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Vol 11, No 2 (2017)
Review paper
Published online: 2017-10-12
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Pharmacotherapy of neuropathic pain

Jerzy Wordliczek, Renata Zajączkowska, Wojciech Leppert
Medycyna Paliatywna w Praktyce 2017;11(2):61-73.

open access

Vol 11, No 2 (2017)
Review articles
Published online: 2017-10-12

Abstract

Neuropathic pain is a significant problem due to significant incidence and difficulties in effective treatment. Neuropathic pain component is frequent among cancer patients due to co-existence of nervous system changes in patients with bone pain and common use of neurotoxic methods of cancer treatment: radio­therapy, chemotherapy and molecular therapies. The diagnosis of neuropathic pain can be established by means of detailed history taking, clinical symptoms and physical examination, imagine investigations, quantitative sensory testing and validated questionnaires.

The treatment of neuropathic pain in cancer patients is based mainly on pharmacotherapy with opioids recommended as first-line agents for the treatment. Among patients with non-malignant pain adjuvant analgesics, especially antidepressants and anticonvulsants are first-line drugs. In localized neuropathic pain local anesthetics and drugs acting on vanillin receptors play a significant role. In this patient group there is a limited role of opioids which form a second or a third line of treatment when other drugs are ineffective. A limited role is attributed to other drugs such as corticosteroids, NMDA receptor antagonists and botulinum toxin. In some patients interventional techniques play a significant role and in cancer pa­tients oncology treatment (local — mainly radiotherapy and systemic — mainly chemotherapy, hormone manipulation and molecular therapies) should be carefully considered. Therapy of neuropathic pain should be an important element of a wider holistic plan of the treatment, which takes into account a meticulous assessment of pain and other symptoms, evaluation of patients and caregivers needs with the aim of a complex therapeutic approach as an effective treatment of symptoms, psychosocial and spiritual support, which significantly improve the quality of life of both patients and caregivers.

Abstract

Neuropathic pain is a significant problem due to significant incidence and difficulties in effective treatment. Neuropathic pain component is frequent among cancer patients due to co-existence of nervous system changes in patients with bone pain and common use of neurotoxic methods of cancer treatment: radio­therapy, chemotherapy and molecular therapies. The diagnosis of neuropathic pain can be established by means of detailed history taking, clinical symptoms and physical examination, imagine investigations, quantitative sensory testing and validated questionnaires.

The treatment of neuropathic pain in cancer patients is based mainly on pharmacotherapy with opioids recommended as first-line agents for the treatment. Among patients with non-malignant pain adjuvant analgesics, especially antidepressants and anticonvulsants are first-line drugs. In localized neuropathic pain local anesthetics and drugs acting on vanillin receptors play a significant role. In this patient group there is a limited role of opioids which form a second or a third line of treatment when other drugs are ineffective. A limited role is attributed to other drugs such as corticosteroids, NMDA receptor antagonists and botulinum toxin. In some patients interventional techniques play a significant role and in cancer pa­tients oncology treatment (local — mainly radiotherapy and systemic — mainly chemotherapy, hormone manipulation and molecular therapies) should be carefully considered. Therapy of neuropathic pain should be an important element of a wider holistic plan of the treatment, which takes into account a meticulous assessment of pain and other symptoms, evaluation of patients and caregivers needs with the aim of a complex therapeutic approach as an effective treatment of symptoms, psychosocial and spiritual support, which significantly improve the quality of life of both patients and caregivers.

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Keywords

adjuvant analgesics, opioid analgesics, neuropathic pain, treatment, clinical assessment of pain

About this article
Title

Pharmacotherapy of neuropathic pain

Journal

Palliative Medicine in Practice

Issue

Vol 11, No 2 (2017)

Article type

Review paper

Pages

61-73

Published online

2017-10-12

Bibliographic record

Medycyna Paliatywna w Praktyce 2017;11(2):61-73.

