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Presented by Mark Rowbotham, M.D. at the Anesthetic and Life Support Drugs

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.

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Presented by Mark Rowbotham, M.D. at the Anesthetic and Life Support Drugs

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

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

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

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

  5. 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

  6. 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?

  7. Special Cases • PHN? • Trigeminal neuralgia?

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