Global Review Highlights Optimal Treatments for Neuropathic Pain

A comprehensive international study has provided the most thorough evaluation to date of therapeutic options for neuropathic pain—a chronic condition caused by nervous system damage that affects up to 10% of the global population. Neuropathic pain is associated with conditions such as diabetic peripheral neuropathy, postherpetic neuralgia, and nerve pain induced by chemotherapy, all of which significantly impair quality of life and impose substantial social and economic burdens.

Michael Ferraro, a doctoral researcher affiliated with Neuroscience Research Australia, the Center for Pain IMPACT, and the School of Health Sciences at UNSW, contributed to the investigation conducted by the International Association for the Study of Pain Neuropathic Pain Special Interest Group. He emphasized that despite numerous available treatments, effective and safe options remain limited, underscoring the necessity for updated, evidence-based guidelines.

The systematic review and meta-analysis, published in The Lancet Neurology, incorporated data from 313 randomized controlled trials encompassing nearly 50,000 adult participants. The evaluation covered both pharmacological therapies and nerve stimulation techniques, aiming to refine treatment protocols based on effectiveness, safety, cost, accessibility, and patient preferences.

Key findings include recommendations for first-, second-, and third-line treatments. For initial therapy, three medication classes are advised: alpha-2 delta ligands (e.g., pregabalin, gabapentin), serotonin and norepinephrine reuptake inhibitors (e.g., duloxetine), and tricyclic antidepressants (e.g., amitriptyline). However, these drugs offer only modest benefits and require careful patient selection and monitoring. As second-line options, capsaicin and lidocaine patches and capsaicin cream are recommended due to their safety and tolerability, making them suitable for older adults and those on multiple medications.

The review also introduced noninvasive brain stimulation, specifically repetitive transcranial magnetic stimulation, as a treatment option in selected patients. Conversely, evidence was inconclusive or against the use of certain therapies, including selective serotonin reuptake inhibitors like escitalopram, NMDA receptor antagonists such as ketamine, and implanted spinal cord stimulation. Cannabis-based products were also found to be ineffective and are not recommended.

Importantly, the guidelines emphasize a patient-centered approach, recognizing that neuropathic pain manifests differently among individuals. Treatment decisions should consider efficacy, safety, patient values, and any comorbid conditions or concurrent medication use. These recommendations serve as a resource for a broad spectrum of healthcare professionals, including physicians in both primary and specialized care settings.

Future updates to these guidelines may incorporate non-drug, non-surgical interventions, such as exercise, although current high-quality evidence in this area remains lacking. Overall, this research aims to optimize treatment strategies for neuropathic pain, reducing its burden and improving patient outcomes.

Source: https://medicalxpress.com/news/2025-04-global-treatments-neuropathic-pain.html