Workup and Management of Persistent Neuralgia following Nerve Block

Table 3

Nonopioid multimodal analgesic regimen for neuropathic pain.

Supplements/vitamins	(1) Acetyl L-carnitine: 1000 mg–3000 mg per day; (2) Alpha lipoid acid: 600 mg–1200 mg per day; (3) Fish oil: 1000 mg–2000 mg per day; (4) Vitamin C: 1000 mg–1500 mg per day
Nonsteroidal anti-inflammatory drugs (NSAIDs)	(1) Ibuprofen 600 mg–2400 mg per day; (2) Naproxen 750 mg–1000 mg per day; (3) Diclofenac 150 mg–200 mg per day; (4) Meloxicam 7.5 mg–15 mg per day; (5) Celecoxib 200 mg–400 mg per day; (6) Acetaminophen 2000 mg–4000 mg per day; (7) Prednisone taper: 60 mg for 5 days → 40 mg for 5 days → 20 mg for 5 days
Calcium channel antagonists	(1) Gabapentin 1800 mg–3600 mg per day; (2) Pregabalin 300 mg–600 mg per day
Sodium channel antagonists	(1) Carbamazepine 300 mg–1200 mg per day; (2) Oxcarbazepine 1200 mg–1800 mg per day; (3) Topiramate 100 mg–400 mg per day; (4) Mexiletine 300 mg–450 mg per day
Topical agents	(1) Lidocaine; 5% Ointment: 15 g–20 g per day; 5% Patch: 1–3 patches per day. 12 hrs on, 12 hrs off; (2) Capsaicin; 0.025%–0.075% cream: apply 4 times daily; (3) Methyl salicylate/menthol cream; (4) Transcutaneous Electrical Nerve Stimulation (TENS) unit
Antidepressants	(1) Tricyclic antidepressants; Amitriptyline 75 mg–150 mg per day; Nortriptyline 75 mg–150 mg per day; Desipramine 75 mg–150 mg per day; (2) Selective serotonin-norepinephrine reuptake inhibitors; Venlafaxine 75 mg–225 mg per day; Duloxetine 60 mg–120 mg per day; Desvenlafaxine 50 mg per day; Milnacipran 100 mg–200 mg per day