Local Anesthetics

Also used in the treatment of neuropathic pain have been intravenous lidocaine and oral mexiletine. While these drugs clearly have central effects, they also have peripheral effects because they decrease the spontaneous activity of peripheral pain generators. Years ago, studies indicated that there may be an increase in the incidence of cardiac arrhythmia in patients who received these agents immediately after experiencing a myocardial infarction. Thus, local anesthetics must be used cautiously in patients with comorbid cardiac disease.

Table 3.1. Mechanism of action of pharmaceuticals indicated for other conditions and used to treat pain

Agent

GABA receptor

Glutamate and excitatory amino acids

Channels

Ectopic impulses

Miscellaneous

Gabapentin

Augments transmission, increases rate of synthesis

Inhibits release

Blocks Na+ and Ca+

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