mechanical allodynia. Mechanical allodynia is divided into static, which occurs when the pressure on the fixed point of the skin, and the dynamic that occurs when a moving stimulus, such as a brush or your finger mild skin irritation.

When hyperalgesia sensitivity to painful stimuli is much higher than expected rate.

When hyperpathia subjective response as painful and non-painful stimulus is excessive and often persists for a long time after the cessation of stimulation.

Neuralgia (trigeminal, postherpetic) are a typical example of neuropathic pain.

Spontaneous pain is caused by the apparent absence of any external influence; usually has a burning, stinging character.

Paresthesia - tickling sensation, painless tingling or similar.

Dysesthesia - a condition in which the sensations caused by paresthesia, pain.

Neuropathic pain occurs as a result of impaired interaction of nociceptive and antinociceptive systems due to their destruction or impairment of function at different levels of the nervous system. The most studied role of peripheral nerve roots, spinal dorsal horn, the pain neurotransmitter, glutamate receptors, sodium and calcium channels. Possible mechanisms of pain include spontaneous ectopic activity of damaged axons, sensitization of pain receptors, the pathological interaction of peripheral sensory fibers, hypersensitivity to catecholamines.

Central sensitization group of neurons in the spinal cord is the result of neuronal plasticity, activated primary afferent stimulation. This process is considered to be crucial in the formation of neuropathic pain syndrome and leads to the development of allodynia and hyperpathia.

N-Voltazhzavisimye calcium channels are located in the rear surface plate and a horn of the spinal cord are involved in the formation of neuropathic pain. It is believed that the subunit ?2?, which is part of voltazhzavisimyh calcium channel is a target for antiallodinicheskogo action of gabapentin buy.

Methods of treatment of neuropathic pain can be divided into two major groups: non-drug and drug.

Drug-free methods of enhancing the activity of anti-nociceptive system:

  • Acupuncture;
  • Percutaneous electroneurostimulation;
  • Stimulation of the spinal cord;
  • Physiotherapy;
  • Biofeedback;
  • Psychotherapy;

Less blockade and neurosurgical treatments (destruction of the dorsal root entry zone), blocking flow of afferent nociceptive afferent:


  • Local anesthetics;
  • Opioids;
  • Central muscle relaxants;
  • Antiarrhythmic drugs;
  • Antidepressants;
  • Anticonvulsants;

Simple analgesics (paracetamol, aspirin) and steroidal anti-inflammatories (diclofenac, indomethacin, etc.) Are ineffective for neuropathic pain and is not used for its treatment. This is due to the fact that the main mechanisms of neuropathic pain are not inflammatory processes, and receptor and neuronal disorders, peripheral and central sensitization.

Local anesthetics:

- 5% lidocaine cream or patch (versatis) used for the blockade of peripheral nociceptors;

- Perineural injection of corticosteroids or a combination of local anesthetics and corticosteroids may be used to treat pain in mononeuropathy and neuromas;

Central muscle relaxants:

  • Tolperisone (Mydocalmum);
  • Baclofen;
  • Tizanidine (sirdalud);

Often these drugs alone can not adequately arrest neuropathic pain, but in combination with preparations from the group consisting of anticonvulsants enhance the effect of the latter.

Opioid analgesics:

  • Morphine;
  • Codeine;
  • Oxycodone;
  • Tramadol;
  • Dextromethorphan;
  • Methadone;

Experience shows that the use of the above drugs is justified only in the case of neuropathic pain associated with cancer. In our department, we use buy Neurontin (gabapentin).

Antidepressants. Previously, many neurologists often neuropathic pain, including my colleagues, widely used tricyclic antidepressants, such as amitriptyline is well known, both alone and in combination with anticonvulsants (eg, carbamazepine). Experience has shown by many authors and publications, the use of tricyclic antidepressants are currently irrelevant, since they cause adverse effects associated with anticholinergic effect, orthostatic hypotension and cardiac arrhythmias. Contraindications to the appointment of tricyclic anticonvulsants are:

  • Violation of cardiac conduction;
  • Congestive heart failure;
  • Seizure disorders;
  • Urinary retention;
  • liver failure;


Relative contraindications include orthostatic symptoms.

Currently, clinical experience is still insufficient for use in the treatment of neuropathic pain syndromes from other antidepressants groups, both independently and in conjunction with the same anticonvulsant.