An evidence-based algorithm for the treatment of neuropathic pain

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MedGenMed. 2007 May 15;9(2):36.

An evidence-based algorithm for the treatment of neuropathic pain.

Finnerup NB, Otto M, Jensen TS, Sindrup SH.

Department of Neurology, Danish Pain Research Center, Aarhus

University Hospital, Aarhus, Denmark.

OBJECTIVE: The purpose of this article is to discuss an evidence-

based algorithm that can be implemented by the primary care

physician in his/her daily clinical practice for the treatment of

patients with neuropathic pain conditions.

METHOD: A treatment algorithm for neuropathic pain was formulated on

the basis of a review of 105 high-quality, randomized, placebo-

controlled clinical trials. The number needed to treat (NNT) and

number needed to harm (NNH) were used to compare the safety and

effectiveness of current treatments for neuropathic pain syndromes.

Most of the clinical trials reviewed in the analysis assessed

tricyclic antidepressants (TCAs) and antiepileptic drugs (AEDs).

RESULTS: TCAs had the lowest NNT followed by opioids and AEDs, such

as gabapentin and pregabalin. The nature of the retrospective

calculation of the NNT and NNH involves obvious limitations because

of the pooling of studies with different experimental designs and

outcomes.

CONCLUSION: Patients presenting with neuropathic pain are becoming a

more frequent occurrence for the primary care physician as the

population ages. Evidence-based treatment options allow for the most

efficient and effective pharmacotherapy regimen to be implemented.