Journal
DEUTSCHES ARZTEBLATT INTERNATIONAL
Volume 113, Issue 37, Pages 616-+Publisher
DEUTSCHER AERZTE-VERLAG GMBH
DOI: 10.3238/arztebl.2016.0616
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Funding
- Pfizer
- Grunenthal
- Astellas
- Mundipharma
- Genzyme
- Allergan
- Sanofi Pasteur
- Medtronic
- Eisai
- Lilly
- Boehringer Ingelheim
- Novartis
- Bristol Myers-Squibb
- Biogenidec
- AstraZeneca
- Merck
- Abbvie
- Daiichi Sankyo
- Glenmark Pharmaceuticals
- Seguris
- Teva
- Genentech
- Galapagos
- Desitin
- Teva Pharma
- Bayer-Schering MSD
- bioCSL
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Background: Chronic neuropathic pain, including painful peripheral polyneuropathy and post-herpetic neuralgia, affects 6.9-10% of the general population. Methods: In this article, we present current treatment recommendations on the basis of a selective review of the literature. Results: Neuropathic pain does not respond consistently to classic non-opioid analgesic drugs and is better treated with co-analgesic, antidepressant, and anticonvulsant drugs and topical agents. Under certain conditions, however, neuropathic pain can be treated with opioids, even chronically. It was concluded in a large-scale meta-analysis that tricyclic antidepressants, selective serotonin-norepinephrine reuptake inhibitors, and calcium-channel anticonvulsants are the drugs of first choice, with a number needed to treat (NNT) of 3.5-7.7 for a 50% reduction of pain. An analysis of all studies yielded an estimated publication bias of 10%. Treatment planning must include adequate consideration of the patient's age and comorbidities, concomitant medication, and potential side effects. Conclusion: Drugs are now chosen to treat neuropathic pain independently of the cause and symptoms of the pain. Topical agents are used only to treat peripheral neuropathy. The utility of a treatment approach based on the patient's symptoms and pathological mechanisms was recently demonstrated for the first time in a randomized trial. The goal of current research is to facilitate treatment planning on the basis of the clinical phenotype.
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