Pharmacologic Treatment of Neuropathic Pain–Some Resources


Neuropathic pain –pharmacological management: The pharmacological management of neuropathic pain in adults in non-specialist settings.          NICE clinical guideline 173 (Developed by the Centre for Clinical Practice at NICE). This guideline updates and replaces NICE clinical guideline 96. Issued: November 2013. [PubMed Excerpt] [Full Text PDF] [Guideline 173 Website]
London: National Institute for Health and Care Excellence, (UK); 2013 Nov.
National Institute for Health and Clinical Excellence: Guidance .

This short clinical guideline aims to improve the care of adults with neuropathic pain by making evidence-based recommendations on the pharmacological management of neuropathic pain outside of specialist pain management services. A further aim is to ensure that people who require specialist assessment and interventions are referred appropriately and in a timely fashion to a specialist pain management service and/or other condition-specific services.
Copyright © 2013, National Institute for Health and Care Excellence.

Neuropathic pain: a pathway for care developed by the British Pain Society.     [PubMed Abstract] [Full Text HTML] [Full Text PDF] Br J Anaesth. 2013 Jul;111(1):73-9. doi: 10.1093/bja/aet206. [This pathway discusses and compares itself to the previous NICE Guideline on Neuropathic Pain, Guideline 96, and not to the current Guideline 173 referenced above].

Neuropathic pain is a common chronic pain condition that can be challenging to treat, particularly for non-specialists. The development of the Map of Medicine care pathway for the management of neuropathic pain was led by the British Pain Society. Focusing on treatment by non-specialists, this pathway is based on new evidence, consensus, and the interests of service users. This paper presents the care pathway and accompanying evidence base, highlighting its salient features, and discussing important treatment points. After initial assessment, the pathway progresses through first-, second-, and third-line drug treatment, includes advice on topical treatment and opioids (in specific circumstances), and describes non-pharmacological approaches. Importantly, timely review of patients and referral to specialist secondary or tertiary care must be considered as vital components of the pathway. Although the emphasis was not on specialist treatment, advice is given on existing interventions, including neural stimulation and multi-disciplinary care. These, and other steps on the pathway, will be subject to further review as more evidence becomes available. In the meantime, the pathway represents a straightforward, valuable and accessible approach for healthcare professionals managing the distress and impact of neuropathic pain.

Recommendations for the pharmacological management of neuropathic pain: an overview and literature update. [PubMed Abstract] [Full Text HTML]               [Full Text PubReader] [Download Full Text PDF]. Mayo Clin Proc. 2010 Mar;85(3 Suppl):S3-14. doi: 10.4065/mcp.2009.0649.

The Neuropathic Pain Special Interest Group of the International Association for the Study of Pain recently sponsored the development of evidence-based guidelines for the pharmacological treatment of neuropathic pain. Tricyclic antidepressants, dual reuptake inhibitors of serotonin and norepinephrine, calcium channel alpha(2)-delta ligands (ie, gabapentin and pregabalin), and topical lidocaine were recommended as first-line treatment options on the basis of the results of randomized clinical trials. Opioid analgesics and tramadol were recommended as second-line treatments that can be considered for first-line use in certain clinical circumstances. Results of several recent clinical trials have become available since the development of these guidelines. These studies have examined botulinum toxin, high-concentration capsaicin patch, lacosamide, selective serotonin reuptake inhibitors, and combination therapies in various neuropathic pain conditions. The increasing number of negative clinical trials of pharmacological treatments for neuropathic pain and ambiguities in the interpretation of these negative trials must also be considered in developing treatment guidelines. The objectives of the current article are to review the Neuropathic Pain Special Interest Group guidelines for the pharmacological management of neuropathic pain and to provide a brief overview of these recent studies.
PMID: 20194146 [PubMed – indexed for MEDLINE] PMCID: PMC2844007




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