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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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Finnerup, N. B., Attal, N., Haroutounian, S., McNicol, E., Baron, R., Dworkin, R. H., Gilron, I., Haanpää, M., Hansson, P., Jensen, T. S., et al. (2015) · The Lancet Neurology · doi:10.1016/s1474-4422(14)70251-0 · Cited by 3,980
Self-citationCDC Guideline for Prescribing Opioids for Chronic Pain — United States, 2016
Dowell, D., Haegerich, T. M., & Chou, R. (2016) · MMWR. Recommendations and Reports · doi:10.15585/mmwr.rr6501e1 · Cited by 2,697
Colloca, L., Ludman, T., Bouhassira, D., Baron, R., Dickenson, A. H., Yarnitsky, D., Freeman, R. L., Truini, A., Attal, N., Finnerup, N. B., et al. (2017) · Nature Reviews Disease Primers · doi:10.1038/nrdp.2017.2 · Cited by 2,271
Self-citationFeldman, E. L., Callaghan, B. C., Pop-Busui, R., Zochodne, D. W., Wright, D. E., Bennett, D. L., Bril, V., Russell, J. W., & Viswanathan, V. (2019) · Nature Reviews Disease Primers · doi:10.1038/s41572-019-0092-1 · Cited by 1,697
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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