Pain Medicine· 2019Q1· Review
A Comprehensive Algorithm for Management of Neuropathic Pain
- 404citations
- Q1SCImago
- 2019year
Short summary
A new algorithm integrates current guidelines and best practices for neuropathic pain management, recommending multidisciplinary conservative care and nonopioid medications as first-line therapy for primary physicians.
AI-generated from the title and abstract; the full text is not read.
Key points
- A treatment algorithm is proposed for neuropathic pain management, integrating assessment, conservative care, and pharmacological/interventional therapies.
- First-line therapy recommends multidisciplinary conservative care and nonopioid medications (tricyclic antidepressants, SNRIs, gabapentinoids, topicals).
- Subsequent lines of therapy include combination treatments, tramadol/tapentadol, SSRIs/anticonvulsants/NMDA antagonists, interventional therapies, neurostimulation, low-dose opioids (≤90 MME), and targeted drug delivery.
- The algorithm provides clear indicators for progression between therapy lines and serves as a visual guide for primary care practitioners.
AI-generated from the title and abstract; the full text is not read.
Abstract
BACKGROUND: The objective of this review was to merge current treatment guidelines and best practice recommendations for management of neuropathic pain into a comprehensive algorithm for primary physicians. The algorithm covers assessment, multidisciplinary conservative care, nonopioid pharmacological management, interventional therapies, neurostimulation, low-dose opioid treatment, and targeted drug delivery therapy. METHODS: Available literature was identified through a search of the US National Library of Medicine's Medline database, PubMed.gov. References from identified published articles also were reviewed for relevant citations. RESULTS: The algorithm provides a comprehensive treatment pathway from assessment to the provision of first- through sixth-line therapies for primary care physicians. Clear indicators for progression of therapy from firstline to sixth-line are provided. Multidisciplinary conservative care and nonopioid medications (tricyclic antidepressants, serotonin norepinephrine reuptake inhibitors, gabapentanoids, topicals, and transdermal substances) are recommended as firstline therapy; combination therapy (firstline medications) and tramadol and tapentadol are recommended as secondline; serotonin-specific reuptake inhibitors/anticonvulsants/NMDA antagonists and interventional therapies as third-line; neurostimulation as a fourth-line treatment; low-dose opioids (no greater than 90 morphine equivalent units) are fifth-line; and finally, targeted drug delivery is the last-line therapy for patients with refractory pain. CONCLUSIONS: The presented treatment algorithm provides clear-cut tools for the assessment and treatment of neuropathic pain based on international guidelines, published data, and best practice recommendations. It defines the benefits and limitations of the current treatments at our disposal. Additionally, it provides an easy-to-follow visual guide of the recommended steps in the algorithm for primary care and family practitioners to utilize.
The authors' abstract, as published at the source. Pain Medicine, 2019 · DOI ↗
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Field: Anesthesiology and Pain Medicine
Anesthesiology and Pain MedicineMedicine