Pharmacologic management of chronic neuropathic pain: Review of the Canadian Pain Society consensus statement

Abstract

Objective: To provide family physicians with a practical clinical summary of the Canadian Pain Society (CPS) revised consensus statement on the pharmacologic management of neuropathic pain.

Quality of evidence: A multidisciplinary interest group within the CPS conducted a systematic review of the literature on the current treatments of neuropathic pain in drafting the revised consensus statement.

Main message: Gabapentinoids, tricyclic antidepressants, and serotonin-norepinephrine reuptake inhibitors are the first-line agents for treating neuropathic pain. Tramadol and other opioids are recommended as second-line agents, while cannabinoids are newly recommended as third-line agents. Other anticonvulsants, methadone, tapentadol, topical lidocaine, and botulinum toxin are recommended as fourth-line agents.

Conclusion: Many pharmacologic analgesics exist for the treatment of neuropathic pain. Through evidence-based recommendations, the CPS revised consensus statement helps guide family physicians in the management of patients with neuropathic pain.

Copyright© the College of Family Physicians of Canada.

Figures

Figure 1.

Algorithm for the pharmacologic management of neuropathic pain SNRI—serotonin-norepinephrine reuptake inhibitor, TCA—tricyclic antidepressant. *Fourth-line agents include topical lidocaine (second-line for postherpetic neuralgia), methadone, lamotrigine, lacosamide, tapentadol, and botulinum toxin. †There is limited randomized controlled trial evidence to support add-on combination therapy. Adapted from Moulin et al.