2010 EFNS神经病理性疼痛的药物治疗指南（2010修订版）

Background and objectives: This second European Federation of Neurological Societies Task Force aimed at updating the existing evidence about the pharmacologicaltreatment of neuropathic pain since 2005.Methods: Studies were identified using the Cochrane Database and Medline. Trialswere classified according to the aetiological condition. All class I and II randomizedcontrolled trials (RCTs) were assessed; lower class studies were considered only inconditions that had no top-level studies. Treatments administered using repeated orsingle administrations were considered, provided they are feasible in an outpatientsetting.Results: Most large RCTs included patients with diabetic polyneuropathies and postherpeticneuralgia, while an increasing number of smaller studies explored otherconditions. Drugs generally have similar efficacy in various conditions, except in trigeminalneuralgia, chronic radiculopathy and HIV neuropathy, with level A evidencein support of tricyclic antidepressants (TCA), pregabalin, gabapentin, tramadol andopioids (in various conditions), duloxetine, venlafaxine, topical lidocaine and capsaicinpatches (in restricted conditions). Combination therapy appears useful for TCAgabapentinand gabapentin-opioids (level A).Conclusions: There are still too few large-scale comparative studies. For future trials,we recommend to assess comorbidities, quality of life, symptoms and signs withstandardized tools and attempt to better define responder profiles to specific drugtreatments