Pharmacological treatment of central neuropathic pain: consensus of the Brazilian Academy of Neurology
ABSTRACT 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...
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Thieme Revinter Publicações
2020-12-01
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| Series: | Arquivos de Neuro-Psiquiatria |
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| Online Access: | http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0004-282X2020001100741&tlng=en |
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| author | Rogério Adas Ayres de Oliveira Abrahão Fontes Baptista Katia Nunes Sá Luciana Mendonça Barbosa Osvaldo José Moreira do Nascimento Clarice Listik Xavier Moisset Manoel Jacobsen Teixeira Daniel Ciampi de Andrade |
| author_facet | Rogério Adas Ayres de Oliveira Abrahão Fontes Baptista Katia Nunes Sá Luciana Mendonça Barbosa Osvaldo José Moreira do Nascimento Clarice Listik Xavier Moisset Manoel Jacobsen Teixeira Daniel Ciampi de Andrade |
| author_sort | Rogério Adas Ayres de Oliveira |
| collection | DOAJ |
| description | ABSTRACT 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. |
| format | Article |
| id | doaj-art-4943114fa7ec4ee5badbce5e9874a8f8 |
| institution | OA Journals |
| issn | 1678-4227 |
| language | English |
| publishDate | 2020-12-01 |
| publisher | Thieme Revinter Publicações |
| record_format | Article |
| series | Arquivos de Neuro-Psiquiatria |
| spelling | doaj-art-4943114fa7ec4ee5badbce5e9874a8f82025-08-20T02:17:46ZengThieme Revinter PublicaçõesArquivos de Neuro-Psiquiatria1678-42272020-12-01781174175210.1590/0004-282x20200166Pharmacological treatment of central neuropathic pain: consensus of the Brazilian Academy of NeurologyRogério Adas Ayres de Oliveirahttps://orcid.org/0000-0002-0254-8497Abrahão Fontes Baptistahttps://orcid.org/0000-0001-7870-3820Katia Nunes Sáhttps://orcid.org/0000-0002-0255-4379Luciana Mendonça Barbosahttps://orcid.org/0000-0002-5239-5935Osvaldo José Moreira do Nascimentohttps://orcid.org/0000-0003-3516-485XClarice Listikhttps://orcid.org/0000-0002-7660-3970Xavier Moissethttps://orcid.org/0000-0002-8799-0750Manoel Jacobsen Teixeirahttps://orcid.org/0000-0002-7974-6045Daniel Ciampi de Andradehttps://orcid.org/0000-0003-3411-632XABSTRACT 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.http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0004-282X2020001100741&tlng=enPainPain managementNeuropathic painDrug therapyConsensus |
| spellingShingle | Rogério Adas Ayres de Oliveira Abrahão Fontes Baptista Katia Nunes Sá Luciana Mendonça Barbosa Osvaldo José Moreira do Nascimento Clarice Listik Xavier Moisset Manoel Jacobsen Teixeira Daniel Ciampi de Andrade Pharmacological treatment of central neuropathic pain: consensus of the Brazilian Academy of Neurology Arquivos de Neuro-Psiquiatria Pain Pain management Neuropathic pain Drug therapy Consensus |
| title | Pharmacological treatment of central neuropathic pain: consensus of the Brazilian Academy of Neurology |
| title_full | Pharmacological treatment of central neuropathic pain: consensus of the Brazilian Academy of Neurology |
| title_fullStr | Pharmacological treatment of central neuropathic pain: consensus of the Brazilian Academy of Neurology |
| title_full_unstemmed | Pharmacological treatment of central neuropathic pain: consensus of the Brazilian Academy of Neurology |
| title_short | Pharmacological treatment of central neuropathic pain: consensus of the Brazilian Academy of Neurology |
| title_sort | pharmacological treatment of central neuropathic pain consensus of the brazilian academy of neurology |
| topic | Pain Pain management Neuropathic pain Drug therapy Consensus |
| url | http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0004-282X2020001100741&tlng=en |
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