Cited by 785Pain Mechanisms and TreatmentsPain Management and TreatmentPain Management and Opioid Use

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Treatment of neuropathic pain: an overview of recent guidelines.

O'Connor, Alec B., Dworkin, Robert H.·2009·The American Journal of Medicine

DOI 10.1016/j.amjmed.2009.04.007

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Abstract

A number of different treatments for neuropathic pain have been studied, but the literature is sizable, rapidly evolving, and lacks important information about practical aspects of patient management. Under the auspices of the International Association for the Study of Pain (IASP) Neuropathic Pain Special Interest Group (NeuPSIG), a consensus process was used to develop evidence-based guidelines for the pharmacologic management of neuropathic pain that take into account clinical efficacy, adverse effects, impact on health-related quality of life, convenience, and costs. On the basis of randomized clinical trials, medications recommended as first-line treatments for neuropathic pain included certain antidepressants (i.e., tricyclic antidepressants and dual reuptake inhibitors of both serotonin and norepinephrine), calcium channel alpha(2)-delta ligands (i.e., gabapentin and pregabalin), and topical lidocaine. Opioid analgesics and tramadol were recommended as second-line treatments that can be considered for first-line use in selected clinical circumstances. Other medications that generally would be used as third-line treatments include certain other antidepressant and antiepileptic medications, topical capsaicin, mexiletine, and N-methyl-d-aspartate receptor antagonists. Two other national and international associations recently published pharmacologic treatment guidelines for neuropathic pain, which are summarized and contrasted with the NeuPSIG recommendations. Recent guidelines for the use of neurostimulation for the treatment of neuropathic pain also are summarized. For all treatments for neuropathic pain, long-term studies, head-to-head comparisons, and studies of treatment combinations are a priority for future research.

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Authors: O'Connor, A. B., & Dworkin, R. H.
Affiliations: University of Rochester Medicine (US)
Corresponding author: O'Connor, Alec B.
ORCID: O'Connor, Alec B.
Dworkin, Robert H.
Venue: The American Journal of Medicine
Publisher: Elsevier BV
Published: 2009-10
Volume: 122
Issue: 10
Pages: S22-S32
ISSN: 0002-9343 (ISSN-L)
DOI: 10.1016/j.amjmed.2009.04.007
OpenAlex: W2092918915
Cited by: 781
References: 36
Citations by year: 2026: 9 · 2025: 19 · 2024: 16 · 2023: 21 · 2022: 29 · 2021: 29 · 2020: 23 · 2019: 38 · 2018: 33 · 2017: 50 · 2016: 73 · 2015: 77 · 2014: 73 · 2013: 91 · 2012: 67
FWCI: 7.23
Type: journal article
Language: en
Open access: closed
Licence: www.elsevier.com/tdm/userlicense/1.0/ (tdm)
www.elsevier.com/legal/tdmrep-license (tdm)
Locations: The American Journal of Medicine (publishedVersion)
PubMed (publishedVersion)
Topics: Health Sciences › Medicine › Physiology (medical) › Pain Mechanisms and Treatments
Health Sciences › Medicine › Anesthesiology and Pain Medicine › Pain Management and Treatment
Health Sciences › Medicine › Anesthesiology and Pain Medicine › Pain Management and Opioid Use
Keywords: neuropathic pain, pharmacotherapy, treatment guidelines, antidepressants, tricyclic antidepressants, serotonin-norepinephrine reuptake inhibitors, gabapentin, pregabalin, topical lidocaine, opioid analgesics, tramadol, antiepileptic drugs, topical capsaicin, mexiletine, NMDA receptor antagonists, neuromodulation, evidence-based medicine
MeSH terms: Pregabalin, Gabapentin, Amines, Analgesics, Analgesics, Opioid, Anesthetics, Local, Antidepressive Agents, Canada, Cyclohexanecarboxylic Acids, Europe, gamma-Aminobutyric Acid, Humans, International Cooperation, Lidocaine, Neuralgia, Societies, Medical, Tramadol, Selective Serotonin Reuptake Inhibitors, Practice Guidelines as Topic, Evidence-Based Medicine

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Treatment of neuropathic pain: an overview of recent guidelines.

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