Both nociceptive pain and neuropathic pain are commonly encountered in the orthopaedic setting. In most patients, nociceptive pain (eg, acute postoperative pain or pain associated with a fracture) may be adequately controlled with nonsteroidal anti-inflammatory drugs (NSAIDs), opioid analgesics, or a combination of these. Neuropathic pain refers to a group of disorders characterized by pain resulting from dysfunction or disease of the nervous system at a peripheral level, central level, or both. Frequently, NSAIDs and opioid analgesics do not provide relief, and adequate control requires medications directed specifically at neuropathic pain. Medications commonly used include antispasmodics, tricyclic antidepressants, and anticonvulsant agents. Anticonvulsant drugs have been used in pain management since the 1960s, soon after they were first used in the management of epilepsy. A recent addition to this class of agents is gabapentin. Gabapentin was initially approved by the FDA for use as an adjunct in treating partial seizures with or without generalization. Its safety and efficacy soon led to its use in treating a wide variety of neuropathic pain conditions. It has some distinct advantages over other available medications. As a result, gabapentin has rapidly become a first-line agent for the treatment of neuropathic pain.



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