Evidence-based recommendations for the management of neuropathic pain (review of the literature)

Abstract

Objective: To synthesize, through a literature review, the current recommendations in the management of neuropathic pain. Methodology: Thematic review based on a highly sensitive literature search for the identification of clinical practice guidelines and systematic reviews, focused on diagnosis and management of neuropathic pain, from 2012 to 2017. From the included references, it was obtained information related to definitions, relevant considerations, indications and objectives of treatment, both pharmacological and non-pharmacological, as well as remission criteria. Results: We included 34 relevant clinical practice guidelines for the management of neuropathic pain. The synthesis of relevant aspects focused on: 1) the screening tools available for identification and classification of neuropathic pain; 2) diagnosis and follow-up of confirmation tests; 3) pain management principles, as well as pharmacological and non-pharmacological management as first, second and third line, according to the location of lesions; and 4) follow-up. The most commonly recommended first-line treatments include tricyclic antidepressants, α2δ-ligands (pregabalin and gabapentin), and selective serotonin / noradrenaline reuptake inhibitors. Conclusion: Neuropathic pain is a common condition in clinical practice, where the non-pain specialist will perform the diagnosis based on a detailed clinical history and directed physical exam. The treatment must be multidisciplinary and begin early with first-line drugs.