EFNS guidelines on the pharmacological treatment of neuropathic pain: 2010 revision.
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.
Attal
N
N
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.
Cruccu
G
G
EFNS Panel Neuropathic Pain.|Department of Neurological Sciences, La Sapienza University, Rome, Italy.
Baron
R
R
EFNS Panel Neuropathic Pain.|Division of Neurological Pain Research and Therapy, Department of Neurology, Universitatsklinikum Schleswig-Holstein, Kiel, Germany.
Haanpää
M
M
EFNS Panel Neuropathic Pain.|Rehabilitation ORTON and Department of Neurosurgery, Helsinki University Hospital, Helsinki, Finland.
Hansson
P
P
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.
Jensen
T S
TS
EFNS Panel Neuropathic Pain.|Departmen of Neurology and Danish Pain Research Center, Aarhus University Hospital, Aarhus, Denmark.
Nurmikko
T
T
EFNS Panel Neuropathic Pain.|Pain Research Institute, Neuroscience Research Unit, School of Clinical Sciences, University of Liverpool, Liverpool, UK.
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
D000588:Amines; D000700:Analgesics; D000701:Analgesics, Opioid; D000929:Antidepressive Agents, Tricyclic; D003509:Cyclohexanecarboxylic Acids; D005680:gamma-Aminobutyric Acid; D000077206:Gabapentin
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