Clinical practice guidelines for management of neuropathic pain: Expert panel recommendations for South Africa
Neuropathic pain (NeuP) is challenging to diagnose and manage, despite ongoing improved understanding of the underlying mechanisms. Many patients do not respond satisfactorily to existing treatments. There are no published guidelines for diagnosis or management of NeuP in South Africa. A multidiscip...
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| Format: | Article |
| Language: | English |
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AOSIS
2013-04-01
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| Series: | South African Family Practice |
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| Online Access: | https://safpj.co.za/index.php/safpj/article/view/3794 |
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| author | S. Chetty E. Baalbergen A.I. Bhigjee K. Kamerman J. Ouma R. Raath M. Raff S. Salduker |
| author_facet | S. Chetty E. Baalbergen A.I. Bhigjee K. Kamerman J. Ouma R. Raath M. Raff S. Salduker |
| author_sort | S. Chetty |
| collection | DOAJ |
| description | Neuropathic pain (NeuP) is challenging to diagnose and manage, despite ongoing improved understanding of the underlying mechanisms. Many patients do not respond satisfactorily to existing treatments. There are no published guidelines for diagnosis or management of NeuP in South Africa. A multidisciplinary expert panel critically reviewed available evidence to provide consensus recommendations for diagnosis and management of NeuP in South Africa. Following accurate diagnosis of NeuP, pregabalin, gabapentin, low-dose tricyclic antidepressants (e.g. amitriptyline) and serotonin norepinephrine reuptake inhibitors (duloxetine and venlafaxine) are all recommended as first-line options for the treatment of peripheral NeuP. If the response is insufficient after 2 - 4 weeks, the recommended next step is to switch to a different class, or combine different classes of agent. Opioids should be reserved for use later in the treatment pathway, if switching drugs and combination therapy fails. For central NeuP, pregabalin or amitriptyline are recommended as first-line agents. Companion treatments (cognitive behavioural therapy and physical therapy) should be administered as part of a multidisciplinary approach. Dorsal root entry zone rhizotomy (DREZ) is not recommended to treat NeuP. Given the large population of HIV/AIDS patients in South Africa, and the paucity of positive efficacy data for its management, research in the form of randomised controlled trials in painful HIV-associated sensory neuropathy (HIV-SN) must be prioritised in this country. |
| format | Article |
| id | doaj-art-06c20fff109c4f05abb3d983c103ffcb |
| institution | Kabale University |
| issn | 2078-6190 2078-6204 |
| language | English |
| publishDate | 2013-04-01 |
| publisher | AOSIS |
| record_format | Article |
| series | South African Family Practice |
| spelling | doaj-art-06c20fff109c4f05abb3d983c103ffcb2025-08-20T04:03:13ZengAOSISSouth African Family Practice2078-61902078-62042013-04-0155210.1080/20786204.2013.108743234837Clinical practice guidelines for management of neuropathic pain: Expert panel recommendations for South AfricaS. Chetty0E. Baalbergen1A.I. Bhigjee2K. Kamerman3J. Ouma4R. Raath5M. Raff6S. Salduker7Department of Anaesthesiology, School of Clinical Medicine, Faculty of Health Sciences, University of the WitwatersrandLife Vincent Pallotti Rehabilitation UnitDepartment of Neurology, Nelson R Mandela School of Medicine, University of KwaZulu-NatalBrain Function Research Group, School of Physiology, University of the WitwatersrandDepartment of Neurosurgery, University of the WitwatersrandJacaranda HospitalChristiaan Barnard Memorial HospitalSt Augustines HospitalNeuropathic pain (NeuP) is challenging to diagnose and manage, despite ongoing improved understanding of the underlying mechanisms. Many patients do not respond satisfactorily to existing treatments. There are no published guidelines for diagnosis or management of NeuP in South Africa. A multidisciplinary expert panel critically reviewed available evidence to provide consensus recommendations for diagnosis and management of NeuP in South Africa. Following accurate diagnosis of NeuP, pregabalin, gabapentin, low-dose tricyclic antidepressants (e.g. amitriptyline) and serotonin norepinephrine reuptake inhibitors (duloxetine and venlafaxine) are all recommended as first-line options for the treatment of peripheral NeuP. If the response is insufficient after 2 - 4 weeks, the recommended next step is to switch to a different class, or combine different classes of agent. Opioids should be reserved for use later in the treatment pathway, if switching drugs and combination therapy fails. For central NeuP, pregabalin or amitriptyline are recommended as first-line agents. Companion treatments (cognitive behavioural therapy and physical therapy) should be administered as part of a multidisciplinary approach. Dorsal root entry zone rhizotomy (DREZ) is not recommended to treat NeuP. Given the large population of HIV/AIDS patients in South Africa, and the paucity of positive efficacy data for its management, research in the form of randomised controlled trials in painful HIV-associated sensory neuropathy (HIV-SN) must be prioritised in this country.https://safpj.co.za/index.php/safpj/article/view/3794neuropathic painmanagementclinical practice guidelines |
| spellingShingle | S. Chetty E. Baalbergen A.I. Bhigjee K. Kamerman J. Ouma R. Raath M. Raff S. Salduker Clinical practice guidelines for management of neuropathic pain: Expert panel recommendations for South Africa South African Family Practice neuropathic pain management clinical practice guidelines |
| title | Clinical practice guidelines for management of neuropathic pain: Expert panel recommendations for South Africa |
| title_full | Clinical practice guidelines for management of neuropathic pain: Expert panel recommendations for South Africa |
| title_fullStr | Clinical practice guidelines for management of neuropathic pain: Expert panel recommendations for South Africa |
| title_full_unstemmed | Clinical practice guidelines for management of neuropathic pain: Expert panel recommendations for South Africa |
| title_short | Clinical practice guidelines for management of neuropathic pain: Expert panel recommendations for South Africa |
| title_sort | clinical practice guidelines for management of neuropathic pain expert panel recommendations for south africa |
| topic | neuropathic pain management clinical practice guidelines |
| url | https://safpj.co.za/index.php/safpj/article/view/3794 |
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