EFNS guidelines on the pharmacological treatment of neuropathic pain: 2010 revision
Article first published online: 7 APR 2010
© 2010 The Author(s). European Journal of Neurology © 2010 EFNS
European Journal of Neurology
Volume 17, Issue 9, pages 1113–e88, September 2010
How to Cite
Attal, N., Cruccu, G., Baron, R., Haanpää, M., Hansson, P., Jensen, T. S. and Nurmikko, T. (2010), EFNS guidelines on the pharmacological treatment of neuropathic pain: 2010 revision. European Journal of Neurology, 17: 1113–e88. doi: 10.1111/j.1468-1331.2010.02999.x
- Issue published online: 16 AUG 2010
- Article first published online: 7 APR 2010
- Received 13 October 2009 Accepted 2 February 2010
- neuropathic pain;
- painful diabetic polyneuropathy;
- post-herpetic neuralgia;
- trigeminal neuralgia;
- central neuropathic pain;
- evidence-based recommendations;
- pharmacological treatment;
- randomized clinical trials
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.