Research papers

Algorithm for neuropathic pain treatment: An evidence based proposal

Finnerup, N. B.^a,*; Otto, M.^b,1; McQuay, H. J.^c,2; Jensen, T. S.^a,3; Sindrup, S. H.^b,4

^aDepartment of Neurology, Danish Pain Research Centre, Aarhus University Hospital, Aarhus Sygehus, Noerrebrogade 44, Aarhus 8000, Denmark

^bDepartment of Neurology, Odense University Hospital, Sdr. Boulevard 29, Odense 5000, Denmark

^cPain Relief Unit, Churchill Hospital, Oxford OX3 7LJ, UK

^*Corresponding author. Tel.: +45 8949 3455; fax: +45 8949 3269.

¹Tel.: +45 6541 2433; fax: +45 6541 3389.

²Tel.: +44 1865 225404; fax: +44 7092 160948.

³Tel.: +45 8949 3380; fax: +45 8949 3269.

⁴Tel.: +45 6541 2471; fax: +45 6541 3389.

E-mail: [email protected]

Submitted May 5, 2005; revised July 14, 2005; accepted August 8, 2005.

Pain 118(3):p 289-305, December 2005. | DOI: 10.1016/j.pain.2005.08.013

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Abstract

New studies of the treatment of neuropathic pain have increased the need for an updated review of randomized, double-blind, placebo-controlled trials to support an evidence based algorithm to treat neuropathic pain conditions. Available studies were identified using a MEDLINE and EMBASE search. One hundred and five studies were included. Numbers needed to treat (NNT) and numbers needed to harm (NNH) were used to compare efficacy and safety of the treatments in different neuropathic pain syndromes. The quality of each trial was assessed. Tricyclic antidepressants and the anticonvulsants gabapentin and pregabalin were the most frequently studied drug classes. In peripheral neuropathic pain, the lowest NNT was for tricyclic antidepressants, followed by opioids and the anticonvulsants gabapentin and pregabalin. For central neuropathic pain there is limited data. NNT and NNH are currently the best way to assess relative efficacy and safety, but the need for dichotomous data, which may have to be estimated retrospectively for old trials, and the methodological complexity of pooling data from small cross-over and large parallel group trials, remain as limitations.