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Cited by 2,126Pain Mechanisms and TreatmentsPain Management and TreatmentPain Management and Opioid Use

Pharmacologic management of neuropathic pain: Evidence-based recommendations

Dworkin, Robert H., O’Connor, Alec B., Backonja, Miroslav, Farrar, John T., Finnerup, Nanna B., Jensen, Troels S., Kalso, Eija A., Loeser, John D. +8 more·2007·Pain
DOI 10.1016/j.pain.2007.08.033
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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.

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Crossref · 10.1016/j.pain.2007.08.033

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  • Antidepressant treatment may be effective in reducing some forms of pain (e.g. those linked to depression or neuropathy) independent of a mood-enhancing effect.

    “Although treatment with antidepressants may be effective in reducing some forms of pain (e.g. those linked to depression or neuropathy) independent of a mood-enhancing effect (Dworkin et al., 2007; McCleane, 2008)”

    From Presence and predictors of pain in depression: Results from the FINDER study (2010) · cites this paper as Dworkin et al., 2007

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Authors
Dworkin, R. H., O’Connor, A. B., Backonja, M., Farrar, J. T., Finnerup, N. B., Jensen, T. S., Kalso, E. A., Loeser, J. D., Miaskowski, C., Nurmikko, T. J., Portenoy, R. K., Rice, A. S. C., Stacey, B. R., Treede, R.-D., Turk, D. C., & Wallace, M. S.
Affiliations
  • University of Wisconsin–Madison (US)
  • University of Pennsylvania (US)
  • Aarhus University Hospital (DK)
  • Helsinki University Hospital (FI)
  • University of Washington (US)
  • University of California, San Francisco (US)
  • University of Liverpool (GB)
  • Mount Sinai Beth Israel (US)
  • Imperial College London (GB)
  • Oregon Health & Science University (US)
  • Johannes Gutenberg University Mainz (DE)
  • University of California San Diego (US)
Corresponding author
Dworkin, Robert H.
ORCID
Venue
Pain
Publisher
Ovid Technologies (Wolters Kluwer Health)
Published
2007-12
Volume
132
Issue
3
Pages
237-251
ISSN
0304-3959 (ISSN-L)
DOI
10.1016/j.pain.2007.08.033
OpenAlex
W2094310013
Cited by
2,126
References
139
Citations by year
2026: 35 · 2025: 48 · 2024: 54 · 2023: 56 · 2022: 53 · 2021: 87 · 2020: 95 · 2019: 103 · 2018: 101 · 2017: 136 · 2016: 141 · 2015: 160 · 2014: 157 · 2013: 171 · 2012: 147
FWCI
13.55
Type
journal article
Language
en
Open access
closed
Locations
  • Pain (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Physiology › 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, pharmacological management, antidepressants, tricyclic antidepressants, serotonin-norepinephrine reuptake inhibitors, gabapentin, pregabalin, topical lidocaine, opioid analgesics, tramadol, antiepileptic drugs, mexiletine, NMDA receptor antagonists, topical capsaicin, lumbosacral radiculopathy, central pain, treatment guidelines
MeSH terms
Animals, Health Planning Guidelines, Humans, Neuralgia, Pain, Evidence-Based Medicine

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