Guideline “diagnosis and non interventional therapy of neuropathic pain” of the German Society of Neurology (deutsche Gesellschaft für Neurologie)

Abstract

2019 the DGN (Deutsche Gesellschaft für Neurology) published a new guideline on the diagnosis and non-interventional therapy of neuropathic pain of any etiology excluding trigeminal neuralgia and CRPS (complex regional pain syndrome). Neuropathic pain occurs after lesion or damage of the somatosensory system. Besides clinical examination several diagnostic procedures are recommended to assess the function of nociceptive A-delta and C-Fibers (skin biopsy, quantitative sensory testing, Laser-evoked potentials, Pain-evoked potentials, corneal confocal microscopy, axon reflex testing). First line treatment in neuropathic pain is pregabalin, gabapentin, duloxetine and amitriptyline. Second choice drugs are topical capsaicin and lidocaine, which can also be considered as primary treatment in focal neuropathic pain. Opioids are considered as third choice treatment. Botulinum toxin can be considered as a third choice drug for focal limited pain in specialized centers only. Carbamazepine and oxcarbazepine cannot be generally recommended, but might be helpful in single cases. In Germany, cannabinoids can be prescribed, but only after approval of reimbursement. However, the use is not recommended, and can only be considered as off-label therapy within a multimodal therapy concept.

Cannabis-Based Medicines and Medical Cannabis for Chronic Neuropathic Pain

“…Three groups (the Canadian Pain Society, the EFIC, the German Pain Society) recommended CbMs as a thirdline treatment option for chronic neuropathic pain [14,30,31]. The German Society of Neurology recommended only off-label use in conjunction with a multimodal treatment strategy [32]. The National Institute for Health Care Excellence (UK), French Society of Neurology and the IASP all recommended against the use of CbMs/MC, citing the lack of high-quality evidence [33][34][35].…”

“…In 2019, the German Society of Neurology published a new guideline on the diagnosis and non-interventional therapy for any aetiology neuropathic pain, but with the exclusion of trigeminal neuralgia and complex regional pain syndrome. Cannabinoids were not recommended and could only be considered as off-label therapy within a multimodal therapy concept [ 32 ].…”

Injuries after Forklift Trucks Accidents – Injury Patterns, Therapy and Outcome in the Context of the Statutory Accident Insurance

“…Limb amputations required in the course of inpatient stays were not designated as complications due to existing complex injuries and patient requests for initial attempts at limb preservation or in cases of prior subtotal amputation of the affected extremity without possibility of preservation. Late post-surgical infections [18,19], pseudarthroses [20], accompanying posttraumatic mental reactions [21] and chronic pain syndromes such as a complex regional pain syndrome (CRPS) [22], phantom pains and other neuropathic and nociceptive pain syndromes [23,24] were considered further forms of complications.…”

Spinale Ozontherapie

“…von neuropathischen Schmerzen (posttherapeutische Neuropathie, diabetische Polyneuropathie, posttraumatische Nervenschädigung, Phantomschmerz) und deren Mischformen (lumbo-oder zervikoradikuläre Schmerzen, posttraumatischer Schmerz; [10,11] [11]. Als noziplastische Schmerzen werden Schmerzen bezeichnet, die durch eine veränderte Nozizeption bedingt sind, jedoch ohne Nachweis einer bestehenden oder potenziellen Gewebeschädigung als Ursache einer Aktivierung peripherer Nozizeptoren und ohne Hinweise auf eine Erkrankung oder Schädigung des somatosensorischen Systems als Ursache der Schmerzen [12].…”