Pharmacologic management of neuropathic pain: Evidence-based recommendations. Export

@article{citeulike:1758955, abstract = {Patients with neuropathic pain (NP) are challenging to manage and evidence-based clinical recommendations for pharmacologic management are needed. Systematic literature reviews, randomized clinical trials, and existing guidelines were evaluated at a consensus meeting. Medications were considered for recommendation if their efficacy was supported by at least one methodologically-sound, randomized clinical trial (RCT) demonstrating superiority to placebo or a relevant comparison treatment. Recommendations were based on the amount and consistency of evidence, degree of efficacy, safety, and clinical experience of the authors. Available RCTs typically evaluated chronic NP of moderate to severe intensity. Recommended first-line treatments include certain antidepressants (i.e., tricyclic antidepressants and dual reuptake inhibitors of both serotonin and norepinephrine), calcium channel alpha2-delta ligands (i.e., gabapentin and pregabalin), and topical lidocaine. Opioid analgesics and tramadol are recommended as generally second-line treatments that can be considered for first-line use in select clinical circumstances. Other medications that would generally be used as third-line treatments but that could also be used as second-line treatments in some circumstances include certain antiepileptic and antidepressant medications, mexiletine, N-methyl-d-aspartate receptor antagonists, and topical capsaicin. Medication selection should be individualized, considering side effects, potential beneficial or deleterious effects on comorbidities, and whether prompt onset of pain relief is necessary. To date, no medications have demonstrated efficacy in lumbosacral radiculopathy, which is probably the most common type of NP. Long-term studies, head-to-head comparisons between medications, studies involving combinations of medications, and RCTs examining treatment of central NP are lacking and should be a priority for future research.}, address = {University of Rochester School of Medicine and Dentistry, Rochester, NY 14642, USA.}, author = {Dworkin, Robert H H. and O'connor, Alec B B. and Backonja, Miroslav and Farrar, John T T. and Finnerup, Nanna B B. and Jensen, Troels S S. and Kalso, Eija A A. and Loeser, John D D. and Miaskowski, Christine and Nurmikko, Turo J J. and Portenoy, Russell K K. and Rice, Andrew S C S. and Stacey, Brett R R. and Treede, Rolf-Detlef D. and Turk, Dennis C C. and Wallace, Mark S S.}, citeulike-article-id = {1758955}, citeulike-linkout-0 = {http://dx.doi.org/10.1016/j.pain.2007.08.033}, citeulike-linkout-1 = {http://linkinghub.elsevier.com/retrieve/pii/S0304395907004691}, citeulike-linkout-2 = {http://view.ncbi.nlm.nih.gov/pubmed/17920770}, citeulike-linkout-3 = {http://www.hubmed.org/display.cgi?uids=17920770}, citeulike-linkout-4 = {http://www.sciencedirect.com/science/article/B6T0K-4R008RJ-1/2/81c160e8fc7ee9c5fa2d37cc5feadd8b}, day = {5}, doi = {10.1016/j.pain.2007.08.033}, issn = {1872-6623}, journal = {Pain}, keywords = {guideline, neuropathic-pain}, month = {October}, posted-at = {2008-03-16 03:33:28}, priority = {3}, title = {Pharmacologic management of neuropathic pain: Evidence-based recommendations.}, url = {http://dx.doi.org/10.1016/j.pain.2007.08.033}, year = {2007} }

TY - JOUR ID - citeulike:1758955 L3 - citeulike-article-id:1758955 N2 - Patients with neuropathic pain (NP) are challenging to manage and evidence-based clinical recommendations for pharmacologic management are needed. Systematic literature reviews, randomized clinical trials, and existing guidelines were evaluated at a consensus meeting. Medications were considered for recommendation if their efficacy was supported by at least one methodologically-sound, randomized clinical trial (RCT) demonstrating superiority to placebo or a relevant comparison treatment. Recommendations were based on the amount and consistency of evidence, degree of efficacy, safety, and clinical experience of the authors. Available RCTs typically evaluated chronic NP of moderate to severe intensity. Recommended first-line treatments include certain antidepressants (i.e., tricyclic antidepressants and dual reuptake inhibitors of both serotonin and norepinephrine), calcium channel alpha2-delta ligands (i.e., gabapentin and pregabalin), and topical lidocaine. Opioid analgesics and tramadol are recommended as generally second-line treatments that can be considered for first-line use in select clinical circumstances. Other medications that would generally be used as third-line treatments but that could also be used as second-line treatments in some circumstances include certain antiepileptic and antidepressant medications, mexiletine, N-methyl-d-aspartate receptor antagonists, and topical capsaicin. Medication selection should be individualized, considering side effects, potential beneficial or deleterious effects on comorbidities, and whether prompt onset of pain relief is necessary. To date, no medications have demonstrated efficacy in lumbosacral radiculopathy, which is probably the most common type of NP. Long-term studies, head-to-head comparisons between medications, studies involving combinations of medications, and RCTs examining treatment of central NP are lacking and should be a priority for future research. JF - Pain SN - 1872-6623 AD - University of Rochester School of Medicine and Dentistry, Rochester, NY 14642, USA. TI - Pharmacologic management of neuropathic pain: Evidence-based recommendations. KW - guideline KW - neuropathic-pain AU - Dworkin, Robert H AU - O'connor, Alec B AU - Backonja, Miroslav AU - Farrar, John T AU - Finnerup, Nanna B AU - Jensen, Troels S AU - Kalso, Eija A AU - Loeser, John D AU - Miaskowski, Christine AU - Nurmikko, Turo J AU - Portenoy, Russell K AU - Rice, Andrew S C AU - Stacey, Brett R AU - Treede, Rolf-Detlef AU - Turk, Dennis C AU - Wallace, Mark S PY - 2007/10/05/ UR - http://dx.doi.org/10.1016/j.pain.2007.08.033 ER -