title: Interventional management of neuropathic pain: NeuPSIG recommendations.
abstract: Neuropathic pain (NP) is often refractory to pharmacologic and noninterventional treatment. On behalf of the International Association for the Study of Pain Neuropathic Pain Special Interest Group, the authors evaluated systematic reviews, clinical trials, and existing guidelines for the interventional management of NP. Evidence is summarized and presented for neural blockade, spinal cord stimulation (SCS), intrathecal medication, and neurosurgical interventions in patients with the following peripheral and central NP conditions: herpes zoster and postherpetic neuralgia (PHN); painful diabetic and other peripheral neuropathies; spinal cord injury NP; central poststroke pain; radiculopathy and failed back surgery syndrome (FBSS); complex regional pain syndrome (CRPS); and trigeminal neuralgia and neuropathy. Due to the paucity of high-quality clinical trials, no strong recommendations can be made. Four weak recommendations based on the amount and consistency of evidence, including degree of efficacy and safety, are: 1) epidural injections for herpes zoster; 2) steroid injections for radiculopathy; 3) SCS for FBSS; and 4) SCS for CRPS type 1. Based on the available data, we recommend not to use sympathetic blocks for PHN nor radiofrequency lesions for radiculopathy. No other conclusive recommendations can be made due to the poor quality of available data. Whenever possible, these interventions should either be part of randomized clinical trials or documented in pain registries. Priorities for future research include randomized clinical trials, long-term studies, and head-to-head comparisons among different interventional and noninterventional treatments.
authors.affiliation: Department of Anesthesiology, University of Rochester School of Medicine and Dentistry, Rochester, NY 14642, USA Department of Neurology, Center for Human Experimental Therapeutics, University of Rochester School of Medicine and Dentistry, Rochester, NY 14642, USA University of Rochester, Rochester, NY, USA Stanford University, Palo Alto, CA, USA Johns Hopkins University, Baltimore, MD, USA Oregon Health and Science University, Portland, OR, USA Northwestern University, Chicago, IL, USA University of Wisconsin, Madison, WI, USA University of Kiel, Kiel, Germany Schmerzfachpraxis, Krefeld, Germany University of Washington, Seattle, WA, USA Universität Heidelberg, Mannheim, Germany Pain Matters, Liverpool, UK.
authors.forename: Robert H
authors.initials: RH
authors.lastname: Dworkin
authors.forename: Alec B
authors.initials: AB
authors.lastname: O'Connor
authors.forename: Joel
authors.initials: J
authors.lastname: Kent
authors.forename: Sean C
authors.initials: SC
authors.lastname: Mackey
authors.forename: Srinivasa N
authors.initials: SN
authors.lastname: Raja
authors.forename: Brett R
authors.initials: BR
authors.lastname: Stacey
authors.forename: Robert M
authors.initials: RM
authors.lastname: Levy
authors.forename: Miroslav
authors.initials: M
authors.lastname: Backonja
authors.forename: Ralf
authors.initials: R
authors.lastname: Baron
authors.forename: Henning
authors.initials: H
authors.lastname: Harke
authors.forename: John D
authors.initials: JD
authors.lastname: Loeser
authors.forename: Rolf-Detlef
authors.initials: RD
authors.lastname: Treede
authors.forename: Dennis C
authors.initials: DC
authors.lastname: Turk
authors.forename: Christopher D
authors.initials: CD
authors.lastname: Wells
mesh_terms: D020918:Complex Regional Pain Syndromes / Q000503:physiopathology / Q000628:therapy; D055111:Failed Back Surgery Syndrome / Q000150:complications / Q000503:physiopathology / Q000628:therapy; D006801:Humans; D009437:Neuralgia / Q000628:therapy*; D059408:Pain Management / Q000592:standards*; D010523:Peripheral Nervous System Diseases / Q000150:complications / Q000503:physiopathology / Q000628:therapy; D011843:Radiculopathy / Q000150:complications / Q000503:physiopathology / Q000628:therapy; D016032:Randomized Controlled Trials as Topic; D014277:Trigeminal Neuralgia / Q000503:physiopathology / Q000628:therapy
keywords: Clinical trials; Evidence-based recommendations; Intrathecal medication; Neural blockade; Neuropathic pain; Neurosurgery; Spinal cord stimulation