Pain in Chronic Inflammatory Demyelinating Polyradiculoneuropathy: A Systematic Review and Meta-Analysis

Michaelides, Athena; Hadden, Robert D.M.; Sarrigiannis, Ptolemaios G.; Hadjivassiliou, Marios; Zis, Panagiotis

doi:10.1007/s40122-019-0128-y

Cited by 24 publications

(26 citation statements)

References 54 publications

(63 reference statements)

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“…There is low certainty evidence for treatment of pain in CIDP. The use of anti‐neuropathic pain drugs in CIDP is described in only a few small uncontrolled series 223,225 . This limited evidence does not suggest that treatment of neuropathic pain in CIDP should differ from other neuropathic pain conditions.…”

Section: Resultsmentioning

confidence: 99%

“…This limited evidence does not suggest that treatment of neuropathic pain in CIDP should differ from other neuropathic pain conditions. Immune treatment (mostly steroids and/or IVIg), although primarily given to treat motor and sensory deficit, also improved pain in 89% of 46 patients with painful CIDP in pooled uncontrolled small series reviewed by Michaelides et al 223 However, this evidence is very low certainty, and pain has not been investigated as an outcome in controlled trials demonstrating efficacy of immune treatments. The TF does not recommend using immune treatment primarily for treating pain.…”

Section: Resultsmentioning

confidence: 99%

See 1 more Smart Citation

European Academy of Neurology/Peripheral Nerve Society guideline on diagnosis and treatment of chronic inflammatory demyelinating polyradiculoneuropathy: Report of a joint Task Force—Second revision

Bergh

Doorn

Hadden

et al. 2021

J Peripheral Nervous Sys

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393

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

European Academy of Neurology/Peripheral Nerve Society guideline on diagnosis and treatment of chronic inflammatory demyelinating polyradiculoneuropathy: Report of a joint Task Force—Second revision

Bergh

Doorn

Hadden

et al. 2021

J Peripheral Nervous Sys

Self Cite

265

393

View full text Add to dashboard Cite

show abstract

“…This limited evidence does not suggest that treatment of neuropathic pain in CIDP should differ from other neuropathic pain conditions. Immune treatment (mostly steroids and/or IVIg), although primarily given to treat motor and sensory deficit, also improved pain in 89% of 46 patients with painful CIDP in pooled uncontrolled small series reviewed by Michaelides et al [223]. However, this evidence is very low certainty, and pain has not been investigated as an outcome in controlled trials demonstrating efficacy of immune treatments.…”

Section: Resultsmentioning

confidence: 99%

European Academy of Neurology/Peripheral Nerve Society guideline on diagnosis and treatment of chronic inflammatory demyelinating polyradiculoneuropathy: Report of a joint Task Force—Second revision

Bergh

Doorn

Hadden

et al. 2021

Euro J of Neurology

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214

282

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Objective To revise the 2010 consensus guideline on chronic inflammatory demyelinating polyradiculoneuropathy (CIDP). Methods Seventeen disease experts, a patient representative, and two Cochrane methodologists constructed 12 Population/Intervention/Comparison/Outcome (PICO) questions regarding diagnosis and treatment to guide the literature search. Data were extracted and summarized in GRADE summary of findings (for treatment PICOs) or evidence tables (for diagnostic PICOs). Results Statements were prepared according to the GRADE Evidence‐to‐Decision frameworks. Typical CIDP and CIDP variants were distinguished. The previous term “atypical CIDP” was replaced by “CIDP variants” because these are well characterized entities (multifocal, focal, distal, motor, or sensory CIDP). The levels of diagnostic certainty were reduced from three (definite, probable, possible CIDP) to only two (CIDP and possible CIDP), because the diagnostic accuracy of criteria for probable and definite CIDP did not significantly differ. Good Practice Points were formulated for supportive criteria and investigations to be considered to diagnose CIDP. The principal treatment recommendations were: (a) intravenous immunoglobulin (IVIg) or corticosteroids are strongly recommended as initial treatment in typical CIDP and CIDP variants; (b) plasma exchange is strongly recommended if IVIg and corticosteroids are ineffective; (c) IVIg should be considered as first‐line treatment in motor CIDP (Good Practice Point); (d) for maintenance treatment, IVIg, subcutaneous immunoglobulin or corticosteroids are recommended; (e) if the maintenance dose of any of these is high, consider either combination treatments or adding an immunosuppressant or immunomodulatory drug (Good Practice Point); and (f) if pain is present, consider drugs against neuropathic pain and multidisciplinary management (Good Practice Point).

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“…Peripheral neuropathic pain (PNP) is very prevalent, affecting up to two-thirds of patients with PN, independently of the aetiology [10][11][12]. It is one of the most-if not the mostburdensome of neuropathic symptoms, leading to an overall poor quality of life, regardless of disease severity [13,14].…”

Section: Introductionmentioning

confidence: 99%

Pharmacological Management of Painful Peripheral Neuropathies: A Systematic Review

et al. 2020

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Introduction: Peripheral neuropathic pain (PNP) arises either acutely or in the chronic phase of a lesion or disease of the peripheral nervous system and is associated with a notable disease burden. The management of PNP is often challenging. The aim of this systematic review was to evaluate current evidence, derived from randomized controlled trials (RCTs) that have assessed pharmacological interventions for the treatment of PNP due to polyneuropathy (PN). Methods: A systematic search of the PubMed database led to the identification of 538 papers, of which 457 were excluded due to not meeting the eligibility criteria, and two articles were identified through screening of the reference lists of the 81 eligible studies. Ultimately, 83 papers were included in this systematic review. Results: The best available evidence for the management of painful diabetic polyneuropathy (DPN) is for amitriptyline, duloxetine, gabapentin, pregabalin and venlafaxine as monotherapies and oxycodone as add-on therapy (level II of evidence). Tramadol appears to be effective when used as a monotherapy and add-on therapy in patients with PN of various etiologies (level II of evidence). Weaker evidence (level III) is available on the effectiveness of several other agents discussed in this review for the management of PNP due to PN. Discussion: Response to treatment may be affected by the underlying pathophysiological mechanisms that are involved in the pathogenesis of the PN and, therefore, it is very important to thoroughly investigate patients presenting with PNP to determine the causes of this neuropathy. Future RCTs should be conducted to shed more light on the use of pharmacological approaches in patients with other forms of PNP and to design specific treatment algorithms.

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Pain in Chronic Inflammatory Demyelinating Polyradiculoneuropathy: A Systematic Review and Meta-Analysis

Cited by 24 publications

References 54 publications

European Academy of Neurology/Peripheral Nerve Society guideline on diagnosis and treatment of chronic inflammatory demyelinating polyradiculoneuropathy: Report of a joint Task Force—Second revision

European Academy of Neurology/Peripheral Nerve Society guideline on diagnosis and treatment of chronic inflammatory demyelinating polyradiculoneuropathy: Report of a joint Task Force—Second revision

European Academy of Neurology/Peripheral Nerve Society guideline on diagnosis and treatment of chronic inflammatory demyelinating polyradiculoneuropathy: Report of a joint Task Force—Second revision

Pharmacological Management of Painful Peripheral Neuropathies: A Systematic Review

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