- Start treatment early
- Include a mind/body strategy to improve coping and to help with mood and sleep disturbances
- For mild to moderate pain, start with topical and physical approaches including the use of a lidocaine patch, TENS, or capsaicin cream. If pain persists, the addition of an antidepressant such as nortriptyline or an anticonvulsant such as gabapentin should be tried.
- For more severe pain, a lidocaine patch plus an antidepressant or anticonvulsant
should be started. Access to an opioid should be considered. If the pain
does not improve, other drug trials, including a trial of an opioid given
around the clock (with appropriate adjustment of the dose) should be considered.
- CAM approaches such as acupuncture, soy, Vitamin E, or AMP may be useful adjunctive
therapies in some patients.