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Previous Volume 348:1243-1255 March 27, 2003 Number 13 Next

	Since this article has no abstract, we have provided an extract of the first 100 words of the full text and any section headings.

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This Journal feature begins with a case vignette highlighting a common clinical problem. Evidence supporting various strategies is then presented, followed by a review of formal guidelines, when they exist. The article ends with the authors' clinical recommendations.

A 67-year-old woman who had been in excellent health noticed the onset of burning pain in the left great toe two years before evaluation. The pain subsequently extended to involve both feet, from the toes to the heels, and was associated with numbness, tingling, and burning. The discomfort has become severe, is present throughout the day, and disrupts sleep. A physical examination . . . [Full Text of this Article]

The Clinical Problem

Strategies and Evidence

Initial Evaluation

Treatment of Painful Neuropathies

Pathophysiology of Painful Neuropathy

Summary of Clinical Trials

Antidepressant Drugs

            Tricyclic Antidepressants

            Selective Serotonin-Reuptake Inhibitors

            Other Antidepressants

Anticonvulsants

            Carbamazepine

            Phenytoin

            Gabapentin

            Lamotrigine

Antiarrhythmic Drugs

            Mexiletine

N-Methyl-D-Aspartate Glutamate Antagonists

Narcotic and Nonnarcotic Analgesics

Levodopa

Topical Agents

            Capsaicin

            Topical Lidocaine

Alternative Therapies

Areas of Uncertainty

Guidelines

Summary and Conclusions

Source Information

From the Department of Neurology, Ohio State University, Columbus.

Address reprint requests to Dr. Mendell at the Department of Neurology, Ohio State University, Rm. 445, Means Hall, 1654 Upham Dr., Columbus, OH 43210, or at mendell.1@osu.edu.

Related Letters:

Painful Sensory Neuropathy
Leiner S., Truini A., Cruccu G., Garcia-Larrea L., Mendell J. R., Sahenk Z.
Extract | Full Text | PDF  
N Engl J Med 2003; 349:306-307, Jul 17, 2003. Correspondence

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