title: EFNS guidelines on the pharmacological treatment of neuropathic pain: 2010 revision.
abstract: OBJECTIVE
  This second European Federation of Neurological Societies Task Force aimed at updating the existing evidence about the pharmacological treatment of neuropathic pain since 2005.
  
  
  METHODS
  Studies were identified using the Cochrane Database and Medline. Trials were classified according to the aetiological condition. All class I and II randomized controlled trials (RCTs) were assessed; lower class studies were considered only in conditions that had no top-level studies. Treatments administered using repeated or single administrations were considered, provided they are feasible in an outpatient setting.
  
  
  RESULTS
  Most large RCTs included patients with diabetic polyneuropathies and post-herpetic neuralgia, while an increasing number of smaller studies explored other conditions. Drugs generally have similar efficacy in various conditions, except in trigeminal neuralgia, chronic radiculopathy and HIV neuropathy, with level A evidence in support of tricyclic antidepressants (TCA), pregabalin, gabapentin, tramadol and opioids (in various conditions), duloxetine, venlafaxine, topical lidocaine and capsaicin patches (in restricted conditions). Combination therapy appears useful for TCA-gabapentin and gabapentin-opioids (level A).
  
  
  CONCLUSIONS
  There are still too few large-scale comparative studies. For future trials, we recommend to assess comorbidities, quality of life, symptoms and signs with standardized tools and attempt to better define responder profiles to specific drug treatments.
authors.affiliation: EFNS Panel Neuropathic Pain.|INSERM U987, Centre d'Evaluation et de Traitement de la Douleur, Hôpital Ambroise Paré, APHP, Boulogne-Billancourt, and Université Versailles-Saint-Quentin,Versailles, France.
authors.forename: N
authors.initials: N
authors.lastname: Attal
authors.affiliation: EFNS Panel Neuropathic Pain.|Department of Neurological Sciences, La Sapienza University, Rome, Italy.
authors.forename: G
authors.initials: G
authors.lastname: Cruccu
authors.affiliation: EFNS Panel Neuropathic Pain.|Division of Neurological Pain Research and Therapy, Department of Neurology, Universitatsklinikum Schleswig-Holstein, Kiel, Germany.
authors.forename: R
authors.initials: R
authors.lastname: Baron
authors.affiliation: EFNS Panel Neuropathic Pain.|Rehabilitation ORTON and Department of Neurosurgery, Helsinki University Hospital, Helsinki, Finland.
authors.forename: M
authors.initials: M
authors.lastname: Haanpää
authors.affiliation: EFNS Panel Neuropathic Pain.|Department of Molecular Medicine and Surgery, Clinical Pain Research and Pain Center, Department of Neurosurgery, Karolinska Institutet/University Hospital, Stockholm, Sweden.
authors.forename: P
authors.initials: P
authors.lastname: Hansson
authors.affiliation: EFNS Panel Neuropathic Pain.|Departmen of Neurology and Danish Pain Research Center, Aarhus University Hospital, Aarhus, Denmark.
authors.forename: T S
authors.initials: TS
authors.lastname: Jensen
authors.affiliation: EFNS Panel Neuropathic Pain.|Pain Research Institute, Neuroscience Research Unit, School of Clinical Sciences, University of Liverpool, Liverpool, UK.
authors.forename: T
authors.initials: T
authors.lastname: Nurmikko
mesh_terms: D000588:Amines / Q000627:therapeutic use; D000698:Analgesia / Q000639:trends*; D000700:Analgesics / Q000627:therapeutic use*; D000701:Analgesics, Opioid / Q000627:therapeutic use; D000929:Antidepressive Agents, Tricyclic / Q000627:therapeutic use; D003509:Cyclohexanecarboxylic Acids / Q000627:therapeutic use; D004359:Drug Therapy, Combination / Q000639:trends; D005060:Europe; D000077206:Gabapentin; D006801:Humans; D009437:Neuralgia / Q000145:classification / Q000188:drug therapy*; D017063:Outcome Assessment, Health Care / Q000639:trends; D010523:Peripheral Nervous System Diseases / Q000145:classification / Q000188:drug therapy*; D016032:Randomized Controlled Trials as Topic / Q000639:trends; D016896:Treatment Outcome; D005680:gamma-Aminobutyric Acid / Q000627:therapeutic use
chemical_list: D000588:Amines; D000700:Analgesics; D000701:Analgesics, Opioid; D000929:Antidepressive Agents, Tricyclic; D003509:Cyclohexanecarboxylic Acids; D005680:gamma-Aminobutyric Acid; D000077206:Gabapentin
references.citation: Treede RD, Jensen TS, Campbell JN, et al. Neuropathic pain: redefinition and a grading system for clinical and research purposes. Neurology 2008; 70: 1630-1635.
