N Attal1,2, G Cruccu1,3, R Baron1,4, M Haanpää1,5, P Hansson1,6, T S Jensen1,7, T Nurmikko1,8. 1. EFNS Panel Neuropathic Pain. 2. INSERM U987, Centre d'Evaluation et de Traitement de la Douleur, Hôpital Ambroise Paré, APHP, Boulogne-Billancourt, and Université Versailles-Saint-Quentin,Versailles, France. 3. Department of Neurological Sciences, La Sapienza University, Rome, Italy. 4. Division of Neurological Pain Research and Therapy, Department of Neurology, Universitatsklinikum Schleswig-Holstein, Kiel, Germany. 5. Rehabilitation ORTON and Department of Neurosurgery, Helsinki University Hospital, Helsinki, Finland. 6. Department of Molecular Medicine and Surgery, Clinical Pain Research and Pain Center, Department of Neurosurgery, Karolinska Institutet/University Hospital, Stockholm, Sweden. 7. Departmen of Neurology and Danish Pain Research Center, Aarhus University Hospital, Aarhus, Denmark. 8. Pain Research Institute, Neuroscience Research Unit, School of Clinical Sciences, University of Liverpool, Liverpool, UK.
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 post-herpetic 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 TCA-gabapentin 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: 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 post-herpetic 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 TCA-gabapentin 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.
Authors: Nora M Hagelberg; Tuukka Saarikoski; Teijo I Saari; Mikko Neuvonen; Pertti J Neuvonen; Miia Turpeinen; Mika Scheinin; Kari Laine; Klaus T Olkkola Journal: Eur J Clin Pharmacol Date: 2012-10-26 Impact factor: 2.953