Revista de la Sociedad Española del Dolor
versión impresa ISSN 1134-8046
GONZALEZ-ESCALADA, J.R. et al. Recommendations for the treatment of neuropathic pain. Rev. Soc. Esp. Dolor [online]. 2009, vol.16, n.8, pp.445-467. ISSN 1134-8046.
The introduction and development of new products with demonstrated efficacy in neuropathic pain has generated a clear need for an evidence based algorithm to treat the different types of neuropathic pain. The present article aims to provide recommendations on the treatment of neuropathic pain supported by the scientific evidence and agreed on by consensus by a multidisciplinary group of experts in methodology and pain management. The evidence was obtained from meta-analyses including the greatest amount of information available for each type of neuropathic pain. The literature search was performed by 5 reviewers, who focussed individually on the distinct forms of presentation of neuropathic pain. The databases consulted were the Cochrane Library, EMBASE (from 2000 onwards), and PUBMED (from 2000 onwards). Meta-analyses and randomized, controlled clinical trials were selected. Finally, retrieved articles were evaluated and clinical recommendations for the treatment of neuropathic pain were designed by the pain specialists. For some types of neuropathic pain, there is insufficient information. In these types of pain, recommendations based on scientific publications without evidence were included to provide the greatest possible amount of information on their treatment. Studies of safety and efficacy in postherpetic neuralgia (PHN), painful diabetic neuropathy (PDN), and trigeminal neuralgia (TN) were reviewed as paradigms of peripheral neuropathic pain. The scarce available information on central neuropathic pain (CNP) and sympathetic pain (SP) was also gathered. Based on the results obtained with this literature review and the evidence extracted, a decision algorithm was designed with the drugs currently available in the Spanish pharmacopeia for PHN and PDN, and separate decision algorithms were designed for TN and finally for CNP and SP. These recommendations take into account the treatments that should be used initially - first line treatments - and subsequently the alternatives are outlined in order of preference, based on daily clinical practice according to the consensus of the pain specialists.
Palabras clave : Peripheral neuropathic pain; Central neuropathic pain; Diabetic neuropathy; Postherpetic neuralgia; Trigeminal neuralgia; Central pain; Therapeutic algorithm; Meta-analysis.