Interventional management of neuropathic pain: NeuPSIG recommendations

Abstract

Neuropathic pain (NP) is often refractory to pharmacologic and non-interventional treatment. On behalf of the International Association for the Study of Pain Neuropathic Pain Special Interest Group (NeuPSIG), 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 post-stroke 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 RF lesions for radiculopathy. No other conclusive recommendations can be made due to the poor quality of available of 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 non-interventional treatments.

Cost of treatment of peripheral neuropathic pain with pregabalin or gabapentin in routine clinical practice: impact of their loss of exclusivity

“…Peripheral neuropathic pain (PNP) is a direct result of a lesion or disease that affects the peripheral somatosensory system 1. According to the International Association for the Study of Pain, neuropathic pain is defined as pain initiated or due to a primary lesion or dysfunction of the nervous system 2.…”

“…According to the International Association for the Study of Pain, neuropathic pain is defined as pain initiated or due to a primary lesion or dysfunction of the nervous system 2. The most commonly used classification of PNP is based on aetiology, subdividing aetiologies according to location of the peripheral or central nervous system lesion 1, 2, 3. The prevalence of PNP varies from 5% to 12% of the adult population 4, 5.…”

“…In some patients, PNP is difficult to treat 1, 2, 3. Neuromodulators such as pregabalin and gabapentin are considered to be treatments of choice for PNP 1, 3, 8, 9, 10.…”

“…Neuromodulators such as pregabalin and gabapentin are considered to be treatments of choice for PNP 1, 3, 8, 9, 10. Both drugs seem to have a positive impact on the set of symptoms accompanying PNP and have similar efficacy and tolerability profiles 8, 9, 10, 11, 12.…”

“…PNP has a high impact, particularly on sufferers, and also on the society in general as well, becoming to be considered a public health problem 1, 3. Patients experience a worsening of their state of health and a greater degree of disability, and they often develop mood disorders associated with anxiety, depression, and sleep disorders 16, 17, 18.…”