Pharmacological Management of Chronic Neuropathic Pain – Consensus Statement and Guidelines from the Canadian Pain Society
Neuropathic pain (NeP), generated by disorders of the peripheral and central nervous system, can be particularly severe and disabling. Prevalence estimates indicate that 2% to 3% of the population in the developed world suffer from NeP, which suggests that up to one million Canadians have this disab...
Saved in:
| Main Authors: | , , , , , , , , , , , , , , , , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Wiley
2007-01-01
|
| Series: | Pain Research and Management |
| Online Access: | http://dx.doi.org/10.1155/2007/730785 |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1832552118604529664 |
|---|---|
| author | DE Moulin AJ Clark I Gilron MA Ware CPN Watson BJ Sessle T Coderre PK Morley-Forster J Stinson A Boulanger P Peng GA Finley P Taenzer P Squire D Dion A Cholkan A Gilani A Gordon J Henry R Jovey M Lynch A Mailis-Gagnon A Panju GB Rollman A Velly |
| author_facet | DE Moulin AJ Clark I Gilron MA Ware CPN Watson BJ Sessle T Coderre PK Morley-Forster J Stinson A Boulanger P Peng GA Finley P Taenzer P Squire D Dion A Cholkan A Gilani A Gordon J Henry R Jovey M Lynch A Mailis-Gagnon A Panju GB Rollman A Velly |
| author_sort | DE Moulin |
| collection | DOAJ |
| description | Neuropathic pain (NeP), generated by disorders of the peripheral and central nervous system, can be particularly severe and disabling. Prevalence estimates indicate that 2% to 3% of the population in the developed world suffer from NeP, which suggests that up to one million Canadians have this disabling condition. Evidence-based guidelines for the pharmacological management of NeP are therefore urgently needed. Randomized, controlled trials, systematic reviews and existing guidelines focusing on the pharmacological management of NeP were evaluated at a consensus meeting. Medications are recommended in the guidelines if their analgesic efficacy was supported by at least one methodologically sound, randomized, controlled trial showing significant benefit relative to placebo or another relevant control group. Recommendations for treatment are based on degree of evidence of analgesic efficacy, safety, ease of use and cost-effectiveness. Analgesic agents recommended for first-line treatments are certain antidepressants (tricyclics) and anticonvulsants (gabapentin and pregabalin). Second-line treatments recommended are serotonin noradrenaline reuptake inhibitors and topical lidocaine. Tramadol and controlled-release opioid analgesics are recommended as third-line treatments for moderate to severe pain. Recommended fourth-line treatments include cannabinoids, methadone and anticonvulsants with lesser evidence of efficacy, such as lamotrigine, topiramate and valproic acid. Treatment must be individualized for each patient based on efficacy, side-effect profile and drug accessibility, including cost. Further studies are required to examine head-to-head comparisons among analgesics, combinations of analgesics, long-term outcomes, and treatment of pediatric and central NeP. |
| format | Article |
| id | doaj-art-6cfc1cfdbec9491e835e02a6488845ef |
| institution | Kabale University |
| issn | 1203-6765 |
| language | English |
| publishDate | 2007-01-01 |
| publisher | Wiley |
| record_format | Article |
| series | Pain Research and Management |
| spelling | doaj-art-6cfc1cfdbec9491e835e02a6488845ef2025-02-03T05:59:30ZengWileyPain Research and Management1203-67652007-01-01121132110.1155/2007/730785Pharmacological Management of Chronic Neuropathic Pain – Consensus Statement and Guidelines from the Canadian Pain SocietyDE Moulin0AJ Clark1I Gilron2MA Ware3CPN Watson4BJ Sessle5T Coderre6PK Morley-Forster7J Stinson8A Boulanger9P Peng10GA Finley11P Taenzer12P Squire13D Dion14A Cholkan15A Gilani16A Gordon17J Henry18R Jovey19M Lynch20A Mailis-Gagnon21A Panju22GB Rollman23A Velly24University of Western Ontario, London, Ontario, CanadaUniversity of Calgary, Calgary, Alberta, CanadaQueen’s University, Kingston, CanadaMcGill University, Montreal, CanadaUniversity of Toronto, CanadaUniversity of Toronto, CanadaMcGill University, Montreal, CanadaUniversity of Western Ontario, London, Ontario, CanadaThe Hospital for Sick Children, Toronto, Ontario, CanadaUniversite de Montreal, Montreal, Quebec, CanadaUniversity of Toronto, CanadaDalhousie University, CanadaUniversity of Calgary, Calgary, Alberta, CanadaUniversity of British Columbia, Vancouver, British Columbia, CanadaUniversite de Montreal, Montreal, Quebec, CanadaWasser Pain Management Centre, Mount Sinai Hospital, Toronto, Ontario, CanadaMcMaster University, Hamilton, Ontario, CanadaUniversity of Toronto, CanadaMcMaster University, Hamilton, Ontario, CanadaUniversity of Toronto, CanadaDalhousie University, CanadaUniversity of Toronto, CanadaMcMaster University, Hamilton, Ontario, CanadaUniversity of Western Ontario, London, Ontario, CanadaUniversity of Minnesota, Minneapolis, Minnesota, USANeuropathic pain (NeP), generated by disorders of the peripheral and central nervous system, can be particularly severe and disabling. Prevalence estimates indicate that 2% to 3% of the population in the developed world suffer from NeP, which suggests that up to one million Canadians have this disabling condition. Evidence-based guidelines for the pharmacological management of NeP are therefore urgently needed. Randomized, controlled trials, systematic reviews and existing guidelines focusing on the pharmacological management of NeP were evaluated at a