references.citation: Bouhassira D, Lantéri-Minet M, Attal N, Laurent B, Touboul C. Prevalence of chronic pain with neuropathic characteristics in the general population. Pain 2008; 136: 380-387.
references.citation: Torrance N, Smith BH, Bennett MI, Lee AJ. The epidemiology of chronic pain of predominantly neuropathic origin. Results from a general population survey. J Pain 2006; 7: 281-289.
references.citation: Dworkin RH, O’Connor AB, Backonja M, et al. Pharmacologic management of neuropathic pain: evidence based recommendations. Pain 2007; 132: 237-251. (class I SR).
references.citation: Finnerup NB, Jensen TS. Mechanisms of disease: mechanism-based classification of neuropathic pain-a critical analysis. Nat Clin Pract Neurol 2006; 2: 107-115. (class I SR).
references.citation: Baron R. Mechanisms of disease: neuropathic pain: a clinical perspective. Nat Clin Pract Neurol, 2006; 2: 95-106. (class I SR).
references.citation: Attal N, Cruccu G, Haanpää M, et al. EFNS Task Force. EFNS guidelines on pharmacological treatment of neuropathic pain. Eur J Neurol 2006; 13: 1153-1169. (class I SR).
references.citation: Brainin M, Barnes M, Baron JC, et al. Guidance for the preparation of neurological management guidelines by EFNS scientific task forces--revised recommendations. Eur J Neurol 2004; 11: 577-581.
references.citation: Saarto T, Wiffen PJ. Antidepressants for neuropathic pain. Cochrane Database Syst Rev. 2007, 4: CD005454. (class I SR).
references.citation: Finnerup NB, Otto M, McQuay HJ, Jensen TS, Sindrup SH. Algorithm for neuropathic pain treatment: an evidence based proposal. Pain 2005; 118: 289-305. (class I SR).
references.citation: Kadiroglu AK, Sit D, Kayabasi H, Tuzcu AK, Tasdemir N, Yilmaz ME. The effect of venlafaxine HCl on painful peripheral diabetic neuropathy in patients with type 2 diabetes mellitus. J Diabetes Complications 2008; 22: 241-245. (class II).
references.citation: Kajdasz DK, Iyengar S, Desaiah D, et al. Duloxetine for the management of diabetic peripheral neuropathic pain: evidence-based findings from post hoc analysis of three multicenter, randomized, double-blind, placebo-controlled, parallel-group studies. Clin Ther 2007; 29(Suppl): 2536-2546, (class I SR).
references.citation: Quilici S, Chancellor J, Löthgren M, et al. Meta-analysis of duloxetine versus pregabalin and gabapentin in the treatment of diabetic peripheral neuropathic pain. BMC Neurology, 2009; 9: 6. class I SR).
references.citation: Skljarevski V, Desaiah D, Zhang Q, et al. Evaluating the maintenance of effect of duloxetine in patients with diabetic peripheral neuropathic pain. Diab. Met. Res. Rev 2009; 25: 623-631. (class IV).
references.citation: Gahimer J, Wernicke J, Yalcin I, Ossanna MJ, Wulster-Radcliffe M, Viktrup L. A retrospective pooled analysis of duloxetine safety in 23983 subjects. Curr Med Res Opin 2007; 23: 175-184. (class I SR).
references.citation: Sultan A, Gaskell H, Derry S, Moore RA. Duloxetine for painful diabetic neuropathy and fibromyalgia pain: systematic review of randomised trials. BMC Neurology 2008; 8: 29. class I SR).
references.citation: Otto M, Bach FW, Jensen TS, Brøsen K, Sindrup SH. Escitalopram in painful polyneuropathy: a randomized, placebo-controlled, cross-over trial. Pain 2008; 139: 275-283. (class I).