Keywords

adjuvant analgesics
opioid analgesics
neuropathic pain
treatment
clinical assessment of pain

Authors

Jerzy Wordliczek
Renata Zajączkowska
Wojciech Leppert

References (76)
  1. Finnerup NB, Haroutounian S, Kamerman P, et al. Neuropathic pain: an updated grading system for research and clinical practice. Pain. 2016; 157(8): 1599–1606.
  2. Neuropathic Pain: The Pharmacological Management of Neuropathic Pain in Adults in Non-specialist Settings [Internet]. Centre for Clinical Practice at NICE. 2013.
  3. Szczudlik A, Dobrogowski J, Wordliczek J, et al. Diagnosis and management of neuropathic pain: review of literature and recommendations of the Polish Association for the study of pain and the Polish Neurological Society - part one. Neurol Neurochir Pol. 2014; 48(4): 262–271.
  4. Chien CW, Bagraith KS, Khan A, et al. Comparative responsiveness of verbal and numerical rating scales to measure pain intensity in patients with chronic pain. J Pain. 2013; 14(12): 1653–1662.
  5. Attal N, Bouhassira D. Pharmacotherapy of neuropathic pain: which drugs, which treatment algorithms? Pain. 2015; 156 Suppl 1: S104–S114.
  6. Jongen JLM, Hans G, Benzon HT, et al. Neuropathic pain and pharmacological treatment. Pain Pract. 2014; 14(3): 283–295.
  7. Finnerup NB, Attal N, Haroutounian S, et al. Pharmacotherapy for neuropathic pain in adults: a systematic review and meta-analysis. Lancet Neurol. 2015; 14(2): 162–173.
  8. Dosenovic S, Jelicic Kadic A, Miljanovic M, et al. Interventions for Neuropathic Pain: An Overview of Systematic Reviews. Anesth Analg. 2017; 125(2): 643–652.
  9. Dworkin RH, O'Connor AB, Audette J, et al. Recommendations for the pharmacological management of neuropathic pain: an overview and literature update. Mayo Clin Proc. 2010; 85(3 Suppl): S3–14.
  10. Attal N, Gruccu G, Haanpaa M, et al. EFNS guidelines on pharmacological treatment of neuropathic pain; 2009 revision. Eur J Neurol. 2010; 13: 1153–1169.
  11. Jensen TS, Finnerup NB. Management of neuropathic pain.Mogil J. ed. IASP Press 2010: 283–290.
  12. Simpson DM, Schifitto G, Clifford DB, et al. 1066 HIV Neuropathy Study Group. Pregabalin for painful HIV neuropathy: a randomized, double-blind, placebo-controlled trial. Neurology. 2010; 74(5): 413–420.
  13. Moore RA, Derry S, Aldington D, et al. Amitriptyline for neuropathic pain in adults. Cochrane Database Syst Rev. 2015(7): CD008242.
  14. Pickering G, Marcoux M, Chapiro S, et al. An Algorithm for Neuropathic Pain Management in Older People. Drugs Aging. 2016; 33(8): 575–583.
  15. Berger A, Dukes EM, Edelsberg J, et al. Use of tricyclic antidepressants in older patients with painful neuropathies. Eur J Clin Pharmacol. 2006; 62(9): 757–764.
  16. Przeklasa-Muszyńska A, Wordliczek J, Kocot-Kępska M, Dobrogowski J. Koanalgetyki (adjuwanty), w: Leczenie bólu. PZWL 2017: 94–109.
  17. Gallagher HC, Gallagher RM, Butler M, et al. Venlafaxine for neuropathic pain in adults. Cochrane Database Syst Rev. 2015(8): CD011091.
  18. Attal N, Cruccu G, Baron R, et al. European Federation of Neurological Societies. EFNS guidelines on the pharmacological treatment of neuropathic pain: 2010 revision. Eur J Neurol. 2010; 17(9): 1113–e88.
