TY - JOUR
T1 - Pharmacological treatment of central neuropathic pain
T2 - consensus of the Brazilian Academy of Neurology
AU - Oliveira, Rogério Adas Ayres de
AU - Baptista, Abrahão Fontes
AU - Sá, Katia Nunes
AU - Barbosa, Luciana Mendonça
AU - Nascimento, Osvaldo José Moreira do
AU - Listik, Clarice
AU - Moisset, Xavier
AU - Teixeira, Manoel Jacobsen
AU - Andrade, Daniel Ciampi de
AU - Clinicians participants of the panel of experts recommended by the Brazilian Academy of Neurology
PY - 2020
Y1 - 2020
N2 - BACKGROUND: Central neuropathic pain (CNP) is often refractory to available therapeutic strategies and there are few evidence-based treatment options. Many patients with neuropathic pain are not diagnosed or treated properly. Thus, consensus-based recommendations, adapted to the available drugs in the country, are necessary to guide clinical decisions.OBJECTIVE: To develop recommendations for the treatment of CNP in Brazil.METHODS: Systematic review, meta-analysis, and specialists opinions considering efficacy, adverse events profile, cost, and drug availability in public health.RESULTS: Forty-four studies on CNP treatment were found, 20 were included in the qualitative analysis, and 15 in the quantitative analysis. Medications were classified as first-, second-, and third-line treatment based on systematic review, meta-analysis, and expert opinion. As first-line treatment, gabapentin, duloxetine, and tricyclic antidepressants were included. As second-line, venlafaxine, pregabalin for CND secondary to spinal cord injury, lamotrigine for CNP after stroke, and, in association with first-line drugs, weak opioids, in particular tramadol. For refractory patients, strong opioids (methadone and oxycodone), cannabidiol/delta-9-tetrahydrocannabinol, were classified as third-line of treatment, in combination with first or second-line drugs and, for central nervous system (CNS) in multiple sclerosis, dronabinol.CONCLUSIONS: Studies that address the treatment of CNS are scarce and heterogeneous, and a significant part of the recommendations is based on experts opinions. The CNP approach must be individualized, taking into account the availability of medication, the profile of adverse effects, including addiction risk, and patients' comorbidities.
AB - BACKGROUND: Central neuropathic pain (CNP) is often refractory to available therapeutic strategies and there are few evidence-based treatment options. Many patients with neuropathic pain are not diagnosed or treated properly. Thus, consensus-based recommendations, adapted to the available drugs in the country, are necessary to guide clinical decisions.OBJECTIVE: To develop recommendations for the treatment of CNP in Brazil.METHODS: Systematic review, meta-analysis, and specialists opinions considering efficacy, adverse events profile, cost, and drug availability in public health.RESULTS: Forty-four studies on CNP treatment were found, 20 were included in the qualitative analysis, and 15 in the quantitative analysis. Medications were classified as first-, second-, and third-line treatment based on systematic review, meta-analysis, and expert opinion. As first-line treatment, gabapentin, duloxetine, and tricyclic antidepressants were included. As second-line, venlafaxine, pregabalin for CND secondary to spinal cord injury, lamotrigine for CNP after stroke, and, in association with first-line drugs, weak opioids, in particular tramadol. For refractory patients, strong opioids (methadone and oxycodone), cannabidiol/delta-9-tetrahydrocannabinol, were classified as third-line of treatment, in combination with first or second-line drugs and, for central nervous system (CNS) in multiple sclerosis, dronabinol.CONCLUSIONS: Studies that address the treatment of CNS are scarce and heterogeneous, and a significant part of the recommendations is based on experts opinions. The CNP approach must be individualized, taking into account the availability of medication, the profile of adverse effects, including addiction risk, and patients' comorbidities.
KW - Analgesics, Opioid
KW - Brazil
KW - Consensus
KW - Humans
KW - Neuralgia/drug therapy
KW - Neurology
U2 - 10.1590/0004-282X20200166
DO - 10.1590/0004-282X20200166
M3 - Journal article
C2 - 33331468
SN - 0004-282X
VL - 78
SP - 741
EP - 752
JO - Arquivos de neuro-psiquiatria
JF - Arquivos de neuro-psiquiatria
IS - 11
ER -