A Randomized Placebo-Controlled Trial of Duloxetine for Central Pain in Multiple Sclerosis

Brown, Theodore R.; Slee, April

doi:10.7224/1537-2073.2014-001

Cited by 22 publications

(16 citation statements)

References 22 publications

(19 reference statements)

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“…They facilitate descending inhibition by blocking serotonin and noradrenaline reuptake [3,9]. They have been shown to be effective in peripheral diabetic neuropathy, painful peripheral neuropathy [8,13], and more recently in central neuropathic pain secondary to multiple sclerosis [50]. However, venlafaxine is not effective in post-herpetic neuralgia [13].…”

Section: Resultsmentioning

confidence: 99%

A Comprehensive Algorithm for Management of Neuropathic Pain

Bates

Schultheis

Hanes³

et al. 2019

Pain Medicine

265

208

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Background The objective of this review was to merge current treatment guidelines and best practice recommendations for management of neuropathic pain into a comprehensive algorithm for primary physicians. The algorithm covers assessment, multidisciplinary conservative care, nonopioid pharmacological management, interventional therapies, neurostimulation, low-dose opioid treatment, and targeted drug delivery therapy. Methods Available literature was identified through a search of the US National Library of Medicine’s Medline database, PubMed.gov. References from identified published articles also were reviewed for relevant citations. Results The algorithm provides a comprehensive treatment pathway from assessment to the provision of first- through sixth-line therapies for primary care physicians. Clear indicators for progression of therapy from firstline to sixth-line are provided. Multidisciplinary conservative care and nonopioid medications (tricyclic antidepressants, serotonin norepinephrine reuptake inhibitors, gabapentanoids, topicals, and transdermal substances) are recommended as firstline therapy; combination therapy (firstline medications) and tramadol and tapentadol are recommended as secondline; serotonin-specific reuptake inhibitors/anticonvulsants/NMDA antagonists and interventional therapies as third-line; neurostimulation as a fourth-line treatment; low-dose opioids (no greater than 90 morphine equivalent units) are fifth-line; and finally, targeted drug delivery is the last-line therapy for patients with refractory pain. Conclusions The presented treatment algorithm provides clear-cut tools for the assessment and treatment of neuropathic pain based on international guidelines, published data, and best practice recommendations. It defines the benefits and limitations of the current treatments at our disposal. Additionally, it provides an easy-to-follow visual guide of the recommended steps in the algorithm for primary care and family practitioners to utilize.

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Section: Resultsmentioning

confidence: 99%

A Comprehensive Algorithm for Management of Neuropathic Pain

Bates

Schultheis

Hanes³

et al. 2019

Pain Medicine

265

208

View full text Add to dashboard Cite

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“…Its safety has been confirmed in a 52-week study [ 34 ]. Further, it was shown that duloxetine improved central neuropathic pain compared to placebo in patients with multiple sclerosiss [ 35 ]. Duloxetine is approved in Japan for not only painful diabetic polyneuropathy and other chronic pain condition (i.e., osteoarthritis, chronic low back pain, and fibromyalgia), but also major depression.…”

Section: Introductionmentioning

confidence: 99%

Executive summary of the Clinical Guidelines of Pharmacotherapy for Neuropathic Pain: second edition by the Japanese Society of Pain Clinicians

et al. 2018

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Neuropathic pain has a substantial effect on quality of life (QOL). The Japanese Society of Pain Clinicians (JSPC) has developed clinical guidelines of pharmacotherapy for neuropathic pain. These guidelines offer clarity on recommendations based on both the most recent scientific evidence and expert opinions. Understanding the concept, disease entity, and burden of neuropathic pain, as well as its screening and diagnosis are important steps before starting pharmacotherapy. As well as other guidelines, the guidelines propose several lines of pharmacotherapies in a step-wise manner. To name a few different points, our guidelines propose an extract from inflamed cutaneous tissue of rabbits inoculated with vaccinia virus, which has been found to be effective for post-herpetic neuralgia in Japan, as one of the second-line drugs. When prescribing opioid analgesics, proposed as the third-line drugs, for neuropathic pain, the guidelines recommend physicians continue evaluations on either abuse or addiction. The guidelines do not recommend concomitant use of nonsteroidal anti-inflammatory drugs and acetaminophen because of lack of clinical evidence of their efficacy. If patients do not respond well to pharmacotherapy, which is prescribed in a step-wise manner, other treatment strategies should be considered to improve patients’ activities of daily living and QOL.

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“…The study by Leijon et al (1989) 19 was also excluded from the quantitative synthesis as, in addition to having presented mean and standard deviations as central tendency and dispersion measures, the statistical analysis was performed with non-parametric tests, making these measures inappropriate. The 20 studies included pharmacological agents employed in the treatment of central pain in multiple sclerosis 20,21,22,23,24,25,26,27,28 , spinal cord injury 16,22,27,29,30 , stroke 15,[20][21][22]31 , and brachial plexus injury with avulsion 32 . They used as pharmacological agents pregabalin 20,21,22,31 , gabapentin 29 , duloxetine 26,27,30 , amitriptyline 19 , combinations of cannabidiol/delta-9-tetrahydrocannabinol (CBD/THC) 14, 24,32,33 , lamotrigine 14,15,24 , levetiracetam 15 , carbamazepine 19 , dronabinol 28 , and valproate 16 .…”

Section: Systematic Review Of the Literature And Formulation Of The Fmentioning

confidence: 99%

Pharmacological treatment of central neuropathic pain: consensus of the Brazilian Academy of Neurology

Oliveira

Baptista

Sá

et al. 2020

Arq. Neuro-Psiquiatr.

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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.

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A Randomized Placebo-Controlled Trial of Duloxetine for Central Pain in Multiple Sclerosis

Abstract: Background: Pain is common in multiple sclerosis (MS). Duloxetine has a potential therapeutic role in treating MS-related pain.

Cited by 22 publications

References 22 publications

A Comprehensive Algorithm for Management of Neuropathic Pain

A Comprehensive Algorithm for Management of Neuropathic Pain

Executive summary of the Clinical Guidelines of Pharmacotherapy for Neuropathic Pain: second edition by the Japanese Society of Pain Clinicians

Pharmacological treatment of central neuropathic pain: consensus of the Brazilian Academy of Neurology

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