Recommendations for the Pharmacological Management of Neuropathic Pain: An Overview and Literature Update

Robert Dworkin, Alec O'Connor, Joseph Audette, Ralph Baron, Geoffrey Gourlay, Maija Haanpaa, Joel Kent, Elliot Krane, Alyssa LeBel, Robert Levy, Sean Mackey, John Mayer, Christine Miaskowski, Srinivasa Raja, Andrew Rice, Kenneth Schmader, Brett Stacey, Steven Stanos, Rolf-Detlef Treede, Dennis TurkGary Walco, Christopher Wells

    Research output: Contribution to journalArticlepeer-review

    1027 Citations (Scopus)


    The Neuropathic Pain Special Interest Group of the International Association for the Study of Pain recently sponsored the development of evidence-based guidelines for the pharmacological treatment of neuropathic pain. Tricyclic antidepressants, dual reuptake inhibitors of serotonin and norepinephrine, calcium channel α2-δ ligands (ie, gabapentin and pregabalin), and topical lidocaine were recommended as first-line treatment options on the basis of the results of randomized clinical trials. Opioid analgesics and tramadol were recommended as second-line treatments that can be considered for first-line use in certain clinical circumstances. Results of several recent clinical trials have become available since the development of these guidelines. These studies have examined botulinum toxin, high-concentration capsaicin patch, lacosamide, selective serotonin reuptake inhibitors, and combination therapies in various neuropathic pain conditions. The increasing number of negative clinical trials of pharmacological treatments for neuropathic pain and ambiguities in the interpretation of these negative trials must also be considered in developing treatment guidelines. The objectives of the current article are to review the Neuropathic Pain Special Interest Group guidelines for the pharmacological management of neuropathic pain and to provide a brief overview of these recent studies.

    Original languageEnglish
    Pages (from-to)S3-S14
    Number of pages12
    JournalMayo Clinic Proceedings
    Issue number3 SUPPL.
    Publication statusPublished - Mar 2010


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