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This approach carries the risk that relapse may occur as the dose is reduced, particularly if this is done too quickly. In order to avoid this relapse, the dose is often increased again and maintained. The danger then is that the patient becomes dependent on corticosteroids.

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This is because the drug has to be in a lipid soluble form to diffuse through the myelin sheath and neuronal membrane. Once inside the neuron dissociation is necessary, because it is the ionized form binds to the sodium ion channel.

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What advice can you give Mrs Dexter about what appears to be neuropathic pain. You may need to refer to Chapter treatment of neuropathic pain in the BNF.

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As far as radiography is concerned, this committee can have a direct impact on practice. Of aspects such as efficacy andor cost implications, and could therefore replace one medicine with another.

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