SUPPLEMENT ARTICLERecommendations for the Pharmacological Management of Neuropathic Pain: An Overview and Literature Update
Section snippets
GUIDELINES FOR THE PHARMACOLOGICAL MANAGEMENT OF NP
The NeuPSIG guidelines recommend medications as first-line treatment if efficacy in NP has been established in multiple RCTs (Oxford Centre for Evidence-based Medicine grade A recommendation18), and these results are consistent with the authors' clinical experience; as second-line if efficacy in NP has been established in multiple RCTs (grade A recommendation), but there were reservations about the use of the medication relative to the first-line medications based on the authors' clinical
RECENT CLINICAL TRIALS
In this section, we briefly discuss several recent RCTs that should be considered in future efforts to revise the treatment guidelines summarized herein. These studies do not represent a comprehensive update of recent NP trials but rather have been selected because they involve novel treatments or provocative issues.
NEGATIVE TRIALS OF PHARMACOLOGICAL TREATMENTS FOR NP AND THEIR INTERPRETATION
An increasing number of RCTs have failed to show significant differences in primary efficacy analyses comparing groups treated with a medication for NP and placebo, despite previous preclinical and clinical studies suggesting that efficacy would be expected.71, 72, 73, 74, 75, 76, 77 It is unclear whether these results reflect a true lack of efficacy in the specific conditions studied or whether other factors have accounted for the lack of success in demonstrating efficacy (eg, inadequate power
CONCLUSION
Diverse pharmacological treatments of NP have become available, and interpreting the data on their efficacy and safety involves substantial complexities and ambiguities. In updating the NeuPSIG pharmacological guidelines for the management of NP, a multifactorial evaluation will be required that carefully considers the clinical importance of the improvements shown by patients and the benefits and risks of each treatment in view of the other available treatments for NP95, 96, 97 (Table 3). In
Acknowledgments
We thank Paul J. Lambiase for coordinating the meeting on which this supplement is based.
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Support for the meeting on which this article is based and article preparation was provided by an unrestricted grant from Endo Pharmaceuticals to the University of Rochester Office of Continuing Professional Education, from which all authors received honoraria for their participation. Individual disclosures can be found on page S11.
Individual Disclosures for Authors: Dr Dworkin has received in the past 12 months research support from Arcion, Montel Williams Foundation, and NeurogesX and consulting fees from Allergan, Astellas, AstraZeneca, Boehringer Ingelheim, Durect, Eisai, Endo Pharmaceuticals, Epicept, Forest, Genzyme, Johnson & Johnson, Eli Lilly, Michael J. Fox Foundation for Parkinson's Research, NeurogesX, Nuvo, Pfizer, PainReform, Philips Respironics, Sanofi Aventis, Solace, Solvay, Spinifex, UCB Pharma, US Department of Veterans Affairs, US National Institutes of Health, Wyeth, and Xenon; Dr O'Connor has no financial arrangement or affiliation with a corporate organization or a manfacturer of a product discussed in this supplement; Dr Audette has served on the speakers' bureau for Allergan, Endo Pharmaceuticals, and Johnson & Johnson; Dr Baron has received grant/research support from Pfizer Pharma, Genzyme, and Grünenthal and has served on the speakers' bureau and as a consultant for Pfizer Pharma, Genzyme, Grünenthal, Mundipharma, Allergan, Sanofi Pasteur, Astellas, Eisai, Medtronic, USB, and Eli Lilly; Dr. Gourlay has no financial arrangement or affiliation with a corporate organization or a manfacturer of a product discussed in this supplement; Dr Haanpää has served as consultant for Boehringer Ingelheim, GlaxoSmithKline, Eli Lilly, Medtronic, MSD, Mundipharma, Orion, Pfizer, and Sanofi Pasteur and is a permanent assessor of EMEA; Dr Kent has received grant/research support from GlaxoSmithKline and has served on the speakers' bureau for Medtronic; Dr Krane has no financial arrangement or affiliation with a corporate organization or a manfacturer of a product discussed in this supplement; Dr LeBel has no financial arrangement or affiliation with a corporate organization or a manfacturer of a product discussed in this supplement; Dr Levy has received grant/research support from St. Jude Medical Neuromodulation, has served as a consultant for Bioness, Codman, Medtronic, St Jude Medical Neuromodulation, and Stryker; Dr Mackey has no financial arrangement or affiliation with a corporate organization or a manfacturer of a product discussed in this supplement; Dr Mayer has received grant/research support from Johnson & Johnson and is on the Clinical Advisory Board for Palladian Health; Dr Miaskowski has no financial arrangement or affiliation with a corporate organization or a manfacturer of a product discussed in this supplement; Dr Raja has received grant/research support from Allergan and Medtronic and served as a consultant for Allergan, Alpharma (King), Schering-Plough, and Solvay; Dr Rice has received grant/research support from Pfizer and Spinifex and has served as a consultant for Pfizer, Allergen, Astellas, Daiichi Sankyo, GlaxoSmithKline, NeurogesX, Spinifex, and Eisia; Dr Schmader has received grant/research support from Merck and Wyeth and has served as a consultant for Merck and GlaxoSmithKline; Dr Stacey has received grant/research support from AstraZeneca and has served as a consultant for GlaxoSmithKline, Boehringer Ingelheim, Boston Scientific, Eli Lilly, Niktar, QRX Pharma, Pfizer, AstraZeneca, and Xenon; Dr Stanos has received grant/research support from Ortho-McNeil; has served as a consultant for Abbott Labs, Eli Lilly, Endo Pharmaceuticals, King, and Ortho-McNeil; and is on the speakers' bureau for Endo Pharmaceuticals, Eli Lilly, Ortho-McNeil, Pfizer, King, and Forest; Dr Treede has received grant/research support from Kade and Boehringer Ingelheim and has served as a consultant for Grünenthal, UCB, AWD pharma, GmbH & Co, and Kade; Dr Turk has received grant/research support from Endo Pharmaceuticals, Johnson & Johnson, and Philips Respironics and has served as a consultant for Eli Lilly, Johnson & Johnson, Philips Respironics, and SK Lifescience; Dr Walco has served as a consultant for Neuromed, Pfizer, and Purdue Pharma; Dr Wells has served as a consultant for Prostrachan and is on the speakers' bureau for Grünenthal, Napp (Purdue in the United States), and Pfizer.