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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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Molecular Mechanisms of Astaxanthin as a Potential Neurotherapeutic Agent
Bahbah, E. I., Ghozy, S. A., Attia, M. S., Negida, A., Emran, T. B., Mitra, S., Albadrani, G. M., Abdel‐Daim, M. M., Uddin, M. S., & Simal‐Gándara, J. (2021) · Marine Drugs · doi:10.3390/md19040201 · Cited by 89
“Marine carotenoids are highly antioxidant, reparative, antiproliferative, and antiinflammatory and can be applied as photo-protective skin to inhibit harmful ultraviolet radiation effects [1,2].”
BackgroundLidocaine patch (5%) produces a selective, but incomplete block of Aδ and C fibers
Krumova, E. K., Zeller, M., Westermann, A., & Maier, C. (2011) · Pain · doi:10.1016/j.pain.2011.08.020 · Cited by 89
Zhang, M., Liu, S., Chen, T., Koga, K., Zhang, T., Li, Y.-Q., & Zhuo, M. (2014) · Molecular Brain · doi:10.1186/1756-6606-7-47 · Cited by 94
Effect of Minocycline on Lumbar Radicular Neuropathic Pain
Vanelderen, P., Zundert, J. H. M. V., Kozicz, T., Puylaert, M., Vooght, P. D., Mestrum, R., Heylen, R. J., Roubos, E. W., & Vissers, K. C. P. (2014) · Anesthesiology · doi:10.1097/aln.0000000000000508 · Cited by 88
Meng, W., Deshmukh, H., Donnelly, L. A., Torrance, N., Colhoun, H. M., Palmer, C. N. A., & Smith, B. H. (2015) · EBioMedicine · doi:10.1016/j.ebiom.2015.08.001 · Cited by 93
Capsaicin 8% Dermal Patch: A Review in Peripheral Neuropathic Pain
Blair, H. A. (2018) · Drugs · doi:10.1007/s40265-018-0982-7 · Cited by 87
Neuropathic pain: From actual pharmacological treatments to new therapeutic horizons
Thouaye, M., & Yalçın, İ. (2023) · Pharmacology & Therapeutics · doi:10.1016/j.pharmthera.2023.108546 · Cited by 95
Topical Treatments for Localized Neuropathic Pain
Casale, R., Symeonidou, Z., & Bartolo, M. (2017) · Current Pain and Headache Reports · doi:10.1007/s11916-017-0615-y · Cited by 93
Anticonvulsants for fibromyalgia
Üçeyler, N., Sommer, C., Walitt, B. T., & Häuser, W. (2013) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd010782 · Cited by 89
RetractedHughes, S., Hickey, L., Hulse, R. P., Lumb, B. M., & Pickering, A. E. (2013) · Pain · doi:10.1016/j.pain.2013.05.010 · Cited by 86
Antoine, J.-C. G., & Camdessanché, J. (2017) · Current Opinion in Neurology · doi:10.1097/wco.0000000000000475 · Cited by 86
microRNAs in nociceptive circuits as predictors of future clinical applications
Kress, M., Hüttenhofer, A., Landry, M., Kuner, R., Favereaux, A., Greenberg, D., Bednařík, J., Heppenstall, P. A., Kronenberg, F., Malcangio, M., et al. (2013) · Frontiers in Molecular Neuroscience · doi:10.3389/fnmol.2013.00033 · Cited by 87
Exercise and Neuropathic Pain: A General Overview of Preclinical and Clinical Research
Leitzelar, B. N., & Koltyn, K. F. (2021) · Sports Medicine - Open · doi:10.1186/s40798-021-00307-9 · Cited by 89
Painful diabetic neuropathy: Diagnosis and management
Hartemann, A., Attal, N., Bouhassira, D., Dumont, I., Gin, H., Jeanne, S., Saïd, G., & Richard, J.-L. (2011) · Diabetes & Metabolism · doi:10.1016/j.diabet.2011.06.003 · Cited by 87
Self-citationMeng, W., Deshmukh, H., van Zuydam, N. R., Liu, Y., Donnelly, L. A., Zhou, K., Surrogate Markers for Micro‐ and Macro‐Vascular Hard Endpoints for Innovative Diabetes Tools (SUMMIT) Study Group, Morris, A. D., Colhoun, H. M., Palmer, C. N. A., et al. (2014) · European Journal of Pain · doi:10.1002/ejp.560 · Cited by 90
Sommer, C., Klose, P., Welsch, P., Petzke, F. W., & Häuser, W. (2019) · European Journal of Pain · doi:10.1002/ejp.1494 · Cited by 83
“In order to facilitate the assessment and treatment of CNP, clinical practice guidelines have been published by international pain associations such as the International Association for the Study of Pain (IASP) (Finnerup et al., 2015) and the European Federation of Neurological Societies (EFNS) (Attal et al., 2010).”
BackgroundA Comprehensive Drug Safety Evaluation of Pregabalin in Peripheral Neuropathic Pain
Freynhagen, R., Serpell, M. G., Emir, B., Whalen, E., Parsons, B., Clair, A. G., & Latymer, M. (2013) · Pain Practice · doi:10.1111/papr.12146 · Cited by 83
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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