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Interventions for Neuropathic Pain: An Overview of Systematic Reviews

Dosenovic, Svjetlana MD*; Jelicic Kadic, Antonia MD, PhD; Miljanovic, Maja MA; Biocic, Marina MD§; Boric, Krste MD§; Cavar, Marija MD; Markovina, Nikolina§; Vucic, Katarina MD; Puljak, Livia MD, PhD§

doi: 10.1213/ANE.0000000000001998
Chronic Pain Medicine: Systematic Review Article
Continuing Medical Education

Numerous interventions for neuropathic pain (NeuP) are available, but its treatment remains unsatisfactory. We systematically summarized evidence from systematic reviews (SRs) of randomized controlled trials on interventions for NeuP. Five electronic databases were searched up to March 2015. Study quality was analyzed using A Measurement Tool to Assess Systematic Reviews. The most common interventions in 97 included SRs were pharmacologic (59%) and surgical (15%). The majority of analyzed SRs were of medium quality. More than 50% of conclusions from abstracts on efficacy and approximately 80% on safety were inconclusive. Effective interventions were described for painful diabetic neuropathy (pregabalin, gabapentin, certain tricyclic antidepressants [TCAs], opioids, antidepressants, and anticonvulsants), postherpetic neuralgia (gabapentin, pregabalin, certain TCAs, antidepressants and anticonvulsants, opioids, sodium valproate, topical capsaicin, and lidocaine), lumbar radicular pain (epidural corticosteroids, repetitive transcranial magnetic stimulation [rTMS], and discectomy), cervical radicular pain (rTMS), carpal tunnel syndrome (carpal tunnel release), cubital tunnel syndrome (simple decompression and ulnar nerve transposition), trigeminal neuralgia (carbamazepine, lamotrigine, and pimozide for refractory cases, rTMS), HIV-related neuropathy (topical capsaicin), and central NeuP (certain TCAs, pregabalin, cannabinoids, and rTMS). Evidence about interventions for NeuP is frequently inconclusive or completely lacking. New randomized controlled trials about interventions for NeuP are necessary; they should address safety and use clear diagnostic criteria.

From the Departments of *Anesthesiology and Intensive Care and Pediatrics, University Hospital Center Split, Split, Croatia; Agency for Quality and Accreditation in Health Care and Social Welfare, Zagreb, Croatia; §Laboratory for Pain Research, Department of Anatomy, Histology and Embryology, University of Split School of Medicine, Split, Croatia; Department of Radiology, University Hospital Center Split, Split, Croatia; and Agency for Medicinal Products and Medical Devices, Zagreb, Croatia.

Accepted for publication January 23, 2017.

Funding: None.

The authors declare no conflicts of interest.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s website.

Reprints will not be available from the authors.

Address correspondence to Livia Puljak, MD, PhD, Laboratory for Pain Research, University of Split School of Medicine, Soltanska 2, Split, Croatia. Address e-mail to livia@mefst.hr.

© 2017 International Anesthesia Research Society
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