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  1. Start treatment early

  2. Include a mind/body strategy to improve coping and to help with mood and sleep disturbances

  3. 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.

  4. 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.

  5. CAM approaches such as acupuncture, soy, Vitamin E, or AMP may be useful adjunctive therapies in some patients.

   

 

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