Consensus Guidelines: Treatment Planning and Options

Argoff, Charles E.; Backonja, M.; Belgrade, Miles; Bennett, Gary J.; Clark, Michael R.; Cole, Brandly; Fishbain, David A.; Irving, Gordon; McCarberg, Bill; McLean, Michael J.

doi:10.1016/s0025-6196(11)61475-4

Cited by 127 publications

(97 citation statements)

References 49 publications

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“…Central sensitization of intact nociceptors that share innervation networks with injured nerves can result in ongoing pain and hyperalgesia (27). Because of the potentially severe and multifactorial nature of neuropathic pain associated with DPN, patients may require treatment with multiple agents with complementary mechanisms of action (28,29). Although combination therapies are used for the management of neuropathic pain, the combination of two or more medications may burden patients with multiple side effects.…”

Section: Discussionmentioning

confidence: 99%

A Randomized Withdrawal, Placebo-Controlled Study Evaluating the Efficacy and Tolerability of Tapentadol Extended Release in Patients With Chronic Painful Diabetic Peripheral Neuropathy

Vinik¹,

et al. 2014

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OBJECTIVEThis study evaluated the efficacy and tolerability of tapentadol extended release (ER) for the management of chronic pain associated with diabetic peripheral neuropathy (DPN). RESEARCH DESIGN AND METHODSAdults with moderate to severe DPN pain were titrated to tapentadol ER 100-250 mg bid during a 3-week open-label period; patients with ‡1-point reduction in pain intensity (11-point numerical rating scale) at end of titration were randomized to receive placebo or tapentadol ER (optimal dose from titration) for 12 weeks (double-blind, fixed-dose maintenance phase). The primary end point was mean change in average pain intensity from the start to week 12 (last observation carried forward [LOCF]) of the double-blind maintenance phase. RESULTSA total of 358 patients completed the titration period; 318 patients (placebo, n = 152; tapentadol ER, n = 166) were randomized and received one or more doses of double-blind study medication. Mean (SD) pain intensity (observed case) was 7.33 (1.30) at the start and 4.16 (2.12) at week 3 of the open-label titration period (mean [SD] change, -3.22 [1.97]). The mean (SD) change in pain intensity (LOCF) from start of double-blind treatment to week 12 was as follows: placebo, 1.30 (2.43); tapentadol ER, 0.28 (2.04; least squares mean difference, -0.95 [95% CI -1.42 to -0.49]; P < 0.001). Treatment-emergent adverse events ( ‡10%) in the tapentadol ER group during the double-blind maintenance phase were nausea (21.1%) and vomiting (12.7%). CONCLUSIONSTapentadol ER (100-250 mg bid) was effective and well tolerated for the management of moderate to severe chronic pain associated with DPN.

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Section: Discussionmentioning

confidence: 99%

A Randomized Withdrawal, Placebo-Controlled Study Evaluating the Efficacy and Tolerability of Tapentadol Extended Release in Patients With Chronic Painful Diabetic Peripheral Neuropathy

Vinik¹,

et al. 2014

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“…Показаны эффе-ктивность и безопасность прегабалина, который достовер-но по сравнению с плацебо уменьшал выраженность боле-вого синдрома, а также сопутствующих нарушений сна и тревоги [39]. Благодаря уникальному механизму действия и выраженному противоболевому эффекту, а также нали-чию обширной доказательной базы прегабалин получил широкое распространение в клинической практике и во-шел в ряд международных и российских рекомендаций по лечению невропатической боли в качестве препарата пер-вой линии [40][41][42][43].…”

Section: в статье изложены современные представления о механизмах разunclassified

Current views of the development of pain syndrome mechanisms in patients with osteoarthrosis. Rational pharmacotherapy

Иголкина¹

2014

RJTAO

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“…The aim of rational polypharmacy should be focused at decreasing toxicity and drug interactions, addressing treatment failures and taking advantage of complementary mechanisms of actions for additive benefit. 20,21 There have been various small to large studies assessing the efficacy of monotherapy vs. combination therapy with drugs of different class. In a randomized trial of 57 patients with PDNP and PHN, combining gabapentin with morphine demonstrated small but significantly superior benefits versus gabapentin and morphine alone.…”

Section: Rational Polypharmacy: Choosing Combinationsmentioning

confidence: 99%

“…The NNT for gabapentin/pregabalin was 4.7 (4.0 -5.6); for opioid, 2.5 (2.0-3.2) and for tramadol, 3.9 (2.7-6.7). The NNH for TCAs was 14.7 (10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25), for gabapentin/pregabalin, 17.8 (12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30), for opioid, 17.1 (10-66) and for tramadol, 9 (6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18). If analgesia is the only criterion for selection, then the chronology of preference would probably be TCAs> opioids ≥ tramadol ≥ gabapentin/pregabalin.…”

Section: What To Choose and When?mentioning

confidence: 99%

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Evidence-based pharmacological management of chronic neuropathic pain

Ansari

2013

Int J Basic Clin Pharmacol

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Neuropathic pain (NP) is a chronic, debilitating symptomatology of lesions/injuries of the central and peripheral nervous system. As per pooled estimates, the prevalence is 7-8% in the general population; however, the prevalence varies with different neuropathic conditions. The aetiology can range from peripheral neuropathic conditions viz. peripheral diabetic neuropathic pain (PDNP), post-herpetic neuralgia (PHN), trigeminal neuralgia, HIV-associated polyneuropathy, cervical radiculopathy to central neuropathic conditions, viz. central post-stroke pain, spinal cord injury and the neuropathic pain associated with multiple sclerosis. Apart from the symptomatic perception of pain, neuropathic pain affects the cognitive and emotional aspects of the affected individual. The pain, being debilitating and resistant to over-the-counter analgesics, diminishes the quality of life, disrupts sleep and leads to psychiatric complications such as comorbid anxiety and depression. The management is palliative and involves drugs, psychological intervention, stimulations and nerve-blocking techniques. This review concentrates on the pharmacological therapeutic options available and focuses on the selection of the agent/s in accordance with the evidence. The first-line treatment includes the tricyclic antidepressants ([TCAs]; amitriptyline, nortriptyline), selective serotonin norepinephrine inhibitors ([SNRIs]; duloxetine, venlafaxine), calcium channel alpha 2 -delta ligands (pregabalin, gabapentin), carbamazepine and oxcarbazepine. Lidocaine plasters are first-line options for specific focal conditions such as post-herpetic neuralgia. The second-line therapy includes the opioid analgesics and tramadol. The choice of drug selection should complement the patient's age, type of neuropathic condition, tolerability to an agent, comorbid condition and cost-effectiveness. Management must be individualized with a realistic and composite goal of making the pain tolerable and improving the cognitive and emotional well-being.

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Consensus Guidelines: Treatment Planning and Options

Cited by 127 publications

References 49 publications

A Randomized Withdrawal, Placebo-Controlled Study Evaluating the Efficacy and Tolerability of Tapentadol Extended Release in Patients With Chronic Painful Diabetic Peripheral Neuropathy

A Randomized Withdrawal, Placebo-Controlled Study Evaluating the Efficacy and Tolerability of Tapentadol Extended Release in Patients With Chronic Painful Diabetic Peripheral Neuropathy

Current views of the development of pain syndrome mechanisms in patients with osteoarthrosis. Rational pharmacotherapy

Evidence-based pharmacological management of chronic neuropathic pain

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