Neurol. praxi. 2020;21(5):373-377 | DOI: 10.36290/neu.2020.092
Pharmacotherapy for neuropathic pain in adults
- 1 Neurologická klinika FN Brno
- 2 Neuromuskulární centrum ERN, Brno
- 3 Lékařská fakulta Masarykovy univerzity, Brno
Neuropathic pain is a severe clinical symptom of many different conditions affecting peripheral and central nervous system. Cancer-related and spondylogenic pain frequently has neuropathic component. Contrary to nociceptive pain, analgetics such as paracetamole or nonsteroid anti-inflammatory drugs are typically ineffective in neuropathic pain. All current foreign and Czech recommendations agree on the first-line treatment and partially on the other treatment lines. First line treatments include anticonvulsants, in particular α2δ subunit of voltage gated calcium channels ligands (gabapentin, pregabalin), serotonine-norepinephrine reuptake inhibitors (duloxetine, venlafaxine) and tricyclic antidepressants (amitriptyline). Further therapy includes opioids (especially oxycodone), other anticonvulsants and topical agents (capsaicine, lidocain), eventually Botulinum toxine type A. In some cases combined therapy is necessary.
Keywords: neuropathic pain, pharmacotherapy, guideline, antidepressive agents, anticonvulsants, opioids, side effects.
Received: June 4, 2020; Revised: September 7, 2020; Accepted: September 7, 2020; Prepublished online: September 7, 2020; Published: November 11, 2020 Show citation
References
- Attal N. Pharmacological treatments of neuropathic pain: The latest recommendations. Rev Neurol (Paris) 2019; 175(1-2): 46-50.
Go to original source... 
Go to PubMed... - Attal N, de Andrade DC, Adam F, Ranoux D, Teixeira MJ, Galhardoni R, Raicher I, Üçeyler N, Sommer C, Bouhassira D. Safety and efficacy of repeated injections of botulinum toxin A in peripheral neuropathic pain (BOTNEP): a randomised, double-blind, placebo-controlled trial. Lancet Neurol 2016; 15(6): 555-565. Go to original source...
- Bednařík J, Ambler Z, Opavský J, Keller O, Rokyta R, Mazanec R, Lejčko J, Kozák J, Suchý M, Pátá M, Kožený P. Klinický standard pro farmakoterapii neuropatické bolesti. Česká a slovenská neurologie a neurochirurgie: časopis českých a slovenských neurologů a neurochirurgů 2012; 75(1): 93-101.
- Bendtsen L, Zakrzewska JM, Abbott J, Braschinsky M, Di Stefano G, Donnet A, Eide PK, Leal PRL, Maarbjerg S, May A, Nurmikko T, Obermann M, Jensen TS, Cruccu G. European Academy of Neurology guideline on trigeminal neuralgia. Eur J Neurol 2019; 26(6): 831-849. Go to original source...
- Bouhassira D, Attal N, Alchaar H, Boureau F, Brochet B, Bruxelle J, Cunin G, Fermanian J, Ginies P, Grun-Overdyking A, Jafari-Schluep H, Lantéri-Minet M, Laurent B, Mick G, Serrie A, Valade D, Vicaut E. Comparison of pain syndromes associated with nervous or somatic lesions and development of a new neuropathic pain diagnostic questionnaire (DN4). Pain 2005; 114(1-2): 29-36. Go to original source... Go to PubMed...
- Deer TR, Malinowski M, Varshney V, Pope J. Choice of intrathecal drug in the treatment of neuropathic pain - new research and opinion. Expert Rev Clin Pharmacol 2019; 12(10): 1003-1007. Go to original source...
- Dworkin RH, O'Connor AB, Kent J, Mackey SC, Raja SN, Stacey BR, Levy RM, Backonja M, Baron R, Harke H, Loeser JD, Treede R-D, Turk DC, Wells CD, International Association for the Study of Pain Neuropathic Pain Special Interest Group. Interventional management of neuropathic pain: NeuPSIG recommendations. Pain 2013; 154(11): 2249-2261. Go to original source...
- Finnerup NB, Attal N, Haroutounian S, McNicol E, Baron R, Dworkin RH, Gilron I, Haanpää M, Hansson P, Jensen TS, Kamerman PR, Lund K, Moore A, Raja SN, Rice ASC, Rowbotham M, Sena E, Siddall P, Smith BH, Wallace M. Pharmacotherapy for neuropathic pain in adults: a systematic review and meta-analysis. Lancet Neurol 2015; 14(2): 162-173. Go to original source...
- Freynhagen R, Baron R, Gockel U, Tölle TR. painDETECT: a new screening questionnaire to identify neuropathic components in patients with back pain. Curr Med Res Opin 2006; 22(10): 1911-1920. Go to original source...
- Hakl M. Léčba neuropatické bolesti. Neurol. Praxi 2016; 17(2): 113-116. Go to original source...
- Häuser W, Petzke F, Fitzcharles MA. Efficacy, tolerability and safety of cannabis-based medicines for chronic pain management - an overview of systematic reviews. Eur J Pain 2018; 22(3): 455-470. Go to original source...
- Holbech JV, Jung A, Jonsson T, Wanning M, Bredahl C, Bach FW. Combination treatment of neuropathic pain: Danish expert recommendations based on a Delphi process. J Pain Res 2017; 10: 1467-1475. Go to original source... Go to PubMed...
- Mücke M, Phillips T, Radbruch L, Petzke F, Häuser W. Cannabis-based medicines for chronic neuropathic pain in adults. Cochrane Database Syst Rev 2018; 3: CD012182. Go to original source...
- Sanchez-Larsen A, Sopelana D, Diaz-Maroto I, Perona-Moratalla AB, Gracia-Gil J, García-Muñozguren S, Palazón-García E, Segura T. Assessment of efficacy and safety of eslicarbazepine acetate for the treatment of trigeminal neuralgia. Eur J Pain 2018; 22(6): 1080-1087. Go to original source...
- Treede R-D, Jensen TS, Campbell JN, Cruccu G, Dostrovsky JO, Griffin JW, Hansson P, Hughes R, Nurmikko T, Serra J. Neuropathic pain: redefinition and a grading system for clinical and research purposes. Neurology 29; 2008; 70(18): 1630-1635. Go to original source... Go to PubMed...
- Viswanath O, Urits I, Burns J, Charipova K, Gress K, McNally A, Urman RD, Welschmeyer A, Berger AA, Kassem H, Sanchez MG, Kaye AD, Eubanks TN, Cornett EM, Ngo AL. Central Neuropathic Mechanisms in Pain Signaling Pathways: Current Evidence and Recommendations. Adv Ther 2020; 37(5): 1946-1959. Go to original source...
- Státní ústav pro kontrolu léčiv (SÚKL). Konopí pro léčebné použití. [online]. Dostupné z URL: http://www.sukl.cz/konopi-pro-lecebne-pouziti.