Pharmacological and non-pharmacological treatments for neuropathic pain: Systematic review and French recommendations

Moisset, Xavier; Bouhassira, Didier; Couturier, J. Avez; Alchaar, H.; Conradi, S; Delmotte, M.-H.; Lantéri-Minet, Michel; Lefaucheur, J.-P.; Mick, G.; Piano, Virginie; Pickering, Gisèle; Piquet, E.; Régis, Cyril Alexandre; Salvat, Éric; Attal, Nadine

doi:10.1016/j.neurol.2020.01.361

Cited by 258 publications

(248 citation statements)

References 193 publications

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“…The subsequent therapeutic management of these symptoms must be adapted to each specific situation in the long term 34 . The presence of neuropathic symptoms with ‘sensory’ descriptors or allodynia could favour the use of antiepileptics, 35 while more affective items and the characterization of a PTSD would rather favour antidepressant treatment or psychotherapy 36,37 . This highlights the importance of careful clinical characterization of chronic pain syndrome in the context of SJS/TEN.…”

Section: Discussionmentioning

confidence: 99%

Chronic pain: a long‐term sequela of epidermal necrolysis (Stevens–Johnson syndrome/toxic epidermal necrolysis) – prevalence, clinical characteristics and risk factors

Lefaucheur

Valeyrie‐Allanore

Tin

et al. 2020

Acad Dermatol Venereol

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BackgroundStevens–Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are associated with various sequelae. Chronic pain, one of these sequelae, has never been systematically evaluated.Objectives and methodsTo assess the persistence of pain in a single‐centre cohort of 113 consecutive patients with SJS/TEN. From this cohort, 81 patients were interviewed more than 1 year after the initial episode and included in the study. Data were collected according to standardized questionnaires.ResultsFrom the 81 interviewed patients, 52 patients (64%) were painless and 29 patients (36%) were painful. Chronic pain syndrome was associated with a more severe initial acute phase of the disease (larger extent of detachment, higher SCORTEN, increased rate of admission in ICU and complications, and longer hospital stay). Pain was mainly located at the level of eyes (55%), mouth and lower limbs (38–41%), with a moderate daily intensity on average (4.7/10). The ‘affective’ descriptors prevailed over the ‘sensory’ descriptors, with the exception of burning and itching sensations. Finally, regarding provoked pain, mechanical allodynia (to brushing and pressure) was more marked than thermal allodynia.DiscussionThe persistence of chronic pain after SJS/TEN is a common phenomenon. Sensory descriptors are consistent with sensitization of both small‐diameter nerve fibres (burning and itching sensations) and large‐diameter nerve fibres (mechanical allodynia), but the affective‐emotional components of pain largely predominate.ConclusionsComplex mechanisms lead to persistent pain as long‐term sequela of SJS/TEN, among which mechanisms, psychological factors related to post‐traumatic stress disorder probably play a key role.

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Section: Discussionmentioning

confidence: 99%

Chronic pain: a long‐term sequela of epidermal necrolysis (Stevens–Johnson syndrome/toxic epidermal necrolysis) – prevalence, clinical characteristics and risk factors

Lefaucheur

Valeyrie‐Allanore

Tin

et al. 2020

Acad Dermatol Venereol

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“…Stroke patients can have both nociceptive and neuropathic pain; it is important to distinguish between Table 2 Common post-stroke complications and management approaches 6,29,30,32,39,44,[47][48][49][50]…”

Section: Neuropathic Painmentioning

confidence: 99%

Pharmacological management of stroke in older people

Thomson

New

2021

Pharmacy Practice and Res

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Stroke is one of the most common causes of death and disability. It is more common in people aged 65 years or older. Most patients survive the stroke and live with their disabilities, impacting their quality of life and day-today function to varying degrees. Stroke sequelae can be associated with a broad range of physical, functional, cognitive, behavioural, emotional and socioeconomic consequences. Optimising the management of stroke and its complications, as well as strategies to prevent stroke recurrence, using both non-pharmacological and pharmacological approaches, is crucial. This narrative review covers the pharmacological management of acute stroke, common post-stroke complications and secondary prevention, with a focus on older people.

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“…The use of duloxetine to treat CNP associated with multiple sclerosis was based on two studies. In a low-quality, class I, positive study, Vollmer et al used doses of 60 mg (30 mg for one week, followed by 60 mg for five weeks) followed by a 12 week-open-label extension phase (30-120 mg/day) 27 . Outcomes included daily changes in pain intensity, pain impact on daily activities, quality of life, anxiety/depression, fatigue, and patients' global impression of improvement.…”

Section: Duloxetinementioning

confidence: 99%

“…The use of venlafaxine in the treatment of CNP was not investigated in any of the included studies. Analgesic effects are due to central noradrenergic effects, obtained with higher doses of venlafaxine (150-225mg/day) 12,48 , being titrated from 37.5mg up and in some cases being used 300 mg/day. Advent or worsening of high blood pressure must be monitored during treatment 56 .…”

Section: Venlafaxinementioning

confidence: 99%

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Pharmacological treatment of central neuropathic pain: consensus of the Brazilian Academy of Neurology

Oliveira

Baptista

Sá

et al. 2020

Arq. Neuro-Psiquiatr.

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Background: Central neuropathic pain (CNP) is often refractory to available therapeutic strategies and there are few evidence-based treatment options. Many patients with neuropathic pain are not diagnosed or treated properly. Thus, consensus-based recommendations, adapted to the available drugs in the country, are necessary to guide clinical decisions. Objective: To develop recommendations for the treatment of CNP in Brazil. Methods: Systematic review, meta-analysis, and specialists opinions considering efficacy, adverse events profile, cost, and drug availability in public health. Results: Forty-four studies on CNP treatment were found, 20 were included in the qualitative analysis, and 15 in the quantitative analysis. Medications were classified as first-, second-, and third-line treatment based on systematic review, meta-analysis, and expert opinion. As first-line treatment, gabapentin, duloxetine, and tricyclic antidepressants were included. As second-line, venlafaxine, pregabalin for CND secondary to spinal cord injury, lamotrigine for CNP after stroke, and, in association with first-line drugs, weak opioids, in particular tramadol. For refractory patients, strong opioids (methadone and oxycodone), cannabidiol/delta-9-tetrahydrocannabinol, were classified as third-line of treatment, in combination with first or second-line drugs and, for central nervous system (CNS) in multiple sclerosis, dronabinol. Conclusions: Studies that address the treatment of CNS are scarce and heterogeneous, and a significant part of the recommendations is based on experts opinions. The CNP approach must be individualized, taking into account the availability of medication, the profile of adverse effects, including addiction risk, and patients' comorbidities.

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Pharmacological and non-pharmacological treatments for neuropathic pain: Systematic review and French recommendations

Cited by 258 publications

References 193 publications

Chronic pain: a long‐term sequela of epidermal necrolysis (Stevens–Johnson syndrome/toxic epidermal necrolysis) – prevalence, clinical characteristics and risk factors

Chronic pain: a long‐term sequela of epidermal necrolysis (Stevens–Johnson syndrome/toxic epidermal necrolysis) – prevalence, clinical characteristics and risk factors

Pharmacological management of stroke in older people

Pharmacological treatment of central neuropathic pain: consensus of the Brazilian Academy of Neurology

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