A variety of other adjuvant drugs including antidepressants, anticonvulsants, oral anti-arrhythmics and corticosteroids are useful for treating patients with nerve invasion, compression or other neuropathic pain syndromes. When opioids are used for pain control, the side effects should be treated aggressively in order to maximize the benefit of the expense of the side effects. Nausea may be treated with the phenothiazines, butyrophenones or Ondansetron. Constipation may be treated with a variety of dietary agents as well as medications. Excessive sedation may be treated with an AM dose of an amphetamine.
Some patients develop untreatable side effects at doses of opioids adequate to control their pain.
These patients may be candidates for intraspinal opioids in order to minimize the dose required to treat pain and to limit the systemic side effects. If this technique appears to be indicated, a trial infusion may be performed using a conventional epidural catheter. Patients suffering from intractable neuropathic pain may benefit from the addition of clonidine to epidural or intrathecal delivery systems. There are a variety of systems available for the long-term infusion of intraspinal opioids. These range from implantable catheters with externalized ports to implanted subcutaneous infusion pumps.