  19. Deng Y, Luo L, Hu Y, et al. Clinical practice guidelines for the management of neuropathic pain: a systematic review. BMC Anesthesiol. 2016; 16: 12.
  20. Duehmke RM, Derry S, Wiffen PJ, et al. Tramadol for neuropathic pain in adults. Cochrane Database Syst Rev. 2017; 6: CD003726.
  21. de Souza MF, Kraychete DC. [The analgesic effect of intravenous lidocaine in the treatment of chronic pain: a literature review]. Rev Bras Reumatol. 2014; 54(5): 386–392.
  22. Przeklasa-Muszyńska A, Kocot-Kępska M, Dobrogowski J, et al. Intravenous lidocaine infusions in a multidirectional model of treatment of neuropathic pain patients. Pharmacol Rep. 2016; 68(5): 1069–1075.
  23. Hutson P, Backonja M, Knurr H. Intravenous lidocaine for neuropathic pain: a retrospective analysis of tolerability and efficacy. Pain Med. 2015; 16(3): 531–536.
  24. de León-Casasola OA, Mayoral V. The topical 5% lidocaine medicated plaster in localized neuropathic pain: a reappraisal of the clinical evidence. J Pain Res. 2016; 9: 67–79.
  25. Wordliczek J, Dobrogowski J. Przezskórne i powierzchniowe podawanie leków w terapii bólu. W: Leczenie bólu (red. Wordliczek J, Dobrogowski J). PZWL : 110–123.
  26. Baron R, Allegri M, Correa-Illanes G, et al. The 5% Lidocaine-Medicated Plaster: Its Inclusion in International Treatment Guidelines for Treating Localized Neuropathic Pain, and Clinical Evidence Supporting its Use. Pain Ther. 2016; 5(2): 149–169.
  27. Zajączkowska R, Wordliczek J. Postępy w farmakoterapii bólu neuropatycznego. Przewodnik Lekarski. 2012; 15: 117–124.
  28. Baron R, Treede RD, Birklein F, et al. Treatment of painful radiculopathies with capsaicin 8% cutaneous patch. Curr Med Res Opin. 2017; 33(8): 1401–1411.
  29. Mankowski C, Poole CD, Ernault E, et al. Effectiveness of the capsaicin 8% patch in the management of peripheral neuropathic pain in European clinical practice: the ASCEND study. BMC Neurol. 2017; 17(1): 80.
  30. Schug SA, Goddard C. Recent advances in the pharmacological management of acute and chronic pain. Ann Palliat Med. 2014; 3(4): 263–275.
  31. Derry S, Rice ASc, Cole P, et al. Topical capsaicin (high concentration) for chronic neuropathic pain in adults. Cochrane Database Syst Rev. 2017; 1: CD007393.
  32. Dworkin RH, Barbano RL, Tyring SK, et al. A randomized, placebo-controlled trial of oxycodone and of gabapentin for acute pain in herpes zoster. Pain. 2009; 142(3): 209–217.
  33. Gimbel JS, Richards P, Portenoy RK. Controlled-release oxycodone for pain in diabetic neuropathy: a randomized controlled trial. Neurology. 2003; 60(6): 927–934.
  34. Ueberall MA, Mueller-Schwefe GHH. Efficacy and tolerability balance of oxycodone/naloxone and tapentadol in chronic low back pain with a neuropathic component: a blinded end point analysis of randomly selected routine data from 12-week prospective open-label observations. J Pain Res. 2016; 9: 1001–1020.
  35. Gaskell H, Derry S, Stannard C, et al. Oxycodone for neuropathic pain in adults. Cochrane Database Syst Rev. 2016; 7: CD010692.
  36. Mannino R, Coyne P, Swainey C, et al. Methadone for cancer-related neuropathic pain: a review of the literature. J Opioid Manag. 2006; 2(5): 269–276.
  37. Ruan X, Luo JJ, Kaye AD. Methadone is superior to fentanyl in treating neuropathic pain in patients with head-and-neck cancer. Eur J Cancer. 2016; 68: 199–200.
