title: Antiepileptic drugs to treat pain in rheumatic conditions. Recommendations based on evidence-based review of the literature and expert opinion.
abstract: OBJECTIVE
  Neuropathic pain is commonly encountered in rheumatology practice, often associated with nociceptive mechanisms. It is caused by nervous system lesions, and the usual treatments with analgesics and anti-inflammatory drugs are mostly ineffective. Antiepileptic drugs (AED) have proved effective in relieving neuropathic pain. AED are recently used by rheumatologists since the role of neuropathic pain in rheumatological conditions has only recently been documented. Nevertheless, the tendency seems to be reversed when these drugs are used inappropriately. The CEDR (Cercle d'Etude de la Douleur en Rhumatologie), a specific interest group of the French Society of Rheumatology that focuses on pain in rheumatology, undertook to develop recommendations for the use of AED in Rheumatology.
  
  
  METHODS
  A list of questions concerning the prescription of AED in painful rheumatic conditions was validated by a working group of 7 experts from the CEDR. The list of questions was used to draw up the recommendations. A literature review was performed using electronic databases (Medline, Embase and Cochrane library between 1980 and 2007) without limitations on the type of publication: case reports, clinical trials, literature review and guidelines about therapeutic management of neuropathic pain. Selected studies were scored for quality. Based on the literature and clinical experience, recommendations were developed using the Delphi method.
  
  
  RESULTS
  We identified 29 studies concerning the use of AED in painful rheumatic conditions and 16 studies were considered valid and scored for quality. These few studies, the guidelines published for neuropathic pain treatment and the clinical experience of each expert, were used to develop 11 recommendations for the use of AED in painful rheumatic conditions.
  
  
  CONCLUSIONS
  These recommendations can be used as guidelines to help prescribers to use AED for the management of pain in rheumatic conditions until further scientific evidence becomes available.
authors.affiliation: Centre de la Douleur et Service de Rhumatologie du Centre Hospitalier de Limoges, France. pascale.vergne-salle@chu-limoges.fr
authors.forename: Pascale
authors.initials: P
authors.lastname: Vergne-Salle
authors.forename: Othmane
authors.initials: O
authors.lastname: Mejjad
authors.forename: Rose Marie
authors.initials: RM
authors.lastname: Javier
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Maheu
authors.forename: Michèle
authors.initials: M
authors.lastname: Fallut
authors.forename: Jacques
authors.initials: J
authors.lastname: Glowinski
authors.forename: Philippe
authors.initials: P
authors.lastname: Bertin
mesh_terms: D000927:Anticonvulsants / Q000627:therapeutic use*; D003697:Delphi Technique; D010146:Pain / Q000188:drug therapy* / Q000209:etiology; D017410:Practice Guidelines as Topic; D011361:Professional Competence; D016032:Randomized Controlled Trials as Topic; D012196:Review Literature as Topic; D012216:Rheumatic Diseases / Q000150:complications / Q000188:drug therapy*
chemical_list: D000927:Anticonvulsants