Skip to main page content
Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
, 20 (Suppl 1), S2-S12

A Comprehensive Algorithm for Management of Neuropathic Pain

Affiliations

A Comprehensive Algorithm for Management of Neuropathic Pain

Daniel Bates et al. Pain Med.

Abstract

Background: The objective of this review was to merge current treatment guidelines and best practice recommendations for management of neuropathic pain into a comprehensive algorithm for primary physicians. The algorithm covers assessment, multidisciplinary conservative care, nonopioid pharmacological management, interventional therapies, neurostimulation, low-dose opioid treatment, and targeted drug delivery therapy.

Methods: Available literature was identified through a search of the US National Library of Medicine's Medline database, PubMed.gov. References from identified published articles also were reviewed for relevant citations.

Results: The algorithm provides a comprehensive treatment pathway from assessment to the provision of first- through sixth-line therapies for primary care physicians. Clear indicators for progression of therapy from firstline to sixth-line are provided. Multidisciplinary conservative care and nonopioid medications (tricyclic antidepressants, serotonin norepinephrine reuptake inhibitors, gabapentanoids, topicals, and transdermal substances) are recommended as firstline therapy; combination therapy (firstline medications) and tramadol and tapentadol are recommended as secondline; serotonin-specific reuptake inhibitors/anticonvulsants/NMDA antagonists and interventional therapies as third-line; neurostimulation as a fourth-line treatment; low-dose opioids (no greater than 90 morphine equivalent units) are fifth-line; and finally, targeted drug delivery is the last-line therapy for patients with refractory pain.

Conclusions: The presented treatment algorithm provides clear-cut tools for the assessment and treatment of neuropathic pain based on international guidelines, published data, and best practice recommendations. It defines the benefits and limitations of the current treatments at our disposal. Additionally, it provides an easy-to-follow visual guide of the recommended steps in the algorithm for primary care and family practitioners to utilize.

Keywords: Neuromodulation; Neuropathic Pain; Pharmacological Treatment; Spinal Cord Stimulation; Targeted Drug Delivery.

Figures

Figure 1
Figure 1
Comprehensive algorithm for the management of neuropathic pain.

Similar articles

See all similar articles

Cited by 1 article

References

    1. NICE. Neuropathic pain in adults: Pharmacological management in non-specialist settings. NICE, Clinical Guideline. 2013. Available at: nice.org.uk/guidance/cg173.
    1. Finnerup NB, Attal N, Haroutounian S., et al. Pharmacotherapy for neuropathic pain in adults: A systematic review and meta-analysis and updated NeuPSIG recommendations. Lancet Neurol 2015;142:162–73. - PMC - PubMed
    1. Sumitani M, Sakai T, Matsuda Y., et al. Executive summary of the clinical guidelines of pharmacologic therapy for neuropathic pain: Second edition by the Japanese Society or Pain Clinicians. J Anesth 2018;323:463–78. - PMC - PubMed
    1. Bouhassira D, Lantéri-Minet M, Attal N, Laurent B, Touboul C. Prevalence of chronic pain with neuropathic characteristics in the general population. Pain 2008;1363:380–7. - PubMed
    1. Dieleman JP, Kerklaan J, Huygen FJ, Bouma PA, Sturkenboom MC. Incidence rates and treatment of neuropathic pain conditions in the general population. Pain 2008;1373:681–8. - PubMed

Publication types

Feedback