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
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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
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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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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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Johnston, S. S., Udall, M., Alvir, J. M., McMorrow, D., Fowler, R., & Mullins, D. C. (2014) · Pain Medicine · doi:10.1111/pme.12328 · Cited by 20
Predictive Factors for Postherpetic Neuralgia Using Ordered Logistic Regression Analysis
Kanbayashi, Y., Onishi, K., Fukazawa, K., Okamoto, K., Ueno, H., Takagi, T., & Hosokawa, T. (2011) · Clinical Journal of Pain · doi:10.1097/ajp.0b013e318243ee01 · Cited by 20
Evaluation of analgesic, antioxidant, cytotoxic and metabolic effects of pregabalin for the use in neuropathic pain
Sałat, K., Librowski, T., Nawieśniak, B., & Głuch‐Lutwin, M. (2013) · Neurological Research · doi:10.1179/1743132813y.0000000236 · Cited by 20
Sensory abnormalities and masticatory function after microvascular decompression or balloon compression for trigeminal neuralgia compared with carbamazepine and healthy controls
Ichida, M. C., de Almeida, A. N., da Nóbrega, J. C. M., Teixeira, M. J., de Siqueira, J. T. T., & de Siqueira, S. R. D. T. (2015) · Journal of neurosurgery · doi:10.3171/2014.9.jns14346 · Cited by 20
Emerging Treatments for Neuropathic Pain
Pessôa, B. L., Escudeiro, G. P., & Nascimento, O. J. M. (2015) · Current Pain and Headache Reports · doi:10.1007/s11916-015-0530-z · Cited by 20
“bo group [20–22].”
Background
Komplexes regionales Schmerzsyndrom
Maihöfner, C. (2014) · Der Schmerz · doi:10.1007/s00482-014-1421-7 · Cited by 1
The Effects of Peripheral Occipital Nerve Stimulation for the Treatment of Patients Suffering from Chronic Migraine: A Single Center Experience
Notaro, P. (2014) · Pain Physician · doi:10.36076/ppj.2014/17/e369 · Cited by 20
Neuropathic pain in patients with chronic leg ulcers
Eusen, M., Brenaut, E., Schoenlaub, P., Saliou, P., & Misery, L. (2016) · Journal of the European Academy of Dermatology and Venereology · doi:10.1111/jdv.13647 · Cited by 20
Effectiveness of repetitive trancranial or peripheral magnetic stimulation in neuropathic pain
Kumru, H., Albu, S., Vidal, J., & Tormos, J. M. (2016) · Disability and Rehabilitation · doi:10.3109/09638288.2016.1170213 · Cited by 22
“[1,2] Despite the advances in pain medicine most NP conditions are refractory to pharmacological therapies [3] and the limited efficacy of drug treatment in monotherapy or various drug combinations also leads to incresed incidence of severe adverse effects and dropping out of treatment.”
Background
Systemic drug therapy for neuropathic pain
Hennemann-Krause, L., & Sredni, S. (2016) · Revista Dor · doi:10.5935/1806-0013.20160057 · Cited by 20
Validity of Algorithms for Identification of Individuals Suffering from Chronic Noncancer Pain in Administrative Databases: A Systematic Review
Lacasse, A., Charest, E. C., Dault, R., Cloutier, A., Choinière, M., Blais, L., & Vanasse, A. (2020) · Pain Medicine · doi:10.1093/pm/pnaa004 · Cited by 25
Treatment Response to Gabapentin in Neuropathic Ocular Pain Associated with Dry Eye
Yoon, H. J., Kim, J.-H., & Yoon, K. C. (2020) · Journal of Clinical Medicine · doi:10.3390/jcm9113765 · Cited by 20
“The efficacy of gabapentin for the alleviation of systemic neuropathic pain was proven by several randomized, double-blind placebo-controlled studies [14].”
