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A variety of mechanisms may generate pain resulting from injury to the peripheral nervous system.None of these mechanisms is disease-specific,and several different pain mechanisms may be simultaneously present in any one patient,independent of diagnosis.An adequate trial for each agent tried is key to pharmacologic treatment of neuropathic pain.Tricyclic antidepressants are first-line agents,although other drugs,including anticonvulsants,local anesthetic antiarrhythmics,clonidine,opioids,and certain topical agents,also offer pain relief in some patient populations. The novel antidepressants venlafaxine and nefaxodone and potentially useful new drugs that are better tolerated than tricyclic antidepressants. |
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