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Algorithm for neuropathic pain treatment: an evidence based proposal.

N B Finnerup1, M Otto, H J McQuay

  • 1Department of Neurology, Danish Pain Research Centre, Aarhus University Hospital, Aarhus Sygehus, Noerrebrogade 44, Aarhus 8000, Denmark Department of Neurology, Odense University Hospital, Sdr. Boulevard 29, Odense 5000, Denmark Pain Relief Unit, Churchill Hospital, Oxford OX3 7LJ, UK.

Pain
|October 11, 2005
PubMed
Summary
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This review of neuropathic pain treatments found tricyclic antidepressants most effective for peripheral pain. Numbers needed to treat (NNT) and harm (NNH) best assess drug efficacy and safety.

Area of Science:

  • Neurology
  • Pharmacology
  • Clinical Trials

Background:

  • Neuropathic pain management requires updated evidence-based treatment algorithms.
  • Randomized, double-blind, placebo-controlled trials are crucial for evaluating treatments.

Purpose of the Study:

  • To conduct an updated review of randomized controlled trials for neuropathic pain.
  • To compare the efficacy and safety of various treatments using Numbers Needed to Treat (NNT) and Numbers Needed to Harm (NNH).

Main Methods:

  • Systematic literature search of MEDLINE and EMBASE databases.
  • Inclusion of 105 randomized, double-blind, placebo-controlled trials.
  • Assessment of trial quality and calculation of NNT and NNH for treatment comparison.

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Main Results:

  • Tricyclic antidepressants, gabapentin, and pregabalin were frequently studied drug classes.
  • For peripheral neuropathic pain, tricyclic antidepressants showed the lowest NNT, followed by opioids, gabapentin, and pregabalin.
  • Limited data exists for central neuropathic pain treatments.

Conclusions:

  • NNT and NNH are optimal metrics for assessing relative treatment efficacy and safety in neuropathic pain.
  • Limitations include the need for dichotomous data and methodological complexities in pooling trial results.