BackgroundInfluential
Top 100 Most-Cited Papers in Neuropathic Pain From 2000 to 2020: A Bibliometric Study
Xiong, H.-Y., Liu, H., & Wang, X. (2021) · Frontiers in Neurology · doi:10.3389/fneur.2021.765193 · Cited by 20
Usefulness of screening tools in the evaluation of long-term effectiveness of DREZ lesioning in the treatment of neuropathic pain after brachial plexus injury
Haninec, P., Kaiser, R., Mencl, L., & Waldauf, P. (2014) · BMC Neurology · doi:10.1186/s12883-014-0225-9 · Cited by 20
An economic evaluation of pregabalin versus usual care in the management of community-treated patients with refractory painful diabetic peripheral neuropathy in primary care settings
de Salas-Cansado, M., Pérez, C., Saldaña, M. T., Navarro, A., González-Gómez, F. J., Ruiz, L., & Rejas, J. (2012) · Primary care diabetes · doi:10.1016/j.pcd.2012.03.001 · Cited by 20
Manipulation of Neurotransmitter Levels Has Differential Effects on Formalin-Evoked Nociceptive Behavior in Male and Female Mice
Mifflin, K. A., Benson, C. A., Thorburn, K. C., Baker, G. B., & Kerr, B. J. (2016) · Journal of Pain · doi:10.1016/j.jpain.2015.12.013 · Cited by 20
Local Injection of Methylcobalamin Combined with Lidocaine for Acute Herpetic Neuralgia
Xú, G., Xu, S., Tang, W., Xú, G., Cheng, C., & Xu, J. (2015) · Pain Medicine · doi:10.1093/pm/pnv005 · Cited by 20
Does duration of neuropathic pain impact the effectiveness of pregabalin?
Pérez, C., Latymer, M., Almas, M., Ortiz, M., Clair, A., Parsons, B., & Varvara, R. (2017) · Pain Practice · doi:10.1111/papr.12469 · Cited by 19
“Trials with flexible dosing more closely resemble realworld clinical practice, where the dose should be tailored to the patient’s needs.(12,35) In this analysis, those patients treated with flexible-dose pregabalin were also assessed for the change in pain score in each pain”
Method
Pregabalin alleviates clinical signs of syringomyelia-related central neuropathic pain in Cavalier King Charles Spaniel dogs: a randomized controlled trial
Thoefner, M. S., Skovgaard, L. T., McEvoy, F. J., Berendt, M., & Bjerrum, O. J. (2019) · Veterinary Anaesthesia and Analgesia · doi:10.1016/j.vaa.2019.09.007 · Cited by 19
ESI–LC–MS/MS for Therapeutic Drug Monitoring of Binary Mixture of Pregabalin and Tramadol: Human Plasma and Urine Applications
Almalki, A. H., Ali, N. A., Elroby, F. A., Ghobashy, M. R. E., Emam, A. A., & Naguib, I. A. (2021) · Separations · doi:10.3390/separations8020021 · Cited by 19
Pharmacotherapeutic management of trigeminal neuropathic pain: an update
Pergolizzi, J. V., Gharibo, C. G., Magnusson, P., Breve, F., LeQuang, J. A., & Varrassi, G. (2022) · Expert Opinion on Pharmacotherapy · doi:10.1080/14656566.2022.2087507 · Cited by 35
“Opioids There is very limited evidence for the use of opioids to treat any form of neuropathic pain and opioids are not specifically recommended for treating the pain of trigeminal neuropathies [55].”
Background
Analgesic Treatment Approach for Postherpetic Neuralgia: A Narrative Review
Valero, E. G., Mendoza, W. A. S., Sarmiento, D. A., & Amaya, S. (2023) · Journal of Pain & Palliative Care Pharmacotherapy · doi:10.1080/15360288.2023.2174632 · Cited by 19
“With regard to potent opioids; buprenorphine, methadone and oxycodone have shown the best performance for the control of neuropathic pain; however, their use should be limited as much as possible given their multiple adverse effects in the short and long term, as well as the risk of dependence (9, 15, 16).”
