EFNS guidelines on the pharmacological treatment of neuropathic pain: 2010 revision

Abstract

Background and objectives: 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 postherpetic 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 TCAgabapentin 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. Background and objectives

Transdermal Buprenorphine Relieves Neuropathic Pain: A Randomized, Double-Blind, Parallel-Group, Placebo-Controlled Trial in Diabetic Peripheral Neuropathic Pain

“…This equated to an NNT of 7.05, which is comparable to existing first-line therapies such as high-dose pregabalin (NNT 6.3) (6) and duloxetine (NNT 5) (7). Because opioids are normally a second-line therapy for the management of DPNP, they are often used in combination with first-line therapies (30,31). It is reassuring that the current study demonstrated that buprenorphine patches are effective in patients concomitantly taking antidepressants or antiepileptics.…”

“…No one therapy is effective for all patients with DPNP, and there is no way to predict which patient will respond to which therapy (5,30). Additional analgesics with robust evidence of clinical effectiveness are needed.…”

A genome‐wide association study suggests an association of Chr8p21.3 (GFRA2) with diabetic neuropathic pain

“…A neuropathic pain case was defined in this study as a type 2 diabetic individual with a history of at least one prescription of any of the following five medicines, which are effective and recommended in diabetic peripheral neuropathy (Attal et al., 2010; Finnerup et al., 2010; NICE, 2013) and used less frequently for other indications: duloxetine, gabapentin, pregabalin, capsaicin cream/patch and lidocaine patch. The cases also had positive monofilament tests in at least one foot, indicating the likely presence of sensory neuropathy.…”

Immunotherapies for Neurological Manifestations in the Context of Systemic Autoimmunity

“…The main symptom is pain; therefore, treatment is symptomatic as recommended by the European Federation of Neurological Societies' guidelines for neuropathic pain [102], with agents such as carbamazepine, gabapentin, and pregabalin (grade 1A). Tricyclic antidepressants may exacerbate sicca symptoms [103], while no immunotherapy has been particularly effective (steroids, IVIg, anti-TNF, or rituximab) [20,88,104,105].…”