The result of the coin toss: Michaellumpier, Bobsplitter.

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Presented by Mark Rowbotham, M.D. at
the Anesthetic and Life Support Drugs Advisory
Committee Meeting on May 16, 2002
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The result of the coin toss Michael-lumpier,
Bob-splitter.
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Neuropathic painIs it all the same from a
treatment perspective?Michael C. Rowbotham,
M.D.UCSF Pain Clinical Research Center
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Neuropathic Pain Types

• Central pain
• Post-stroke (or mass lesion)
• Spinal cord injury
• Multiple sclerosis
• Peripheral neuropathy (distal symmetric)
• Diabetic
• HIV related
• Chemotherapy related
• Inherited
• Other acquired

• Post-herpetic neuralgia
• Trigeminal neuralgia
• Focal peripheral nerve injury
• Anesthesia dolorosa

RSD/CRPS 1 ?????
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Problems with splitting

• Response different? PROVE IT!
• i.v. lidocaine
• Tricyclics/ADs
• opioids
• anticonvulsants
• topicals
• Pure neuropathic? Yes and No
• Spinal cord injury?
• Multiple sclerosis
• Back/neck w/radiculopathy
• Diagnostic certainty? Not always
• Different mechanisms? Broad overlap

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Clinical Trials Issues

• Want to encourage study of a broad range of
  disorders
• Prevalence
• Concomitant medical disorders
• Inhomogeneity within the diagnosis
• Responsivity of disorders may vary
• Central pain - low response rates
• Diabetic neuropathy - high placebo response
• PHN - allodynia prevalent valid outcome measure?

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Special Cases

• PHN?
• Trigeminal neuralgia?