Journal
PAIN
Volume 156, Issue 4, Pages S104-S114Publisher
LIPPINCOTT WILLIAMS & WILKINS
DOI: 10.1097/01.j.pain.0000460358.01998.15
Keywords
Neuropathic pain; Pharmacotherapy; Clinical trials; Therapeutic algorithms; Phenotypic subgrouping
Categories
Funding
- Special Interest Group of the International Association for the Study of Pain (NeuPSIG)
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Neuropathic pain (NP) is a significant medical and socioeconomic burden. Epidemiological surveys have indicated that many patients with NP do not receive appropriate treatment for their pain. A number of pharmacological agents have been found to be effective in NP on the basis of randomized controlled trials including, in particular, tricyclic antidepressants, serotonin and norepinephrine reuptake inhibitor antidepressants, pregabalin, gabapentin, opioids, lidocaine patches, and capsaicin high-concentration patches. Evidence-based recommendations for the pharmacotherapy of NP have recently been updated. However, meta-analyses indicate that only a minority of patients with NP have an adequate response to drug therapy. Several reasons may account for these findings, including a modest efficacy of the active drugs, a high placebo response, the heterogeneity of diagnostic criteria for NP, and an inadequate classification of patients in clinical trials. Improving the current way of conducting clinical trials in NP could contribute to reduce therapeutic failures and may have an impact on future therapeutic algorithms.
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