title: EFNS guidelines on pharmacological treatment of neuropathic pain.
abstract: Neuropathic pain treatment remains unsatisfactory despite a substantial increase in the number of trials. This EFNS Task Force aimed at evaluating the existing evidence about the pharmacological treatment of neuropathic pain. Studies were identified using first the Cochrane Database then Medline. Trials were classified according to the aetiological condition. All class I and II controlled trials (according to EFNS classification of evidence) were assessed, but lower-class studies were considered in conditions that had no top level studies. Only treatments feasible in an outpatient setting were evaluated. Effects on pain symptoms/signs, quality of life and comorbidities were particularly searched for. Most of the randomized controlled trials included patients with postherpetic neuralgia (PHN) and painful polyneuropathies (PPN) mainly caused by diabetes. These trials provide level A evidence for the efficacy of tricyclic antidepressants, gabapentin, pregabalin and opioids, with a large number of class I trials, followed by topical lidocaine (in PHN) and the newer antidepressants venlafaxine and duloxetine (in PPN). A small number of controlled trials were performed in central pain, trigeminal neuralgia, other peripheral neuropathic pain states and multiple-aetiology neuropathic pains. The main peripheral pain conditions respond similarly well to tricyclic antidepressants, gabapentin, and pregabalin, but some conditions, such as HIV-associated polyneuropathy, are more refractory. There are too few studies on central pain, combination therapy, and head-to-head comparison. For future trials, we recommend to assess quality of life and pain symptoms or signs with standardized tools.
authors.affiliation: Centre d'Evaluation at de Traitement de la Douleur, Hôspital Ambroise Paré, Boulogne-Billancourt, France. nadine.attal@apr.ap-hop-paris.fr
authors.forename: N
authors.initials: N
authors.lastname: Attal
authors.forename: G
authors.initials: G
authors.lastname: Cruccu
authors.forename: M
authors.initials: M
authors.lastname: Haanpää
authors.forename: P
authors.initials: P
authors.lastname: Hansson
authors.forename: T S
authors.initials: TS
authors.lastname: Jensen
authors.forename: T
authors.initials: T
authors.lastname: Nurmikko
authors.forename: C
authors.initials: C
authors.lastname: Sampaio
authors.forename: S
authors.initials: S
authors.lastname: Sindrup
authors.forename: P
authors.initials: P
authors.lastname: Wiffen
mesh_terms: D016263:AIDS-Associated Nephropathy / Q000188:drug therapy; D000701:Analgesics, Opioid / Q000627:therapeutic use; D000927:Anticonvulsants / Q000627:therapeutic use; D000928:Antidepressive Agents / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D064420:Drug-Related Side Effects and Adverse Reactions; D006801:Humans; D009422:Nervous System Diseases / Q000139:chemically induced / Q000188:drug therapy; D009437:Neuralgia / Q000188:drug therapy*; D051474:Neuralgia, Postherpetic / Q000188:drug therapy; D010146:Pain / Q000188:drug therapy / Q000503:physiopathology; D011115:Polyneuropathies / Q000188:drug therapy / Q000503:physiopathology; D014277:Trigeminal Neuralgia / Q000188:drug therapy
chemical_list: D000701:Analgesics, Opioid; D000927:Anticonvulsants; D000928:Antidepressive Agents