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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 [52,57,58].”
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Attal, N. (2018) · Revue Neurologique · doi:10.1016/j.neurol.2018.08.005 · Cited by 197
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
Radat, F., Margot-Duclot, A., & Attal, N. (2013) · European Journal of Pain · doi:10.1002/j.1532-2149.2013.00334.x · Cited by 203
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
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
Dieckmann, G., Goyal, S., & Hamrah, P. (2017) · Ophthalmology · doi:10.1016/j.ophtha.2017.08.004 · Cited by 182
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
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
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 173
Pharmacotherapy of neuropathic pain
Attal, N., & Bouhassira, D. (2015) · Pain · doi:10.1097/01.j.pain.0000460358.01998.15 · Cited by 174
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
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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 175
“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
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Central Neuropathic Pain Syndromes
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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 164
Self-citationJohnson, M. I., & Bjordal, J. M. (2011) · Expert Review of Neurotherapeutics · doi:10.1586/ern.11.48 · Cited by 154
Metadata
- 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 (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, 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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