references.citation: Wiffen P, McQuay H, Edwards J, Moore RA. Gabapentin for acute and chronic pain. Cochrane Database Syst Rev 2005; 20: CD005452, (class I SR).
references.citation: Freeman R, Durso-Decruz E, Emir B. Efficacy, safety and tolerability of pregabalin treatment for painful diabetic peripheral neuropathy; findings from seven randomized controlled trials across a range of doses. Diabetes Care 2008; 31: 1448-1454. (class I SR).
references.citation: Gilron I, Baley JM, Tu D, Holdern DR, Jackson AC, Houlden RL. Nortriptyline and gabapentin, alone and in combination for neuropathic pain : a double-blind, randomised controlled crossover trial. Lancet 2009; 374: 1252-1261.
references.citation: Moore RA, Straube S, Wiffen PJ, Derry S, McQuay HJ. Pregabalin for acute and chronic pain in adults. Cochrane Database Syst Rev 2009; 3: CD007076. (class I SR)
references.citation: Rauck RL, Shaibani A, Biton V, Simpson J, Koch B. Lacosamide in painful diabetic peripheral neuropathy : a phase 2 double-blind placebo-controlled study. Clin J Pain 2007; 23: 150-158. (class I).
references.citation: Wymer JP, Simpson J, Sen J, Bongardt S. Efficacy and safety of lacosamide in diabetic neuropathic pain : a 18 weeks double blind placebo controlled trial of fixed doses regimens. Clin J Pain 2009; 25: 376-385. (class I).
references.citation: Dogra S, Beydoun S, Mazzola J, Hopwood M, Wan Y. Oxcarbazepine in painful diabetic neuropathy: a randomized, placebo-controlled study. Eur J Pain 2005; 9: 543-554. (class I).
references.citation: Grosskopf J, Mazzola J, Wan Y, Hopwood M. A randomized, placebo-controlled study of oxcarbazepine in painful diabetic neuropathy. Acta Neurol Scand 2006; 114: 177-180. (class I).
references.citation: Beydoun A, Shaibani A, Hopwood M, Wan Y. Oxcarbazepine in painful diabetic neuropathy: results of a dose-ranging study. Acta Neurol Scand 2006; 113: 395-404. (class I).
references.citation: Vinik AI, Tuchman M, Safirstein B, et al. Lamotrigine for treatment of pain associated with diabetic neuropathy: results of two randomized, double-blind, placebo-controlled studies. Pain 2007; 128: 169-179. (class I).
references.citation: Atli A, Dogra S. Zonisamide in the treatment of painful diabetic neuropathy: a randomized, double-blind, placebo-controlled pilot study. Pain Med 2005; 6: 225-234. (class II).
references.citation: Shaibani A, Fares S, Selam JL, et al. Lacosamide in painful diabetic neuropathy: an 18-week double-blind placebo-controlled trial. J Pain 2009; 10: 818-828. (class I).
references.citation: Katz J, Finnerup NB, Dworkin RH. Clinical outcome in neuropathic pain : relationship to study characteristics. Neurology 2008; 28: 263-272. (class I SR).
references.citation: Eisenberg E, McNicol ED, Carr DB. Efficacy of mu-opioid agonists in the treatment of evoked neuropathic pain: systematic review of randomized controlled trials. Eur J Pain. 2006; 10: 667-676. (class I SR).
references.citation: Hollingshead J, Dühmke RM, Cornblath DR. Tramadol for neuropathic pain. Cochrane Database Syst Rev 2006; 3: CD003726. (class I SR).
references.citation: Freeman R, Raskin P, Hewitt DJ, et al. Randomized study of tramadol/acetaminophen versus placebo in painful diabetic peripheral neuropathy. Curr Med Res Opin 2007; 23: 147-161. (class I).
references.citation: Portenoy RK, Farrar JT, Backonja MM, et al. Long-term use of controlled-release oxycodone for noncancer pain: results of a 3-year registry study. Clin J Pain 2007; 23: 287-299. (class IV).
references.citation: Yuan RY, Sheu JJ, Yu JM, et al. Botulinum toxin for diabetic neuropathic pain: a randomized double-blind crossover trial. Neurology 2009; 72: 1473-1478. (class II).
