Pain and Symptom Management/Palliative Care, BC Cancer Agency, Vancouver Centre, Vancouver, British Columbia, Canada. pippahawley@shaw.ca
There are relatively well-defined and preferred therapies for neuropathic pain including newer generation anticonvulsants (such as gabapentin), TCAs, and opioids in select patients. In patients with ongoing pain despite treatment with these agents, or who are intolerant to them, venlafaxine or duloxetine may be helpful. There are no comparative studies between nontricyclics for neuropathic pain, thus an agent should be selected based on its side effect profile, cost, and familiarity with use.