  38. Vu Bach T, Pan J, Kirstein A, et al. Use of Methadone as an Adjuvant Medication to Low-Dose Opioids for Neuropathic Pain in the Frail Elderly: A Case Series. J Palliat Med. 2016; 19(12): 1351–1355.
  39. McNicol ED, Ferguson MC, Schumann R. Methadone for neuropathic pain in adults. Cochrane Database Syst Rev. 2017; 5: CD012499.
  40. Zajączkowska R, Kocot-Kepska M, Wordliczek J, et al. Tapentadol – stan wiedzy na rok 2017. Terapia. 2017; 8(355): 15–22.
  41. Pierce DM, Shipstone E. Pharmacology update: tapentadol for neuropathic pain. Am J Hosp Palliat Care. 2012; 29(8): 663–666.
  42. Wiffen PJ, Derry S, Naessens K, et al. Oral tapentadol for cancer pain. Cochrane Database Syst Rev. 2015(9): CD011460.
  43. Baron R, Likar R, Martin-Mola E, et al. Effectiveness of Tapentadol Prolonged Release (PR) Compared with Oxycodone/Naloxone PR for the Management of Severe Chronic Low Back Pain with a Neuropathic Component: A Randomized, Controlled, Open-Label, Phase 3b/4 Study. Pain Pract. 2016; 16(5): 580–599.
  44. Afilalo M, Morlion B. Efficacy of tapentadol ER for managing moderate to severe chronic pain. Pain Physician. 2013; 16(1): 27–40.
  45. Cooper TE, Chen J, Wiffen PJ, et al. Morphine for chronic neuropathic pain in adults. Cochrane Database Syst Rev. 2017; 5: CD011669.
  46. Zhou M, Chen N, He Li, et al. Oxcarbazepine for neuropathic pain. Cochrane Database Syst Rev. 2013(3): CD007963.
  47. Wiffen PJ, Derry S, Moore RA, et al. Carbamazepine for chronic neuropathic pain and fibromyalgia in adults. Cochrane Database Syst Rev. 2014(4): CD005451.
  48. Otto M, Bach FW, Jensen TS, et al. Escitalopram in painful polyneuropathy: a randomized, placebo-controlled, cross-over trial. Pain. 2008; 139(2): 275–283.
  49. Dharmshaktu P, Tayal V, Kalra BS. Efficacy of antidepressants as analgesics: a review. J Clin Pharmacol. 2012; 52(1): 6–17.
  50. Patetsos E, Horjales-Araujo E. Treating Chronic Pain with SSRIs: What Do We Know? Pain Res Manag. 2016; 2016: 2020915.
  51. Casale R, Symeonidou Z, Bartolo M. Topical Treatments for Localized Neuropathic Pain. Curr Pain Headache Rep. 2017; 21(3): 15.
  52. Derry S, Moore RA. Topical capsaicin (low concentration) for chronic neuropathic pain in adults. Cochrane Database Syst Rev. 2012(9): CD010111.
  53. Oh HM, Chung ME. Botulinum Toxin for Neuropathic Pain: A Review of the Literature. Toxins (Basel). 2015; 7(8): 3127–3154.
  54. Park J, Park HJ. Botulinum Toxin for the Treatment of Neuropathic Pain. Toxins (Basel). 2017; 9(9).
  55. Mittal SOm, Safarpour D, Jabbari B. Botulinum Toxin Treatment of Neuropathic Pain. Semin Neurol. 2016; 36(1): 73–83.
  56. Wu H, Sultana R, Taylor KB, et al. A prospective randomized double-blinded pilot study to examine the effect of botulinum toxin type A injection versus Lidocaine/Depomedrol injection on residual and phantom limb pain: initial report. Clin J Pain. 2012; 28(2): 108–112.
  57. Maher DP, Chen L, Mao J. Intravenous Ketamine Infusions for Neuropathic Pain Management: A Promising Therapy in Need of Optimization. Anesth Analg. 2017; 124(2): 661–674.