references.citation: Yuen KC, Baker NR, Rayman G. Treatment of chronic painful diabetic neuropathy with isosorbide dinitrate spray: a double-blind placebo-controlled cross-over study. Diabetes Care 2002; 25: 1699-1703. (class I).
references.citation: Agrawal RP, Choudhary R, Sharma P, et al. Glyceryl trinitrate spray in the management of painful diabetic neuropathy: a randomized double blind placebo controlled cross-over study. Diabetes Res Clin Pract 2007; 77: 161-167. (class I).
references.citation: Rowbotham MC, RachelDuan W, Thomas J, Nothaft W, Backonja MM. A randomized, double-blind, placebo-controlled trial evaluating the efficacy and safety of ABT-594 in patients with diabetic peripheral neuropathic pain. Pain 2009; 146: 245-252. (class I).
references.citation: Sindrup SH, Graf A, Sfikas N. The NK1-receptor antagonist TKA731 in painful diabetic neuropathy: a randomised, controlled trial. Eur J Pain 2006; 10: 567-571. (class I).
references.citation: Gilron I, Bailey JM, Tu D, Holden RR, Weaver DF, Houlden RL. Morphine, gabapentin, or their combination for neuropathic pain. N Engl J Med 2005; 352: 1324-1334. (class I).
references.citation: Hanna M, O’Brien C, Wilson MC. Prolonged-release oxycodone enhances the effects of existing gabapentin therapy in painful diabetic neuropathy patients. Eur J Pain 2008; 12: 804-813. (class I).
references.citation: Schifitto G, Yiannoutsos CT, Simpson DM, et al. A placebo-controlled study of memantine for the treatment of human immunodeficiency virus-associated sensory neuropathy. J Neurovirol 2006; 12: 328-331. (class II).
references.citation: Wiffen PJ, Rees J. Lamotrigine for acute and chronic pain. Cochrane Database Syst Rev. 2007; 2: CD006044. (class I SR).
references.citation: Abrams DI, Jay CA, Shade SB, et al. Cannabis in painful HIV-associated sensory neuropathy: a randomized placebo-controlled trial. Neurology 2007; 68: 515-521. (class I).
references.citation: Ellis RJ, Toperoff W, Vaida F, et al. Smoked medicinal cannabis for neuropathic pain in HIV: a randomized, crossover clinical trial. Neuropsychopharmacology 2009; 34: 672-680. (class II).
references.citation: Simpson DM, Brown S, Tobias J, NGX-4010 C107 Study Group. Controlled trial of high-concentration capsaicin patch for treatment of painful HIV neuropathy. Neurology 2008; 70: 2305-2313. (class I).
references.citation: Noto C, Pappagallo M, Szallasi A. NGX-4010, a high-concentration capsaicin dermal patch for lasting relief of peripheral neuropathic pain. Curr Opin Investig Drugs 2009; 10: 702-710. (class I SR).
references.citation: Eisenberg E, McNicol ED, Carr DB. Efficacy and safety of opioid agonists in the treatment of neuropathic pain of nonmalignant origin: systematic review and meta-analysis of randomized controlled trials. JAMA 2005; 293: 3043-3052. (class I SR).
references.citation: Hempenstall K, Nurmikko TJ, Johnson RW, A’Hern RP, Rice AS. Analgesic therapy in postherpetic neuralgia: a quantitative systematic review. PLOS medicine 2005; 2: e164. class I SR).
references.citation: Rowbotham MC, Reisner LA, Davies PS, Fields HL. Treatment response in antidepressant-naive postherpetic neuralgia patients: double-blind, randomized trial. J Pain 2005; 6: 741-746. (class I).
references.citation: Irving G, Jensen M, Cramer M, et al. Efficacy and tolerability of gastric-retentive gabapentin for the treatment of postherpetic neuralgia. Clin J Pain 2009; 25: 185-192. (class I).
references.citation: Chandra K, Shafiq N, Pandhi P, Gupta S, Malhotra S. Gabapentin versus nortriptyline in post-herpetic neuralgia patients: a randomized, double-blind clinical trial-the GONIP Trial. Int J Clin Pharmacol Ther 2006; 44: 358-363. (class II).
