EFNS guidelines on the pharmacological treatment of neuropathic pain: 2010 revision
Open accessAbstract
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.
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The list of adverse symptoms included the most frequent side effects of treatments for pain.
“The list of adverse symptoms included the most frequent side effects of treatments for pain [52,57,58].”
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CDC Guideline for Prescribing Opioids for Chronic Pain—United States, 2016
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Self-citationCDC Guideline for Prescribing Opioids for Chronic Pain — United States, 2016
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Conditioned pain modulation predicts duloxetine efficacy in painful diabetic neuropathy
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CDC Guideline for Prescribing Opioids for Chronic Pain — United States, 2016
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“• For neuropathic pain or dysaesthesia, consider treating according to published guidelines.(221,222) These recommend tricyclic antidepressants, pregabalin, gabapentin, or serotoninnoradrenaline reuptake inhibitors (duloxetine or venlafaxine) as”
BackgroundDiabetic Peripheral Neuropathy: Epidemiology, Diagnosis, and Pharmacotherapy
Iqbal, Z., Azmi, S., Yadav, R., Ferdousi, M., Kumar, M., Cuthbertson, D. J., Lim, J., Malik, R. A., & Alam, U. (2018) · Clinical Therapeutics · doi:10.1016/j.clinthera.2018.04.001 · Cited by 487 · see citing works
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“Multiple other drugs also have been recommended specifically for neuropathic pain which include anticonvulsants (gabapentin or pregabalin), tricyclic antidepressants, and serotonin-norepinephrine reuptake inhibitors (SNRIs) (412,511-514).”
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A Comprehensive Algorithm for Management of Neuropathic Pain
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Mechanisms and Management of Diabetic Painful Distal Symmetrical Polyneuropathy
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Mechanism-based treatment for chemotherapy-induced peripheral neuropathic pain
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Self-citationAntidepressants and gabapentinoids in neuropathic pain: Mechanistic insights
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Amitriptyline for neuropathic pain in adults
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Self-citationDistal Symmetric Polyneuropathy
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Self-citationNeuroplasticity Underlying the Comorbidity of Pain and Depression
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Self-citationPeripheral Neuropathy: A Practical Approach to Diagnosis and Symptom Management
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“367,520 Duloxetine relieves pain by increasing the synaptic availability of serotonin and norepinephrine in descending pathways, enhancing endogenous pain modulation.”
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“Generally, pain reduction (as a result of treatment) is related to improvement in QoL [8,9].”
BackgroundInfluentialUnderstanding Neuropathic Corneal Pain—Gaps and Current Therapeutic Approaches
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“, tetrahydrocannabinol (THC)/cannabidiol (CBD) oromucosal spray) in chronic central NP associated with MS might be beneficial, but generally, it is still a controversial issue due to their inconsistent results regarding their efficacy and numerous side effects [2, 12, 70, 71].”
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“[25] We also expected that baseline scores would be higher for patients with COPD who had experienced an exacerbation compared to scores of those with stable COPD.”
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Self-citationOral and Topical Treatment of Painful Diabetic Polyneuropathy: Practice Guideline Update Summary
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“Another pharmacological therapy includes analgesics, such as tramadol, acetaminophen, and some opioids such as oxycodone, which have constipation and nausea as side effects, and must be taken with care because they can be misused [46].”
BackgroundTopical capsaicin (low concentration) for chronic neuropathic pain in adults
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Pathology of pain and its implications for therapeutic interventions
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“Traditionally, neuropathic pain has been classified on the basis of etiology, and the EFNS guidelines still adhere to this approach [7].”
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Self-citationNeuropathic pain in the community: more under-treated than refractory?
