Treating Neuropathic Pain: A Review of Pharmacotherapy and Non-Invasive Neuromodulation
- FHS Communications, Peter Kamerman
Neuropathic pain, a type of chronic pain caused by nerve damage, can be very hard to treat and affects millions of people worldwide.
This study looked at over 300 clinical trials to find out which medicines and non-invasive treatments work best and are safest. The researchers compared how well different drugs and techniques reduced pain and how often they caused side effects. Based on the results, the researchers aimed to update the treatment guidelines to help doctors choose the most effective and safest options. The study also highlights the need for more research, especially on newer treatments and combinations, to better support people living with this challenging condition.
Study overview
This study is a large-scale review and analysis of treatments for neuropathic pain. Researchers examined 313 high-quality clinical trials involving nearly 49,000 adults with neuropathic pain to evaluate how well different medications and non-invasive brain stimulation techniques work, and how safe they are.
Key findings
The researchers concluded that tricyclic antidepressants (TCAs), serotonin-norepinephrine reuptake inhibitors (SNRIs), and α2δ-ligands (like gabapentin and pregabalin) remain the most effective and safest first-line treatments. Topical treatments such as capsaicin patches, capsaicin cream, and lidocaine plasters are recommended as second-line options, especially for localized pain and in patients who may not tolerate systemic drugs. Third-line treatments include botulinum toxin type A, opioids, and repetitive transcranial magnetic stimulation (rTMS), though these come with more uncertainty or risk. The study also found limited or no benefit from cannabinoids and several other drugs and emphasised that their overall treatment effects are modest. These findings informed revised international guidelines that stress the importance of shared decision-making, patient preferences, and careful consideration of treatment risks, costs, and accessibility.
Original Article In: Lancet Neurology