  58. Barton DL, Wos EJ, Qin R, et al. A double-blind, placebo-controlled trial of a topical treatment for chemotherapy-induced peripheral neuropathy: NCCTG trial N06CA. Support Care Cancer. 2011; 19(6): 833–841.
  59. Uzaraga I, Gerbis B, Holwerda E, et al. Topical amitriptyline, ketamine, and lidocaine in neuropathic pain caused by radiation skin reaction: a pilot study. Support Care Cancer. 2012; 20(7): 1515–1524.
  60. Carlsson KC, Hoem NO, Moberg ER, et al. Analgesic effect of dextromethorphan in neuropathic pain. Acta Anaesthesiol Scand. 2004; 48(3): 328–336.
  61. Morel V, Pickering G, Etienne M, et al. Low doses of dextromethorphan have a beneficial effect in the treatment of neuropathic pain. Fundam Clin Pharmacol. 2014; 28(6): 671–680.
  62. Morel V, Joly D, Villatte C, et al. Memantine before Mastectomy Prevents Post-Surgery Pain: A Randomized, Blinded Clinical Trial in Surgical Patients. PLoS One. 2016; 11(4): e0152741.
  63. McCormick Z, Chang-Chien G, Marshall B, et al. Phantom Limb Pain: A Systematic Neuroanatomical-Based Review of Pharmacologic Treatment. Pain Medicine. 2013; 15(2): 292–305.
  64. Loy BM, Britt RB, Brown JN. Memantine for the Treatment of Phantom Limb Pain: A Systematic Review. J Pain Palliat Care Pharmacother. 2016; 30(4): 276–283.
  65. Ahmad-Sabry MH, Shareghi G. Effects of memantine on pain in patients with complex regional pain syndrome - a retrospective study. Middle East J Anaesthesiol. 2015; 23(1): 51–54.
  66. Rogers M, Rasheed A, Moradimehr A, et al. Memantine (Namenda) for neuropathic pain. Am J Hosp Palliat Care. 2009; 26(1): 57–59.
  67. Buvanendran A, Kroin JS. Early use of memantine for neuropathic pain. Anesth Analg. 2008; 107(4): 1093–1094.
  68. Pickering G, Morel V. Memantine for the treatment of general neuropathic pain: a narrative review. Fundam Clin Pharmacol. 2017 [Epub ahead of print].
  69. Holbech JV, Jung A, Jonsson T, et al. Combination treatment of neuropathic pain: Danish expert recommendations based on a Delphi process. J Pain Res. 2017; 10: 1467–1475.
  70. Meng H, Johnston B, Englesakis M, et al. Selective Cannabinoids for Chronic Neuropathic Pain: A Systematic Review and Meta-analysis. Anesth Analg. 2017 [Epub ahead of print].
  71. Abrams DI. Integrating cannabis into clinical cancer care. Curr Oncol. 2016; 23(Supp. 2): S8–S14.
  72. Wrzosek A, Woron J, Dobrogowski J, et al. Topical clonidine for neuropathic pain. Cochrane Database Syst Rev. 2015; 8: CD010967.
  73. Eker HE, Cok OY, Aribogan A, et al. Management of neuropathic pain with methylprednisolone at the site of nerve injury. Pain Med. 2012; 13(3): 443–451.
  74. Bhatia A, Flamer D, Shah PS. Perineural steroids for trauma and compression-related peripheral neuropathic pain: a systematic review and meta-analysis. Can J Anaesth. 2015; 62(6): 650–662.
  75. Pellicane AJ, Millis SR. Efficacy of methylprednisolone versus other pharmacologic interventions for the treatment of central post-stroke pain: a retrospective analysis. J Pain Res. 2013; 6: 557–563.
  76. McCormick Z, Kennedy DJ, Garvan C, et al. Comparison of Pain Score Reduction Using Triamcinolone vs. Betamethasone in Transforaminal Epidural Steroid Injections for Lumbosacral Radicular Pain. Am J Phys Med Rehabil. 2015; 94(12): 1058–1064.

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