Pharmacotherapy of neuropathic pain: which drugs, which treatment algorithms?

Pain. 2015 Apr;156 Suppl 1:S104-S114. doi: 10.1097/01.j.pain.0000460358.01998.15.

Abstract

Neuropathic pain (NP) is a significant medical and socioeconomic burden. Epidemiological surveys have indicated that many patients with NP do not receive appropriate treatment for their pain. A number of pharmacological agents have been found to be effective in NP on the basis of randomized controlled trials including, in particular, tricyclic antidepressants, serotonin and norepinephrine reuptake inhibitor antidepressants, pregabalin, gabapentin, opioids, lidocaine patches, and capsaicin high-concentration patches. Evidence-based recommendations for the pharmacotherapy of NP have recently been updated. However, meta-analyses indicate that only a minority of patients with NP have an adequate response to drug therapy. Several reasons may account for these findings, including a modest efficacy of the active drugs, a high placebo response, the heterogeneity of diagnostic criteria for NP, and an inadequate classification of patients in clinical trials. Improving the current way of conducting clinical trials in NP could contribute to reduce therapeutic failures and may have an impact on future therapeutic algorithms.

Publication types

  • Review

MeSH terms

  • Algorithms*
  • Analgesics / therapeutic use*
  • Animals
  • Antidepressive Agents / therapeutic use
  • Drug Therapy, Combination
  • Humans
  • Meta-Analysis as Topic
  • Neuralgia / drug therapy*
  • Neuralgia / psychology
  • Pain Management
  • Randomized Controlled Trials as Topic

Substances

  • Analgesics
  • Antidepressive Agents