references.citation: Khaliq W, Alam S, Puri N. Topical lidocaine for the treatment of postherpetic neuralgia. Cochrane Database Syst Rev 2007; 18: CD004846. (class I SR).
references.citation: Binder A, Bruxelle J, Rogers P, Hans G, Böster I, Baron R. Topical 5% lidocaine (lignocaine) medicated plaster treatment for post-herpetic neuralgia. Clin Drug Investig 2009; 29: 393-408. (class II).
references.citation: Baron R, Mayoral V, Leijon G, Binder A, Stergelwald I, Serpell M. 5% lidocaine medicated plaster versus pregabalin in post-herpetic neuralgia and diabetic polyneuropathy: an open-label, non-inferiority two-stage RCT study. Curr Med Res Op 2009; 27: 1663-1676. (class IV).
references.citation: Hans G, Sabatowski R, Binder A, Boesl I, Rogers P, Baron R. Efficacy and tolerability of a 5% lidocaine medicated plaster for the topical treatment of post-herpetic neuralgia: results of a long-term study. Curr Med Res Opin 2009; 25: 1295-1305. (class IV).
references.citation: Backonja M, Wallace MS, Blonsky ER, et al. NGX-4010, a high concentration capsaicin patch, for the treatment of postherpetic neuralgia: a randomised, double-blind study. Lancet Neurology 2009; 7: 1106-1112. (class I).
references.citation: Shackelford S, Rauck R, Quessy S, Blum D, Hodge R, Philipson R. A randomized, double-blind, placebo controlled trial of a selective COX2 inhibitor GW406381 in patients with postherpetic neuralgia. J Pain 2009; 10: 654-660. (class I).
references.citation: Cruccu G, Truini A. Trigeminal neuralgia and orofacial pains. In: Pappagallo M, ed. The Neurological Basis of Pain. New York: McGraw Hill, 2005: 401-414.
references.citation: Cruccu G, Sommer C, Anand P, et al. EFNS guidelines on neuropathic pain assessment revised 2009. Eur J Neurol 2010; doi: 10.1111/j.1468-1331.2010.02969.x [Epub ahead of print].
references.citation: Gronseth G, Cruccu G, Alksne J, et al. Practice parameter: the diagnostic evaluation and treatment of trigeminal neuralgia (an evidence-based review): report of the Quality Standards Subcommittee of the American Academy of Neurology and the European Federation of Neurological Societies. Neurology 2008; 71: 1183-1190. (class I SR).
references.citation: Cruccu G, Gronseth G, Alksne J, et al. AAN-EFNS guidelines on trigeminal neuralgia management. Eur J Neurol 2008; 15: 1013-1028. (class I SR).
references.citation: He L, Wu B, Zhou M. Non-antiepileptic drugs for trigeminal neuralgia. Cochrane Database Syst Rev 2006; 3: CD004029. (class I SR).
references.citation: Nurmikko T, Cruccu G. Botulinum toxin for trigeminal neuralgia. Eur J Neurol 2009; 16: e104.
references.citation: Lemos L, Flores S, Oliveira P, Almeida A. Gabapentin supplemented with ropivacaine block of trigger points improves pain control and quality of life in trigeminal neuralgia patients when compared with gabapentin alone. Clin J Pain 2008; 24: 64-75. (class IV).
references.citation: Klit H, Finnerup NB, Jensen TS. Central post-stroke pain: clinical characteristics, pathophysiology, and management. Lancet Neurol 2009; 9: 857-868. (class I SR).
references.citation: Siddall PJ, Cousins MJ, Otte A, Griesing T, Chambers R, Murphy TK. Pregabalin in central neuropathic pain associated with spinal cord injury: a placebo-controlled trial. Neurology 2006; 67: 1792-1800. (class I).
references.citation: Vranken JH, Dijkgraaf MG, Kruis MR, Van der Vegt MH, Hollmann MW, Heesen M. Pregabalin in patients with central neuropathic pain: a randomized, double-blind, placebo-controlled trial of a flexible-dose regimen. Pain 2008; 136: 150-157. (class I).
references.citation: Rintala DH, Holmes SA, Courtade D, Fiess RN, Tastard LV, Loubser PG. Comparison of the effectiveness of amitriptyline and gabapentin on chronic neuropathic pain in persons with spinal cord injury. Arch Phys Med Rehab 2007; 88: 1547-1560. (class II).