BackgroundInfluential
Issues and challenges in diabetic neuropathy management: A narrative review
Ismail, C. A. N. (2023) · World Journal of Diabetes · doi:10.4239/wjd.v14.i6.741 · Cited by 25
A Randomized Controlled Trial comparing the efficacy of low-dose amitriptyline, amitriptyline with pindolol and surrogate placebo in the treatment of chronic tension-type facial pain
Agius, A. M., Jones, N. S., & Muscat, R. (2013) · Rhinology Journal · doi:10.4193/rhino12.187 · Cited by 19
Reduction of painful area as new possible therapeutic target in post-herpetic neuropathic pain treated with 5% lidocaine medicated plaster: a case series
Allegri, M., Casale, R., Matteo, M. D., Minella, C. E., & Fanelli, G. C. (2014) · Journal of Pain Research · doi:10.2147/jpr.s65398 · Cited by 19
Influence of nitric oxide synthase or cyclooxygenase inhibitors on cannabinoids activity in streptozotocin-induced neuropathy
Bujalska‐Zadrożny, M., de Cordé, A., & Pawlik, K. (2014) · Pharmacological Reports · doi:10.1016/j.pharep.2014.08.023 · Cited by 19
Pharmacological Management of Depression in Patients with Cancer: Practical Considerations
Torta, R., & Ieraci, V. (2013) · Drugs · doi:10.1007/s40265-013-0090-7 · Cited by 20
Progress in the treatment of small fiber peripheral neuropathy
Chiang, M., Tseng, M., Pan, C., Chao, C., & Hsieh, S. (2015) · Expert Review of Neurotherapeutics · doi:10.1586/14737175.2015.1013097 · Cited by 19
Efficacy and safety of gabapentin 1800 mg treatment for post-herpetic neuralgia: a meta-analysis of randomized controlled trials
Fan, H., Yu, W., Zhang, Q., Cao, H., Li, J., Wang, J., Shao, Y., & Hu, X. (2014) · Journal of Clinical Pharmacy and Therapeutics · doi:10.1111/jcpt.12167 · Cited by 21
Untangling Nociceptive, Neuropathic and Neuroplastic Mechanisms Underlying the Biological Domain of Back Pain
Hush, J. M., Stanton, T. R., Siddall, P. J., Marcuzzi, A., & Attal, N. (2013) · Pain Management · doi:10.2217/pmt.13.11 · Cited by 20
Self-citation
Impact of comorbidities on pharmacotherapy of painful diabetic neuropathy in clinical practice
Ziegler, D., Schneider, E. M., Boess, F., Berggren, L., & Birklein, F. (2014) · Journal of Diabetes and its Complications · doi:10.1016/j.jdiacomp.2014.04.004 · Cited by 19
Effects of tapentadol on mechanical hypersensitivity in rats with ligatures of the infraorbital nerve versus the sciatic nerve
Michot, B., Bourgoin, S., Kayser, V., & Hamon, M. (2012) · European Journal of Pain · doi:10.1002/j.1532-2149.2012.00259.x · Cited by 21
Isobolographic Analysis of Drug Combinations With Intrathecal BRL52537 (κ-Opioid Agonist), Pregabalin (Calcium Channel Modulator), AF 353 (P2X3 Receptor Antagonist), and A804598 (P2X7 Receptor Antagonist) in Neuropathic Rats
Jung, K., Kim, Y. O., Han, J. H., Kim, Y., & Yoon, M. H. (2017) · Anesthesia & Analgesia · doi:10.1213/ane.0000000000001883 · Cited by 19
Interventions in pain management for persons with an intellectual disability
Doody, O., & Bailey, M. (2017) · Journal of Intellectual Disabilities · doi:10.1177/1744629517708679 · Cited by 19
Local antinociceptive action of fluoxetine in the rat formalin assay: role of l -arginine/nitric oxide/cGMP/KATP channel pathway
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The analgesic effect of early hyperbaric oxygen treatment in chronic constriction injury rats and its influence on nNOS and iNOS expression and inflammatory factor production
Ding, Y., Yao, P., Hong, T., Li, H., Zhu, Y., Han, Z., & Zhou, G. (2018) · Molecular Pain · doi:10.1177/1744806918765837 · Cited by 19
“Glial cells, particularly astrocytes, play important roles in the generation and transmission of pain signals.(20) Astrocytes could produce neurotrophic factors (such as brain-derived neurotrophic factor), cytokines (glutamic acid, substance P, IL-1, IL-6, nerve growth factor, etc.”
Background
Serotonergically dependent antihyperalgesic and antiallodynic effects of isoliquiritin in a mouse model of neuropathic pain
Yu, C., Zhang, Y., Gao, K.-X., Sun, H.-T., Gong, M., Zhao, X., & Ren, P. (2020) · European Journal of Pharmacology · doi:10.1016/j.ejphar.2020.173184 · Cited by 19

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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