Pharmacological and non-pharmacological treatments for neuropathic pain: Systematic review and French recommendations
•SNRI/tricyclic antidepressants and gabapentin are recommended first line for NP.•Topical lidocaine and TENS are recommended first line for peripheral NP.•Pregabalin is now recommended second line.•Psychotherapy is recommended second line as add-on to other therapies.•rTMS and spinal cord stimulatio...
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| Veröffentlicht in: | Revue neurologique Jg. 176; H. 5; S. 325 - 352 |
|---|---|
| Hauptverfasser: | , , , , , , , , , , , , , , |
| Format: | Journal Article |
| Sprache: | Englisch |
| Veröffentlicht: |
France
Elsevier Masson SAS
01.05.2020
Elsevier Masson |
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| ISSN: | 0035-3787 |
| Online-Zugang: | Volltext |
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| Abstract | •SNRI/tricyclic antidepressants and gabapentin are recommended first line for NP.•Topical lidocaine and TENS are recommended first line for peripheral NP.•Pregabalin is now recommended second line.•Psychotherapy is recommended second line as add-on to other therapies.•rTMS and spinal cord stimulation (select conditions) are third line.
Neuropathic pain remains a significant unmet medical need. Several recommendations have recently been proposed concerning pharmacotherapy, neurostimulation techniques and interventional management, but no comprehensive guideline encompassing all these treatments has yet been issued. We performed a systematic review of pharmacotherapy, neurostimulation, surgery, psychotherapies and other types of therapy for peripheral or central neuropathic pain, based on studies published in peer-reviewed journals before January 2018. The main inclusion criteria were chronic neuropathic pain for at least three months, a randomized controlled methodology, at least three weeks of follow-up, at least 10 patients per group, and a double-blind design for drug therapy. Based on the GRADE system, we provide weak-to-strong recommendations for use and proposal as a first-line treatment for SNRIs (duloxetine and venlafaxine), gabapentin and tricyclic antidepressants and, for topical lidocaine and transcutaneous electrical nerve stimulation specifically for peripheral neuropathic pain; a weak recommendation for use and proposal as a second-line treatment for pregabalin, tramadol, combination therapy (antidepressant combined with gabapentinoids), and for high-concentration capsaicin patches and botulinum toxin A specifically for peripheral neuropathic pain; a weak recommendation for use and proposal as a third-line treatment for high-frequency rTMS of the motor cortex, spinal cord stimulation (failed back surgery syndrome and painful diabetic polyneuropathy) and strong opioids (in the absence of an alternative). Psychotherapy (cognitive behavioral therapy and mindfulness) is recommended as a second-line therapy, as an add-on to other therapies. An algorithm encompassing all the recommended treatments is proposed. |
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| AbstractList | Neuropathic pain remains a significant unmet medical need. Several recommendations have recently been proposed concerning pharmacotherapy, neurostimulation techniques and interventional management, but no comprehensive guideline encompassing all these treatments has yet been issued. We performed a systematic review of pharmacotherapy, neurostimulation, surgery, psychotherapies and other types of therapy for peripheral or central neuropathic pain, based on studies published in peer-reviewed journals before January 2018. The main inclusion criteria were chronic neuropathic pain for at least three months, a randomized controlled methodology, at least three weeks of follow-up, at least 10 patients per group, and a double-blind design for drug therapy. Based on the GRADE system, we provide weak-to-strong recommendations for use and proposal as a first-line treatment for SNRIs (duloxetine and venlafaxine), gabapentin and tricyclic antidepressants and, for topical lidocaine and transcutaneous electrical nerve stimulation specifically for peripheral neuropathic pain; a weak recommendation for use and proposal as a second-line treatment for pregabalin, tramadol, combination therapy (antidepressant combined with gabapentinoids), and for high-concentration capsaicin patches and botulinum toxin A specifically for peripheral neuropathic pain; a weak recommendation for use and proposal as a third-line treatment for high-frequency rTMS of the motor cortex, spinal cord stimulation (failed back surgery syndrome and painful diabetic polyneuropathy) and strong opioids (in the absence of an alternative). Psychotherapy (cognitive behavioral therapy and mindfulness) is recommended as a second-line therapy, as an add-on to other therapies. An algorithm encompassing