Cited by 1,873Pain Mechanisms and TreatmentsPain Management and TreatmentPain Management and Opioid Use

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EFNS guidelines on the pharmacological treatment of neuropathic pain: 2010 revision

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Attal, N., Cruccu, G., Baron, R., Haanpää, M., Hansson, P., Jensen, T. S., Nurmikko, T.·2010·European Journal of Neurology

DOI 10.1111/j.1468-1331.2010.02999.x

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Abstract

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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5 retracted

Anticonvulsant drugs for acute and chronic pain
Wiffen, P. J., Collins, S., McQuay, H. J., Carroll, D., Jadad, A. R., & Moore, R. A. (2005) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd001133.pub2 · Cited by 409
Retracted
Gabapentin for acute and chronic pain
Wiffen, P. J., McQuay, H. J., Edwards, J. E., & Moore, R. A. (2005) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd005452 · Cited by 247
Retracted
Gabapentin for acute and chronic pain
Wiffen, P. J., McQuay, H. J., Edwards, J. E., & Moore, R. A. (2011) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd005452.pub2 · Cited by 230
Retracted
Topical lidocaine for the treatment of postherpetic neuralgia
Khaliq, W., Alam, S., & Puri, N. K. (2007) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd004846.pub2 · Cited by 160
Retracted
Anticonvulsant drugs for acute and chronic pain
Wiffen, P. J., Collins, S., McQuay, H. J., Carroll, D., Jadad, A. R., & Moore, R. A. (2010) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd001133.pub3 · Cited by 153
Retracted
Clinical importance of changes in chronic pain intensity measured on an 11-point numerical pain rating scale
Farrar, J. T., Young, J. P., LaMoreaux, L., Werth, J. L., & Poole, M. R. (2001) · Pain · doi:10.1016/s0304-3959(01)00349-9 · Cited by 5,808
Core outcome domains for chronic pain clinical trials: IMMPACT recommendations
Turk, D. C., Dworkin, R. H., Allen, R. R., Bellamy, N., Brandenburg, N., Carr, D. B., Cleeland, C., Dionne, R., Farrar, J. T., Galer, B. S., et al. (2003) · Pain · doi:10.1016/j.pain.2003.08.001 · Cited by 3,510
Classification of Chronic Pain: Descriptions of Chronic Pain Syndromes and Definitions of Pain Terms
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Untitled work
Treede (2008) · doi:10.1212/01.wnl.0000282763.29778.59 · Cited by 2,746
Self-citation
Pharmacologic management of neuropathic pain: Evidence-based recommendations
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., et al. (2007) · Pain · doi:10.1016/j.pain.2007.08.033 · Cited by 2,126

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“This approach has already shown promise in neuropathies using medications, such as capsaicin and lignocaine patches (12).”
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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.
ORCID: Attal, N.
Cruccu, G.
Baron, R.
Haanpää, M.
Hansson, P.
Jensen, T. S.
Nurmikko, T.
Venue: European Journal of Neurology
Publisher: Wiley
Published: 2010-04-07
Volume: 17
Issue: 9
Pages: 1113
ISSN: 1351-5101 (ISSN-L)
1468-1331
DOI: 10.1111/j.1468-1331.2010.02999.x
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
Licence: onlinelibrary.wiley.com/termsAndConditions#vor (vor)
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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EFNS guidelines on the pharmacological treatment of neuropathic pain: 2010 revision

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