consensus meeting. Medications are recommended in the guidelines if their analgesic efficacy was supported by at least one methodologically sound, randomized, controlled trial showing significant benefit relative to placebo or another relevant control group. Recommendations for treatment are based on degree of evidence of analgesic efficacy, safety, ease of use and cost-effectiveness. Analgesic agents recommended for first-line treatments are certain antidepressants (tricyclics) and anticonvulsants (gabapentin and pregabalin). Second-line treatments recommended are serotonin noradrenaline reuptake inhibitors and topical lidocaine. Tramadol and controlled-release opioid analgesics are recommended as third-line treatments for moderate to severe pain. Recommended fourth-line treatments include cannabinoids, methadone and anticonvulsants with lesser evidence of efficacy, such as lamotrigine, topiramate and valproic acid. Treatment must be individualized for each patient based on efficacy, side-effect profile and drug accessibility, including cost. Further studies are required to examine head-to-head comparisons among analgesics, combinations of analgesics, long-term outcomes, and treatment of pediatric and central NeP.http://dx.doi.org/10.1155/2007/730785 |
| spellingShingle | DE Moulin AJ Clark I Gilron MA Ware CPN Watson BJ Sessle T Coderre PK Morley-Forster J Stinson A Boulanger P Peng GA Finley P Taenzer P Squire D Dion A Cholkan A Gilani A Gordon J Henry R Jovey M Lynch A Mailis-Gagnon A Panju GB Rollman A Velly Pharmacological Management of Chronic Neuropathic Pain – Consensus Statement and Guidelines from the Canadian Pain Society Pain Research and Management |
| title | Pharmacological Management of Chronic Neuropathic Pain – Consensus Statement and Guidelines from the Canadian Pain Society |
| title_full | Pharmacological Management of Chronic Neuropathic Pain – Consensus Statement and Guidelines from the Canadian Pain Society |
| title_fullStr | Pharmacological Management of Chronic Neuropathic Pain – Consensus Statement and Guidelines from the Canadian Pain Society |
| title_full_unstemmed | Pharmacological Management of Chronic Neuropathic Pain – Consensus Statement and Guidelines from the Canadian Pain Society |
| title_short | Pharmacological Management of Chronic Neuropathic Pain – Consensus Statement and Guidelines from the Canadian Pain Society |
| title_sort | pharmacological management of chronic neuropathic pain consensus statement and guidelines from the canadian pain society |
| url | http://dx.doi.org/10.1155/2007/730785 |
| work_keys_str_mv | AT demoulin pharmacologicalmanagementofchronicneuropathicpainconsensusstatementandguidelinesfromthecanadianpainsociety AT ajclark pharmacologicalmanagementofchronicneuropathicpainconsensusstatementandguidelinesfromthecanadianpainsociety AT igilron pharmacologicalmanagementofchronicneuropathicpainconsensusstatementandguidelinesfromthecanadianpainsociety AT maware pharmacologicalmanagementofchronicneuropathicpainconsensusstatementandguidelinesfromthecanadianpainsociety AT cpnwatson pharmacologicalmanagementofchronicneuropathicpainconsensusstatementandguidelinesfromthecanadianpainsociety AT bjsessle pharmacologicalmanagementofchronicneuropathicpainconsensusstatementandguidelinesfromthecanadianpainsociety AT tcoderre pharmacologicalmanagementofchronicneuropathicpainconsensusstatementandguidelinesfromthecanadianpainsociety AT pkmorleyforster pharmacologicalmanagementofchronicneuropathicpainconsensusstatementandguidelinesfromthecanadianpainsociety AT jstinson pharmacologicalmanagementofchronicneuropathicpainconsensusstatementandguidelinesfromthecanadianpainsociety AT aboulanger pharmacologicalmanagementofchronicneuropathicpainconsensusstatementandguidelinesfromthecanadianpainsociety AT ppeng pharmacologicalmanagementofchronicneuropathicpainconsensusstatementandguidelinesfromthecanadianpainsociety AT gafinley pharmacologicalmanagementofchronicneuropathicpainconsensusstatementandguidelinesfromthecanadianpainsociety AT ptaenzer pharmacologicalmanagementofchronicneuropathicpainconsensusstatementandguidelinesfromthecanadianpainsociety AT psquire pharmacologicalmanagementofchronicneuropathicpainconsensusstatementandguidelinesfromthecanadianpainsociety AT ddion pharmacologicalmanagementofchronicneuropathicpainconsensusstatementandguidelinesfromthecanadianpainsociety AT acholkan pharmacologicalmanagementofchronicneuropathicpainconsensusstatementandguidelinesfromthecanadianpainsociety AT agilani pharmacologicalmanagementofchronicneuropathicpainconsensusstatementandguidelinesfromthecanadianpainsociety AT agordon pharmacologicalmanagementofchronicneuropathicpainconsensusstatementandguidelinesfromthecanadianpainsociety AT jhenry pharmacologicalmanagementofchronicneuropathicpainconsensusstatementandguidelinesfromthecanadianpainsociety AT rjovey pharmacologicalmanagementofchronicneuropathicpainconsensusstatementandguidelinesfromthecanadianpainsociety AT mlynch pharmacologicalmanagementofchronicneuropathicpainconsensusstatementandguidelinesfromthecanadianpainsociety AT amailisgagnon pharmacologicalmanagementofchronicneuropathicpainconsensusstatementandguidelinesfromthecanadianpainsociety AT apanju pharmacologicalmanagementofchronicneuropathicpainconsensusstatementandguidelinesfromthecanadianpainsociety AT gbrollman pharmacologicalmanagementofchronicneuropathicpainconsensusstatementandguidelinesfromthecanadianpainsociety AT avelly pharmacologicalmanagementofchronicneuropathicpainconsensusstatementandguidelinesfromthecanadianpainsociety |