all the recommended treatments is proposed. Neuropathic pain remains a significant unmet medical need. Several recommendations have recently been proposed concerning pharmacotherapy, neurostimulation techniques and interventional management, but no comprehensive guideline encompassing all these treatments has yet been issued. We performed a systematic review of pharmacotherapy, neurostimulation, surgery, psychotherapies and other types of therapy for peripheral or central neuropathic pain, based on studies published in peer-reviewed journals before January 2018. The main inclusion criteria were chronic neuropathic pain for at least three months, a randomized controlled methodology, at least three weeks of follow-up, at least 10 patients per group, and a double-blind design for drug therapy. Based on the GRADE system, we provide weak-to-strong recommendations for use and proposal as a first-line treatment for SNRIs (duloxetine and venlafaxine), gabapentin and tricyclic antidepressants and, for topical lidocaine and transcutaneous electrical nerve stimulation specifically for peripheral neuropathic pain; a weak recommendation for use and proposal as a second-line treatment for pregabalin, tramadol, combination therapy (antidepressant combined with gabapentinoids), and for high-concentration capsaicin patches and botulinum toxin A specifically for peripheral neuropathic pain; a weak recommendation for use and proposal as a third-line treatment for high-frequency rTMS of the motor cortex, spinal cord stimulation (failed back surgery syndrome and painful diabetic polyneuropathy) and strong opioids (in the absence of an alternative). Psychotherapy (cognitive behavioral therapy and mindfulness) is recommended as a second-line therapy, as an add-on to other therapies. An algorithm encompassing all the recommended treatments is proposed.Neuropathic pain remains a significant unmet medical need. Several recommendations have recently been proposed concerning pharmacotherapy, neurostimulation techniques and interventional management, but no comprehensive guideline encompassing all these treatments has yet been issued. We performed a systematic review of pharmacotherapy, neurostimulation, surgery, psychotherapies and other types of therapy for peripheral or central neuropathic pain, based on studies published in peer-reviewed journals before January 2018. The main inclusion criteria were chronic neuropathic pain for at least three months, a randomized controlled methodology, at least three weeks of follow-up, at least 10 patients per group, and a double-blind design for drug therapy. Based on the GRADE system, we provide weak-to-strong recommendations for use and proposal as a first-line treatment for SNRIs (duloxetine and venlafaxine), gabapentin and tricyclic antidepressants and, for topical lidocaine and transcutaneous electrical nerve stimulation specifically for peripheral neuropathic pain; a weak recommendation for use and proposal as a second-line treatment for pregabalin, tramadol, combination therapy (antidepressant combined with gabapentinoids), and for high-concentration capsaicin patches and botulinum toxin A specifically for peripheral neuropathic pain; a weak recommendation for use and proposal as a third-line treatment for high-frequency rTMS of the motor cortex, spinal cord stimulation (failed back surgery syndrome and painful diabetic polyneuropathy) and strong opioids (in the absence of an alternative). Psychotherapy (cognitive behavioral therapy and mindfulness) is recommended as a second-line therapy, as an add-on to other therapies. An algorithm encompassing all the recommended treatments is proposed. •SNRI/tricyclic antidepressants and gabapentin are recommended first line for NP.•Topical lidocaine and TENS are recommended first line for peripheral NP.•Pregabalin is now recommended second line.•Psychotherapy is recommended second line as add-on to other therapies.•rTMS and spinal cord stimulation (select conditions) are third line. Neuropathic pain remains a significant unmet medical need. Several recommendations have recently been proposed concerning pharmacotherapy, neurostimulation techniques and interventional management, but no comprehensive guideline encompassing all these treatments has yet been issued. We performed a systematic review of pharmacotherapy, neurostimulation, surgery, psychotherapies and other types of therapy for peripheral or central neuropathic pain, based on studies published in peer-reviewed journals before January 2018. The main inclusion criteria were chronic neuropathic pain for at least three months, a randomized controlled methodology, at least three weeks of follow-up, at least 10 patients per group, and a double-blind design for drug therapy. Based on the GRADE system, we provide weak-to-strong recommendations for use and proposal as a first-line treatment for SNRIs (duloxetine and venlafaxine), gabapentin and tricyclic antidepressants and, for topical lidocaine and transcutaneous electrical nerve stimulation specifically for peripheral neuropathic pain; a weak recommendation for use and proposal as a second-line treatment for pregabalin, tramadol, combination therapy (antidepressant combined with gabapentinoids), and for high-concentration capsaicin patches and botulinum toxin A specifically for peripheral neuropathic pain; a weak recommendation for use and proposal as a third-line treatment for high-frequency rTMS of the motor cortex, spinal cord stimulation (failed back surgery syndrome and painful diabetic polyneuropathy) and strong opioids (in the absence of an alternative). Psychotherapy (cognitive behavioral therapy and mindfulness) is recommended as a second-line therapy, as an add-on to other therapies. An algorithm encompassing all the recommended treatments is proposed. |
| Author | Lanteri-Minet, M. Bouhassira, D. Alchaar, H. Regis, C. Attal, N. Avez Couturier, J. Mick, G. Salvat, E. Delmotte, M.H. Pickering, G. Piano, V. Lefaucheur, J.P. Moisset, X. Conradi, S. Piquet, E. |
| Author_xml | – sequence: 1 givenname: X. orcidid: 0000-0002-8799-0750 surname: Moisset fullname: Moisset, X. email: xavier.moisset@gmail.com organization: Université Clermont Auvergne, Inserm, Neuro-Dol, 63000 Clermont-Ferrand, France – sequence: 2 givenname: D. surname: Bouhassira fullname: Bouhassira, D. organization: INSERM U987, CETD, Ambroise-Paré Hospital, AP–HP, Boulogne-Billancourt, France – sequence: 3 givenname: J. surname: Avez Couturier fullname: Avez Couturier, J. organization: Service de Neuropédiatrie, Consultation Douleur Enfant, CIC-IT 1403, CHU de Lille, Lille, France – sequence: 4 givenname: H. surname: Alchaar fullname: Alchaar, H. organization: 73, boulevard de Cimiez, Nice, France – sequence: 5 givenname: S. surname: Conradi fullname: Conradi, S. organization: CETD, CHRU de Nancy, Vandœuvre-lès-Nancy, France – sequence: 6 givenname: M.H. surname: Delmotte fullname: Delmotte, M.H. organization: GHU, Paris site Ste-Anne, Structure Douleurs, 1, rue Cabanis, Paris 14, France – sequence: 7 givenname: M. orcidid: 0000-0001-6717-9234 surname: Lanteri-Minet fullname: Lanteri-Minet, M. organization: Université Clermont Auvergne, Inserm, Neuro-Dol, 63000 Clermont-Ferrand, France – sequence: 8 givenname: J.P. surname: Lefaucheur fullname: Lefaucheur, J.P. organization: EA 4391, Faculté de Médecine, Université Paris Est Créteil, Créteil, France – sequence: 9 givenname: G. surname: Mick fullname: Mick, G. organization: Centre d’Évaluation et Traitement de la Douleur du Voironnais, Centre Hospitalier de Voiron, Laboratoire P2S, Université de Lyon, Lyon, France – sequence: 10 givenname: V. surname: Piano fullname: Piano, V. organization: Centre Hospitalier de Draguignan, Service Algologie 4e, route de Montferrat, 83007 Draguignan cedex, France – sequence: 11 givenname: G. surname: Pickering fullname: Pickering, G. organization: Université Clermont Auvergne, Inserm, Neuro-Dol, 63000 Clermont-Ferrand, France – sequence: 12 givenname: E. surname: Piquet fullname: Piquet, E. organization: Département d’Évaluation et Traitement de la Douleur, Centre Hospitalier Universitaire (CHU) de Nice, Fédération Hospitalo-Universitaire InovPain, Université Côte d’Azur, Nice, France – sequence: 13 givenname: C. surname: Regis fullname: Regis, C. organization: CETD, CHU Montpellier, Montpellier, France – sequence: 14 givenname: E. surname: Salvat fullname: Salvat, E. organization: Centre d’Évaluation et de Traitement de la Douleur, Hôpitaux Universitaires de Strasbourg, Université de Strasbourg, Institut des Neurosciences Cellulaires et Intégratives, Centre National de la Recherche Scientifique, Strasbourg, France – sequence: 15 givenname: N. surname: Attal fullname: Attal, N. organization: INSERM U987, CETD, Ambroise-Paré Hospital, AP–HP, Boulogne-Billancourt, France |
| BackLink | https://www.ncbi.nlm.nih.gov/pubmed/32276788$$D View this record in MEDLINE/PubMed https://hal.science/hal-04721535$$DView record in HAL |
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| Snippet | •SNRI/tricyclic antidepressants and gabapentin are recommended first line for NP.•Topical lidocaine and TENS are recommended first line for peripheral... Neuropathic pain remains a significant unmet medical need. Several recommendations have recently been proposed concerning pharmacotherapy, neurostimulation... |
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| SubjectTerms | Life Sciences Neurons and Cognition Neuropathic pain Neurostimulation Pharmacotherapy Psychotherapy Randomized controlled trials Recommendations Surgery Systematic review |
| Title | Pharmacological and non-pharmacological treatments for neuropathic pain: Systematic review and French recommendations |
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