references.citation: Breuer B, Pappagallo M, Knotkova H, Guleyupoglu N, Wallenstein S, Portenoy RK. A randomized, double-blind, placebo-controlled, two-period, crossover, pilot trial of lamotrigine in patients with central pain due to multiple sclerosis. Clin Ther 2007; 29: 2022-2030. (class II).
references.citation: Finnerup NB, Grydehoj J, Bong J, et al. Levetiracetam in spinal cord injury pain: a randomized controlled trial. Spinal cord 2009; 47: 861-867. (class I).
references.citation: Rowbotham MC, Twilling L, Davies PS, Reisner L, Taylor K, Mohr D. Oral opioid therapy for chronic peripheral and central neuropathic pain. New Engl J Med 2003; 348: 1223-1232. (class I).
references.citation: Norrbrink C, Lundeberg T. Tramadol in neuropathic pain after spinal cord injury: a randomized double blind placebo-controlled trial. Clin J Pain, 2009; 25: 177-184. (class II).
references.citation: Rog DJ, Nurmikko TJ, Young CA. Oromucosal delta9-tetrahydro cannabinol cannabidiol for neuropathic pain associated with multiple sclerosis: an uncontrolled, open-label, 2-year extension trial. Clin Ther 2007; 29: 2068-2079. (class IV).
references.citation: Vranken JH, Dijkgraaf MG, Kruis MR, Van Dasselaar NT, Van derVegt MH. Iontophoretic administration of S(+)-ketamine in patients with intractable central pain: a placebo-controlled trial. Pain 2005; 118: 224-231. (class II).
references.citation: Arbaiza D, Vidal O. Tramadol in the treatment of neuropathic cancer pain: a double-blind, placebo-controlled study. Clin Drug Investig 2007; 27: 75-83. (class I).
references.citation: Hardy JR, Rees EA, Gwilliam B, Ling J, Broadley K, A’Hern R. A phase II study to establish the efficacy and toxicity of sodium valproate in patients with cancer-related neuropathic pain. J Pain Symptom Manage 2001; 21: 204-209. (class II).
references.citation: Gordh TE, Stubhaug A, Jensen TS, et al. Gabapentin in traumatic nerve injury pain: a randomized, double-blind, placebo-controlled, cross-over, multi-center study. Pain 2008; 138: 255-266. (class I).
references.citation: Ranoux D, Attal N, Morain F, Bouhassira D. Botulinum toxin a induces direct analgesic effects in neuropathic pain: a double blind placebo controlled study. Ann Neurol 2008; 64: 274-283. (class I).
references.citation: Vilholm OJ, Cold S, Rasmussen L, Sindrup SH. Effect of levetiracetam on the postmastectomy pain syndrome. Eur J Neurol 2008; 15: 851-857. (class I).
references.citation: Khoromi S, Patsalides A, Parada S, Salehi V, Meegan JM, Max MB. Topiramate in chronic lumbar radicular pain. J Pain 2005; 6: 829-836. (class II).
references.citation: Khoromi S, Cui L, Nackers L, Max MB. Morphine, nortriptyline and their combination vs. placebo in patients with chronic lumbar root pain. Pain 2007; 130: 66-75. (class II).
references.citation: pdf.clinicalstudyresults.org/documents/company-study4268.
references.citation: Wu CL, Agarwal S, Tella PK, et al. Morphine versus mexiletine for treatment of postamputation pain: a randomized, placebo-controlled, crossover trial. Anesthesiology 2008; 109: 289-296. (class I).
references.citation: Wilder-Smith CH, Hill LT, Laurent S. Postamputation pain and sensory changes in treatment-naive patients: characteristics and responses to treatment with tramadol, amitriptyline, and placebo. Anesthesiology 2005; 103: 619-628. (class II).
references.citation: Karst M, Salim K, Burstein S, Conrad I, Hoy L, Schneider U. Analgesic effect of the synthetic cannabinoid CT-3 on chronic neuropathic pain: a randomized controlled trial. JAMA 2003; 290: 1757-1762. (class I).
references.citation: Nurmikko TJ, Serpell MG, Hoggart B, Toomey PJ, Morlion BJ, Haines D. Sativex successfully treats neuropathic pain characterised by allodynia: a randomised, double-blind, placebo-controlled clinical trial. Pain 2007; 133: 210-220. (class I).
