Presented by Mark Rowbotham, M.D. at the Anesthetic and Life Support Drugs Advisory Committee Meeting on May 16, 2002

The result of the coin toss: Michael-lumpier, Bob-splitter.

Neuropathic pain: Is it all the same from a treatment perspective? Michael C. Rowbotham, M.D. UCSF Pain Clinical Research Center

Neuropathic Pain Types Post-herpetic neuralgia Trigeminal neuralgia Focal peripheral nerve injury Anesthesia dolorosa Central pain –Post-stroke (or mass lesion) –Spinal cord injury –Multiple sclerosis Peripheral neuropathy (distal symmetric) –Diabetic –HIV related –Chemotherapy related –Inherited –Other acquired RSD/CRPS 1 ?????

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

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?

Special Cases PHN? Trigeminal neuralgia?