Off‐label pharmacological treatment for neuropathic pain: A Delphi study by the Spanish Pain Society Neuropathic Pain Task Force

Abstract

Objectives: The use of off-label pharmacotherapies for neuropathic pain (NP) is growing relating to the many unmet needs of patients. However, clinical guidelines fail to address it, and the available evidence is sparse and fragmented. We arranged a formal expert consensus to address this controversial issue and provide some guidance on judicious use. Methods: A two-round standard Delphi survey that involved pain clinic specialists with experience in the research and management of NP was done over an ad hoc 40-item questionnaire prepared by the authors. Consensus on each statement was defined as at least either 80% endorsement or rejection after the second round. Results: Forty-three and thirty-seven panelists participated in the first and second round, respectively. Consensus was reached in 34 out of 40 statements. Endorsed alternatives for unresponsive patients include non-gabapentinoid antiepileptics (oxcarbazepine and eslicarbazepine), venlafaxine, intravenous lidocaine (when doses can be optimized), and some vaporized cannabinoids (under appropriate surveillance). In addition, lacosamide, low-dose naltrexone, propofol, or ketamine could prove beneficial if subjected to more research. Other options were rejected, and there was controversy about the usefulness of topical preparations. Discussion: For patients who do not respond to standard NP treatments, some other viable pharmacological options can be attempted before advancing to other therapeutic stages. This may help patients who are reluctant to or have some contraindication for interventional therapies.

Terapias Farmacológicas para o Tratamento da Dor Neuropática: Uma Análise Integrativa

“…O aprofundamento no entendimento dessas terapias não apenas lança luz sobre os intricados mecanismos subjacentes à dor neuropática, mas também orienta a busca por tratamentos mais específicos e personalizados. (Ancor et al ., 2023).…”

“…Além disso, identificaram potenciais alvos e mecanismos do L-THP para efeitos antidor neuropática, destacando a via Clec7a-MAPK/NF-κB-NLRP3 como uma possível intervenção terapêutica. L-THP regula a expressão gênica, especialmente na modulação da transcrição, indicando sua capacidade de influenciar fatores-chave na patogênese da dor neuropática Serrano et al, (2023). realizaram um estudo Delphi para examinoar alternativas farmacoterapêuticas para o tratamento da dor neuropática (DN) além das terapias de primeira e segunda linha recomendadas pelas diretrizes clínicas atuais.…”

Treatment of neuropathic pain using off‐label pharmacological treatments

“…There is a lack of guidance on the use of off‐label pharmacological therapies for treating neuropathic pain. Serrano et al 1 conducted a study through the Spanish pain society to develop guidelines and recommendations addressing the use of off‐label pharmacological therapies for treating neuropathic pain. The authors sent two rounds of Delphi survey to pain specialists with expertise in pain management and research.…”