Mexiletine therapy for chronic pain: survival analysis identifies factors predicting clinical success.

Mexiletine, a sodium channel blocker, treats neuropathic pain but its clinical value has been questioned due to its significant side effects and limited efficacy. We hypothesized that ongoing therapy with mexiletine would have limited patient acceptance, but that an analgesic response to intravenous (IV) lidocaine (a pharmacologically similar drug) would identify patients most likely to choose ongoing therapy with mexiletine. We identified a cohort of 37 patients with neuropathic pain who underwent IV lidocaine infusions at our institution and were subsequently prescribed mexiletine.

Intrathecal analgesic drug therapy.

Intrathecal analgesic infusion therapy through an implantable pump system is a sophisticated medical therapy for those who suffer from chronic, severe pain who are unresponsive to traditional medical therapy. This article describes the patient selection and monitoring process and reviews available intrathecal medications and combinations.

Intrathecal methods.

Although the use of opioids for intrathecal anesthesia was first reported in 1901, it was not until 25 years ago that the first report of selective blockade of pain by spinal opioids was described. Since its beginning, the promise of selective analgesics derived from intraspinal administration has generated much development in the field of pain management. In fact, many anesthesiologists who had previously relegated themselves to the confines of the operating room discovered that their needles and catheters could reach even beyond the inpatient wards, affording patients outside the hospital the opportunity to receive neuraxial drugs.