Torrance, N., Ferguson, J. A., Afolabi, E., Bennett, M. I., Serpell, M. G., Dunn, K. M., & Smith, B. H. (2013) · Pain · doi:10.1016/j.pain.2012.12.022 · Cited by 188 · see citing works
Radat, F., Margot-Duclot, A., & Attal, N. (2013) · European Journal of Pain · doi:10.1002/j.1532-2149.2013.00334.x · Cited by 187 · see citing works
Self-citationStefano, G. D., Cesa, S. L., Truini, A., & Cruccu, G. (2014) · The Journal of Headache and Pain · doi:10.1186/1129-2377-15-34 · Cited by 186 · see citing works
Self-citationPharmacologic Interventions for Painful Diabetic Neuropathy
Griebeler, M. L., Morey‐Vargas, O. L., Brito, J. P., Τσάπας, Α., Wang, Z., Leon, B. G. C., Phung, O. J., Montori, V. M., & Murad, M. H. (2014) · Annals of Internal Medicine · doi:10.7326/m14-0511 · Cited by 184 · see citing works
Dieckmann, G., Goyal, S., & Hamrah, P. (2017) · Ophthalmology · doi:10.1016/j.ophtha.2017.08.004 · Cited by 182 · see citing works
Zhao, X., Xu, Y., Zhao, Q. C., Chen, C.-R., Liu, A., & Huang, Z. (2011) · Neuropharmacology · doi:10.1016/j.neuropharm.2011.08.050 · Cited by 177 · see citing works
Diagnosis and assessment of neuropathic pain: The saga of clinical tools
Bouhassira, D., & Attal, N. (2010) · Pain · doi:10.1016/j.pain.2010.11.027 · Cited by 175 · see citing works
Self-citationChronic Pain with Neuropathic Characteristics in Diabetic Patients: A French Cross-Sectional Study
Bouhassira, D., Letanoux, M., & Hartemann, A. (2013) · PLoS ONE · doi:10.1371/journal.pone.0074195 · Cited by 165 · see citing works
Pharmacotherapy of neuropathic pain
Attal, N., & Bouhassira, D. (2015) · Pain · doi:10.1097/01.j.pain.0000460358.01998.15 · Cited by 167 · see citing works
Self-citationQuality of Life in Painful Peripheral Neuropathies: A Systematic Review
Girach, A., Julian, T. H., Varrassi, G., Paladini, A., Vadalouka, A., & Zis, P. (2019) · Pain Research and Management · doi:10.1155/2019/2091960 · Cited by 167 · see citing works
Stefano, G. D., Maarbjerg, S., & Truini, A. (2019) · The Journal of Headache and Pain · doi:10.1186/s10194-019-0969-0 · Cited by 168 · see citing works
Attal, N., Perrot, S., Fermanian, J., & Bouhassira, D. (2011) · Journal of Pain · doi:10.1016/j.jpain.2011.05.006 · Cited by 162 · see citing works
Self-citationDiabetic neuropathy: what does the future hold?
Callaghan, B. C., Gallagher, G., Fridman, V., & Feldman, E. L. (2020) · Diabetologia · doi:10.1007/s00125-020-05085-9 · Cited by 170 · see citing works
“Both the American Academy of Neurology (AAN) and the European Federation of Neurological Societies (EFNS) have published guidelines on treating neuropathic pain [34, 35].”
BackgroundThe clinical approach to small fibre neuropathy and painful channelopathy
Themistocleous, A. C., Ramirez, J. D., Serra, J., & Bennett, D. (2014) · Practical Neurology · doi:10.1136/practneurol-2013-000758 · Cited by 161 · see citing works
Central Neuropathic Pain Syndromes
Watson, J. C., & Sandroni, P. (2016) · Mayo Clinic Proceedings · doi:10.1016/j.mayocp.2016.01.017 · Cited by 159 · see citing works
Transcranial magnetic stimulation of the brain
Klein, M. M., Treister, R., Raij, T., Pascual‐Leone, Á., Park, L., Nurmikko, T. J., Lenz, F. A., Lefaucheur, J., Lang, M., Hallett, M., et al. (2015) · Pain · doi:10.1097/j.pain.0000000000000210 · Cited by 158 · see citing works
Self-citationJohnson, M. I., & Bjordal, J. M. (2011) · Expert Review of Neurotherapeutics · doi:10.1586/ern.11.48 · Cited by 154 · see citing works
- Authors
- Attal, N., Cruccu, G., Baron, R., Haanpää, M., Hansson, P., Jensen, T. S., & Nurmikko, T.
- Affiliations
- Inserm (FR)
- Sapienza University of Rome (IT)
- University Hospital Schleswig-Holstein (DE)
- Helsinki University Hospital (FI)
- Karolinska University Hospital (SE)
- Aarhus University Hospital (DK)
- University of Liverpool (GB)
- Corresponding author
- Attal, N.
- Venue
- European Journal of Neurology
- Publisher
- Wiley
- Published
- 2010-04-07
- Volume
- 17
- Issue
- 9
- Pages
- 1113
- ISSN
- 1351-5101 (ISSN-L)
- 1468-1331
- OpenAlex
- W2128412489
- Cited by
- 1,873
- References
- 236
- Citations by year
- 2026: 39 · 2025: 59 · 2024: 85 · 2023: 81 · 2022: 91 · 2021: 128 · 2020: 134 · 2019: 112 · 2018: 102 · 2017: 151 · 2016: 136 · 2015: 152 · 2014: 185 · 2013: 185 · 2012: 121
- FWCI
- 89.44
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- European Journal of Neurology (publishedVersion)
- PubMed (publishedVersion)
- IRIS Research product catalog (Sapienza University of Rome) (submittedVersion)
- 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, pharmacotherapy, diabetic polyneuropathy, postherpetic neuralgia, trigeminal neuralgia, chronic radiculopathy, HIV neuropathy, tricyclic antidepressants, pregabalin, gabapentin, tramadol, opioids, duloxetine, venlafaxine, topical lidocaine, capsaicin patch, combination therapy, treatment efficacy
- MeSH terms
- Gabapentin, Amines, Analgesia, Analgesics, Analgesics, Opioid, Antidepressive Agents, Tricyclic, Cyclohexanecarboxylic Acids, Drug Therapy, Combination, Europe, gamma-Aminobutyric Acid, Humans, Neuralgia, Peripheral Nervous System Diseases, Randomized Controlled Trials as Topic, Treatment Outcome, Outcome Assessment, Health Care
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