Neuromodulating Agents

Chapter 10 explores the variety and mechanisms of medications used for chronic and neuropathic pain. In patients with chronic and neuropathic pain, these medications can and do serve as the primary medication with efficacy. To call these agents “adjuvant” is, therefore, incorrect, despite longstanding custom. The neuromodulating medications discussed here include pain-active anticonvulsants, including gabapentinoids, pain-active antidepressants, local anesthetics, and other neuroactive agents. The medications are divided based on drug class and mechanism in order to facilitate rational combination of medications from different classes when treating patients with neuropathic or chronic pain that does not respond sufficiently to a single agent.