references.citation: Yucel A, Ozyalcin S, Koknel Talu G, et al. The effect of venlafaxine on ongoing and experimentally induced pain in neuropathic pain patients: a double blind, placebo controlled study. Eur J Pain 2005; 9: 407-416. (class II).
references.citation: Frank B, Serpell MG, Hughes J, Matthews JN, Kapur D. Comparison of analgesic effects and patient tolerability of nabilone and dihydrocodeine for chronic neuropathic pain: randomised, crossover, double blind study. BMJ 2008; 336: 199-201. (class I).
references.citation: Ho KY, Huh BK, White WD, Yeh CC, Miller EJ. Topical amitriptyline versus lidocaine in the treatment of neuropathic pain. Clin J Pain 2008; 24: 51-55. (class II).
references.citation: Silver M, Blum D, Grainger J. Double blind placebo-controlled trial of lamotrigine in combination with other medications for neuropathic pain. J Pain Symptom Manage 2007; 34: 446-454. (class I).
references.citation: Yelland MJ, Poulos CJ, Pillans PI, et al. N-of-1 randomized trials to assess the efficacy of gabapentin for chronic neuropathic pain. Pain Med. 2009; 10: 754-761.
references.citation: Jensen MP, Friedman M, Bonzo D, Richards P. The validity of the neuropathic pain scale for assessing diabetic neuropathic pain in a clinical trial. Clin J Pain 2006; 22: 97-103. (class II).
references.citation: Jensen MP, Chiang Y-K, Wu J. Assessment of pain quality in a clinical trial of gabapentin extended release for postherpetic neuralgia. Clin J Pain 2009; 25: 286-292. (class II).
references.citation: Stacey BR, Barrett JA, Whalen E, Phillips KF, Rowbotham MC. Pregabalin for postherpetic neuralgia: placebo-controlled trial of fixed and flexible dosing regimens on allodynia and time to onset of pain relief. J Pain 2008; 9: 1006-1017. (class I).
references.citation: Edwards RR, Haythornthwaite JA, Tella P, Max MB, Raja S. Basal heat pain thresholds predict opioid analgesia in patients with postherpetic neuralgia. Anesthesiology 2006; 104: 1243-1248. (class II).
references.citation: Wasner G, Kleinert A, Binder A, Schattschneider J, Baron R. Postherpetic neuralgia: topical lidocaine is effective in nociceptor deprived skin. J Neurol 2005; 252: 677-686. (class II).
references.citation: Jensen MP, Chodroff MJ, Dworkin RH. The impact of neuropathic pain on health-related quality of life: review and implications. Neurology 2007; 68: 1178-1182.
references.citation: O’Connor AB. Neuropathic pain. Quality-of-life impact, costs and cost effectiveness of therapy. Pharmacoeconomics 2009; 27: 95-112.
references.citation: Deshpande MA, Holden RR, Gilron I. The impact of therapy on quality of life and mood in neuropathic pain: what is the effect of pain reduction? Anesth Analg 2006; 102: 1473-1479.
references.citation: Armstrong DG, Chappell AS, Le TK, et al. Duloxetine for the management of diabetic peripheral neuropathic pain: evaluation of functional outcomes. Pain Med 2007; 8: 410-418.
references.citation: Otto M, Bach FW, Jensen TS, Sindrup SH. Health-related quality of life and its predictive role for analgesic effect in patients with painful polyneuropathy. Eur J Pain 2007; 11: 572-578.
references.citation: Baron R, Tölle TR, Gockel U, Brosz M, Freynhagen R. A cross-sectional cohort survey in 2100 patients with painful diabetic neuropathy and postherpetic neuralgia: differences in demographic data and sensory symptoms. Pain 2009; 146: 34-40.
references.citation: Cruccu G, Truini A. Sensory profiles: a new strategy for selecting patients in treatment trials for neuropathic pain. Pain 2009; 146: 5-6.
references.citation: Attal N, Fermanian C, Fermanian J, Lanteri-Minet M, Alchaar H, Bouhassira D. Neuropathic pain: are there distinct subtypes depending on the aetiology or anatomical lesion? Pain 2008; 138: 343-353.