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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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
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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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Üçel, U. İ., Can, Ö. D., Özkay, Ü. D., & Öztürk, Y. (2015) · European Journal of Pharmacology · doi:10.1016/j.ejphar.2015.02.048 · Cited by 26
Contributions of peripheral, spinal, and supraspinal actions to analgesia
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Increasing spinal 5-HT 2A receptor responsiveness mediates anti-allodynic effect and potentiates fluoxetine efficacy in neuropathic rats. Evidence for GABA release
Dupuis, A., Wattiez, A., Pinguet, J., Richard, D., Libert, F., Chalus, M., Aissouni, Y., Sion, B., Ardid, D., Marin, P., et al. (2016) · Pharmacological Research · doi:10.1016/j.phrs.2016.09.021 · Cited by 26
Neuropathic pain responds better to increased doses of pregabalin: an in-depth analysis of flexible-dose clinical trials
Serpell, M. G., Latymer, M., Almas, M., Ortiz, M., Parsons, B., & Prieto, R. (2017) · Journal of Pain Research · doi:10.2147/jpr.s129832 · Cited by 26
“As a consequence, it is recommended that in clinical practice, pregabalin should be carefully escalated to the dose that delivers optimal analgesia and tolerable side effects.(4,6,15) Despite this, some physicians may not attempt a higher dose of pregabalin in patients who do not respond at an initial low dose and man…”
Pregabalin in Patients With Painful Diabetic Peripheral Neuropathy Using an NSAID for Other Pain Conditions: A Double-Blind Crossover Study
Raskin, P., Huffman, C., Yurkewicz, L., Pauer, L., Scavone, J. M., Yang, R., & Parsons, B. (2016) · The Clinical Journal of Pain · doi:10.1097/ajp.0000000000000254 · Cited by 25
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Toelle, T. R., Varvara, R., Nimour, M., Emir, B., & Brasser, M. (2012) · The Open Pain Journal · doi:10.2174/1876386301205010001 · Cited by 25
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Premedication With Oral Pregabalin for the Prevention of Acute Postsurgical Pain in Coronary Artery Bypass Surgery
Ziyaeifard, M., Mehrabanian, M. J., Faritus, S. Z., Koohpar, M. K., Ferasatkish, R., Hosseinnejad, H., & Mehrabanian, M. (2015) · Anesthesiology and Pain Medicine · doi:10.5812/aapm.24837 · Cited by 25
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Self-citation
Pregabalin enhances the antinociceptive effect of oxycodone and morphine in thermal models of nociception in the rat without any pharmacokinetic interactions
Jokinen, V., Lilius, T. O., Laitila, J., Niemi, M., Rauhala, P. V., & Kalso, E. A. (2015) · European Journal of Pain · doi:10.1002/ejp.728 · Cited by 25
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Pharmacologic Treatment of Pain
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Umpolung of o -Hydroxyaryl Azomethine Ylides: Entry to Functionalized γ-Aminobutyric Acid under Phosphine Catalysis
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Herpes Zoster and Its Prevention by Vaccination
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Low doses of amitriptyline, pregabalin, and gabapentin are preferred for management of neuropathic pain in India: is there a need for revisiting dosing recommendations?
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Efficacy of Pain Relief in Different Postherpetic Neuralgia Therapies: A Network Meta-Analysis
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Background
Efficacy and safety of duloxetine in painful diabetic peripheral neuropathy: a systematic review and meta-analysis of randomized controlled trials
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“It is often described as a burning sensation, pressure, itch or electric current, and can be associated with allodynia or hyperalgesia and located in areas of impaired sensitivity.(43) Acute pain coming from injured osteoarticular structures may be considered nocioceptive pain according to the classification designed…”
Background

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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