TY - JOUR
T1 - Interventional management of neuropathic pain
T2 - NeuPSIG recommendations
AU - Dworkin, Robert H.
AU - O'Connor, Alec B.
AU - Kent, Joel
AU - Mackey, Sean C.
AU - Raja, Srinivasa N.
AU - Stacey, Brett R.
AU - Levy, Robert M.
AU - Backonja, Miroslav
AU - Baron, Ralf
AU - Harke, Henning
AU - Loeser, John D.
AU - Treede, Rolf Detlef
AU - Turk, Dennis C.
AU - Wells, Christopher D.
N1 - Funding Information:
Support for the consensus meeting on which this article is based was provided by the International Association for the Study of Pain Neuropathic Pain Special Interest Group and by the Neuropathic Pain Institute, which received unrestricted support for their activities from pharmaceutical companies. All authors received an honorarium for participation in the consensus meeting from the University of Rochester Office of Professional Education. R.H.D. has received, in the past 12 months, research grants from the U.S. Food and Drug Administration and U.S. National Institutes of Health, and compensation for activities involving clinical trial research methods from Adynxx, Analgesic Solutions, Anika, Avanir, Axsome, Bayer, Biogen, Bioness, Bristol-Myers Squibb, Charleston, Collegium, DePuy, Flexion, Genentech, Johnson & Johnson, Omeros, Pfizer, Prolong, Q-Med, Regenesis, Sanofi, Spinifex, Takeda, Taris, Teva, and Xenon; A.B.O. has no financial disclosures to report; J.K. has received research support from GlaxoSmithKline and honoraria from Medtronic; S.M. has received has received research support in the past 12 months from the U.S. National Institutes of Health; S.N.R. has received research support or consulting fees from Allergan, Alpharma, Schering-Plough, Medtronic, Pfizer, and QRx Pharma; B.R.S has received research support, consulting fees, or honoraria in the past year from Abbott, Astra Zeneca, Cadence, Celgene, GlaxoSmithKline, Lilly, Nektar, QRX Pharma, and Pfizer; R.M.L. has received research support, consulting fees, or honoraria in the past year from Bioness, Codman, Medtronic Neurological, Northstar Neuroscience, St. Jude Neuromodulation, and Stryker; M.B. has received research support, consulting fees, or honoraria in the past year from Abbott, Endo, Grünenthal, Johnson & Johnson, Lilly, Medtronic, Merck, NeurogesX, and UCB Pharma; R.B. is a member of the Innovative Medicines Initiative Europain and has received research support, consulting fees, or honoraria from Allergan, Astellas, AstraZeneca, Biogen, Boehringer Ingelheim, Bristol-Myers Squibb, Desitin, Eisai, Genzyme, Grünenthal, Lilly, Medtronic, Mundipharma, Novartis, Pfizer, Sanofi Pasteur, Schwarz, Teva, and UCB Biosciences; J.D.L. has received consulting fees in the past year from Biodelivery Sciences, Johnson & Johnson, Medtronic, and Xenoport; R.D.T. has received research support, consulting fees, or honoraria in the past year from AWD Pharma, Boehringer Ingelheim, Dr. Kade, GlaxoSmithKline, Grünenthal, and Pfizer; D.C.T. has received research support, consulting fees, or honoraria in the past year from Endo, Feering, GTx, Lilly, Ortho-McNeil Janssen, and Shire.
PY - 2013/11
Y1 - 2013/11
N2 - Neuropathic pain (NP) is often refractory to pharmacologic and noninterventional treatment. On behalf of the International Association for the Study of Pain Neuropathic Pain Special Interest Group, the authors evaluated systematic reviews, clinical trials, and existing guidelines for the interventional management of NP. Evidence is summarized and presented for neural blockade, spinal cord stimulation (SCS), intrathecal medication, and neurosurgical interventions in patients with the following peripheral and central NP conditions: herpes zoster and postherpetic neuralgia (PHN); painful diabetic and other peripheral neuropathies; spinal cord injury NP; central poststroke pain; radiculopathy and failed back surgery syndrome (FBSS); complex regional pain syndrome (CRPS); and trigeminal neuralgia and neuropathy. Due to the paucity of high-quality clinical trials, no strong recommendations can be made. Four weak recommendations based on the amount and consistency of evidence, including degree of efficacy and safety, are: 1) epidural injections for herpes zoster; 2) steroid injections for radiculopathy; 3) SCS for FBSS; and 4) SCS for CRPS type 1. Based on the available data, we recommend not to use sympathetic blocks for PHN nor radiofrequency lesions for radiculopathy. No other conclusive recommendations can be made due to the poor quality of available data. Whenever possible, these interventions should either be part of randomized clinical trials or documented in pain registries. Priorities for future research include randomized clinical trials, long-term studies, and head-to-head comparisons among different interventional and noninterventional treatments.
AB - Neuropathic pain (NP) is often refractory to pharmacologic and noninterventional treatment. On behalf of the International Association for the Study of Pain Neuropathic Pain Special Interest Group, the authors evaluated systematic reviews, clinical trials, and existing guidelines for the interventional management of NP. Evidence is summarized and presented for neural blockade, spinal cord stimulation (SCS), intrathecal medication, and neurosurgical interventions in patients with the following peripheral and central NP conditions: herpes zoster and postherpetic neuralgia (PHN); painful diabetic and other peripheral neuropathies; spinal cord injury NP; central poststroke pain; radiculopathy and failed back surgery syndrome (FBSS); complex regional pain syndrome (CRPS); and trigeminal neuralgia and neuropathy. Due to the paucity of high-quality clinical trials, no strong recommendations can be made. Four weak recommendations based on the amount and consistency of evidence, including degree of efficacy and safety, are: 1) epidural injections for herpes zoster; 2) steroid injections for radiculopathy; 3) SCS for FBSS; and 4) SCS for CRPS type 1. Based on the available data, we recommend not to use sympathetic blocks for PHN nor radiofrequency lesions for radiculopathy. No other conclusive recommendations can be made due to the poor quality of available data. Whenever possible, these interventions should either be part of randomized clinical trials or documented in pain registries. Priorities for future research include randomized clinical trials, long-term studies, and head-to-head comparisons among different interventional and noninterventional treatments.
KW - Clinical trials
KW - Evidence-based recommendations
KW - Intrathecal medication
KW - Neural blockade
KW - Neuropathic pain
KW - Neurosurgery
KW - Spinal cord stimulation
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U2 - 10.1016/j.pain.2013.06.004
DO - 10.1016/j.pain.2013.06.004
M3 - Review article
C2 - 23748119
AN - SCOPUS:84886307868
SN - 0304-3959
VL - 154
SP - 2249
EP - 2261
JO - Pain
JF - Pain
IS - 11
ER -