Recommendations for the pharmacological management of neuropathic pain: an overview and literature update.
The Neuropathic Pain Special Interest Group of the International Association for the Study of Pain recently sponsored the development of evidence-based guidelines for the pharmacological treatment of neuropathic pain. Tricyclic antidepressants, dual reuptake inhibitors of serotonin and norepinephrine, calcium channel alpha(2)-delta ligands (ie, gabapentin and pregabalin), and topical lidocaine were recommended as first-line treatment options on the basis of the results of randomized clinical trials. Opioid analgesics and tramadol were recommended as second-line treatments that can be considered for first-line use in certain clinical circumstances. Results of several recent clinical trials have become available since the development of these guidelines. These studies have examined botulinum toxin, high-concentration capsaicin patch, lacosamide, selective serotonin reuptake inhibitors, and combination therapies in various neuropathic pain conditions. The increasing number of negative clinical trials of pharmacological treatments for neuropathic pain and ambiguities in the interpretation of these negative trials must also be considered in developing treatment guidelines. The objectives of the current article are to review the Neuropathic Pain Special Interest Group guidelines for the pharmacological management of neuropathic pain and to provide a brief overview of these recent studies.
Dworkin
Robert H
RH
Department of Anesthesiology, University of Rochester School of Medicine and Dentistry, NY 14642, USA. robert_dworkin@urmc.rochester.edu
O'Connor
Alec B
AB
Audette
Joseph
J
Baron
Ralf
R
Gourlay
Geoffrey K
GK
Haanpää
Maija L
ML
Kent
Joel L
JL
Krane
Elliot J
EJ
Lebel
Alyssa A
AA
Levy
Robert M
RM
Mackey
Sean C
SC
Mayer
John
J
Miaskowski
Christine
C
Raja
Srinivasa N
SN
Rice
Andrew S C
AS
Schmader
Kenneth E
KE
Stacey
Brett
B
Stanos
Steven
S
Treede
Rolf-Detlef
RD
Turk
Dennis C
DC
Walco
Gary A
GA
Wells
Christopher D
CD
D000081:Acetamides / Q000627:therapeutic use; D000588:Amines / Q000627:therapeutic use; D000700:Analgesics / Q000627:therapeutic use*; D000701:Analgesics, Opioid / Q000627:therapeutic use; D000779:Anesthetics, Local / Q000627:therapeutic use; D000928:Antidepressive Agents / Q000627:therapeutic use*; D003509:Cyclohexanecarboxylic Acids / Q000627:therapeutic use; D019317:Evidence-Based Medicine; D000077206:Gabapentin; D006801:Humans; D000078334:Lacosamide; D009437:Neuralgia / Q000188:drug therapy* / Q000517:prevention & control; D017410:Practice Guidelines as Topic; D000069583:Pregabalin; D016032:Randomized Controlled Trials as Topic; D017367:Selective Serotonin Reuptake Inhibitors / Q000627:therapeutic use; D005680:gamma-Aminobutyric Acid / Q000031:analogs & derivatives / Q000627:therapeutic use
D000081:Acetamides; D000588:Amines; D000700:Analgesics; D000701:Analgesics, Opioid; D000779:Anesthetics, Local; D000928:Antidepressive Agents; D003509:Cyclohexanecarboxylic Acids; D000077206:Gabapentin; D000078334:Lacosamide; D000069583:Pregabalin; D017367:Selective Serotonin Reuptake Inhibitors; D005680:gamma-Aminobutyric Acid