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The evidence for pharmacological treatment of neuropathic pain

Finnerup, Nanna Brixa,*; Sindrup, Søren Heinb; Jensen, Troels Staehelina

doi: 10.1016/j.pain.2010.06.019
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Randomized, double-blind, placebo-controlled trials on neuropathic pain treatment are accumulating, so an updated review of the available evidence is needed. Studies were identified using MEDLINE and EMBASE searches. Numbers needed to treat (NNT) and numbers needed to harm (NNH) values were used to compare the efficacy and safety of different treatments for a number of neuropathic pain conditions. One hundred and seventy-four studies were included, representing a 66% increase in published randomized, placebo-controlled trials in the last 5 years. Painful poly-neuropathy (most often due to diabetes) was examined in 69 studies, postherpetic neuralgia in 23, while peripheral nerve injury, central pain, HIV neuropathy, and trigeminal neuralgia were less often studied. Tricyclic antidepressants, serotonin noradrenaline reuptake inhibitors, the anticonvulsants gabapentin and pregabalin, and opioids are the drug classes for which there is the best evidence for a clinical relevant effect. Despite a 66% increase in published trials only a limited improvement of neuropathic pain treatment has been obtained. A large proportion of neuropathic pain patients are left with insufficient pain relief. This fact calls for other treatment options to target chronic neuropathic pain. Large-scale drug trials that aim to identify possible subgroups of patients who are likely to respond to specific drugs are needed to test the hypothesis that a mechanism-based classification may help improve treatment of the individual patients.

aDepartment of Neurology and Danish Pain Research Center, Aarhus University Hospital, Aarhus, Denmark

bDepartment of Neurology, Odense University Hospital, Odense, Denmark

*Corresponding author. Address: Danish Pain Research Center, Aarhus University Hospital, Norrebrogade 44, Building 1A, 8000 Aarhus C, Denmark. Tel.: +45 8949 3455; fax: +45 8949 3269.

E-mail address:finnerup@ki.au.dk

Submitted October 16, 2009; revised June 14, 2010; accepted June 17, 2010.

© 2010 Lippincott Williams & Wilkins, Inc.
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