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  • Print publication year: 2008
  • Online publication date: December 2009

Postdural puncture headache

from Chief complaints and diagnoses

Summary

The diagnosis of neuropathic pain (NP) encompasses a broad array of conditions. For the acute care provider, the goals of NP therapy are to decrease persistent pain and suppress breakthrough pain. One recommended strategy for NP treatment is to begin the therapy simultaneously with two drugs: an analgesic (e.g. mild opioid) and an adjuvant (e.g. antidepressant). Opioid doses in NP may be relatively higher than customary for non-NP indications, and in fact varying types of NP may warrant different opioid dosages. Clinically, patients with allodynia are potential candidates for local anesthetic use. Local anesthetics may also be useful in NP when administered in the form of regional nerve blocks. Since inflammatory mediators sensitize nociception, the anti-inflammatory corticosteroids have been used for NP. Corticosteroids also decrease local edema, thus reducing pressure on peripheral nerves. As dexamethasone has relative few mineralocorticoid effects, it is preferred by many who use corticosteroids in NP.

References

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