Publication details
Farmakoterapie neuropatické bolesti ve světle medicíny založené na důkazech
| Title in English | Pharmacotherapy of neuropathic pain as reflected by evidence-based medicine |
|---|---|
| Authors | |
| Year of publication | 2014 |
| Type | Article in Periodical |
| Magazine / Source | Bolest |
| MU Faculty or unit | |
| Citation | |
| Field | Neurology, neurosurgery, neurosciences |
| Keywords | Guideline; Neuropathic pain; Pharmacotherapy |
| Description | The Czech Clinical guideline for pharmacotherapy of neuropathic pain was published in 2012. It was created by a team of experts from the Czech neurological society in cooperation with those from the Czech pain society and other relevant societies. This guideline is in agreement with most important international guidelines. Recommendations are organised separately for most important clinical syndromes with neuropathic pain according to their etiology and treatment are stratified to the first, second and third choices. The characteristics of drugs recommended for the treatment of neuropathic pain, i.e., antidepresants, anticonvulsants, opioids, locally administered drugs and unregistered and off-label drugs are summarised. Increasing attention is paid to the management of neuropathic component of back pain in recent years. Back pain is probably the most frequent clinical syndrome accompanied with neuropathic pain, involving up to 6% of population. There is, however, a paucity of studies showing the evidence of the effect of pharmacotherapy on neuropathic compoment of back pain. There is some evidence on the effect of pregabalin, duloxetin, opioids a tricyclic antidepresants, especially regarding the combination of pregabalin and COX II inhibitors, pregabalin and opioids, paracetamol and opioids. Among new drugs, tapentadol with dual effect (opioid u receptor agonist and noradrenalin reuptake inhibitor) is mentioned as having the chance ti be implemented into the therapeutic algorithm of neuropathic pain. In 2011, three american societies published new guideline for the treatment of painful diabetic neuropathy, that interpreted the same studies as both EFNS (2010) and czech guideline, but came to slightly different recommendations. According to the american guideline, only pregabalin reached class A assessment of quality of evidence, while the effect of duloxetin, venlafaxin, amitriptylin, gabapentin, opioids, capsaicin (but not lidocain!), and surprisingly valproate were assessed as class B evidence. |