Pharmacological treatment of central neuropathic pain: consensus of the Brazilian Academy of Neurology

Detalhes bibliográficos
Autor(a) principal: Oliveira,Rogério Adas Ayres de
Data de Publicação: 2020
Outros Autores: Baptista,Abrahão Fontes, Sá,Katia Nunes, Barbosa,Luciana Mendonça, Nascimento,Osvaldo José Moreira do, Listik,Clarice, Moisset,Xavier, Teixeira,Manoel Jacobsen, Andrade,Daniel Ciampi de
Tipo de documento: Artigo
Idioma: eng
Título da fonte: Arquivos de neuro-psiquiatria (Online)
Texto Completo: http://old.scielo.br/scielo.php?script=sci_arttext&pid=S0004-282X2020001100741
Resumo: ABSTRACT Background: Central neuropathic pain (CNP) is often refractory to available therapeutic strategies and there are few evidence-based treatment options. Many patients with neuropathic pain are not diagnosed or treated properly. Thus, consensus-based recommendations, adapted to the available drugs in the country, are necessary to guide clinical decisions. Objective: To develop recommendations for the treatment of CNP in Brazil. Methods: Systematic review, meta-analysis, and specialists opinions considering efficacy, adverse events profile, cost, and drug availability in public health. Results: Forty-four studies on CNP treatment were found, 20 were included in the qualitative analysis, and 15 in the quantitative analysis. Medications were classified as first-, second-, and third-line treatment based on systematic review, meta-analysis, and expert opinion. As first-line treatment, gabapentin, duloxetine, and tricyclic antidepressants were included. As second-line, venlafaxine, pregabalin for CND secondary to spinal cord injury, lamotrigine for CNP after stroke, and, in association with first-line drugs, weak opioids, in particular tramadol. For refractory patients, strong opioids (methadone and oxycodone), cannabidiol/delta-9-tetrahydrocannabinol, were classified as third-line of treatment, in combination with first or second-line drugs and, for central nervous system (CNS) in multiple sclerosis, dronabinol. Conclusions: Studies that address the treatment of CNS are scarce and heterogeneous, and a significant part of the recommendations is based on experts opinions. The CNP approach must be individualized, taking into account the availability of medication, the profile of adverse effects, including addiction risk, and patients' comorbidities.
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spelling Pharmacological treatment of central neuropathic pain: consensus of the Brazilian Academy of NeurologyPainPain managementNeuropathic painDrug therapyConsensusABSTRACT Background: Central neuropathic pain (CNP) is often refractory to available therapeutic strategies and there are few evidence-based treatment options. Many patients with neuropathic pain are not diagnosed or treated properly. Thus, consensus-based recommendations, adapted to the available drugs in the country, are necessary to guide clinical decisions. Objective: To develop recommendations for the treatment of CNP in Brazil. Methods: Systematic review, meta-analysis, and specialists opinions considering efficacy, adverse events profile, cost, and drug availability in public health. Results: Forty-four studies on CNP treatment were found, 20 were included in the qualitative analysis, and 15 in the quantitative analysis. Medications were classified as first-, second-, and third-line treatment based on systematic review, meta-analysis, and expert opinion. As first-line treatment, gabapentin, duloxetine, and tricyclic antidepressants were included. As second-line, venlafaxine, pregabalin for CND secondary to spinal cord injury, lamotrigine for CNP after stroke, and, in association with first-line drugs, weak opioids, in particular tramadol. For refractory patients, strong opioids (methadone and oxycodone), cannabidiol/delta-9-tetrahydrocannabinol, were classified as third-line of treatment, in combination with first or second-line drugs and, for central nervous system (CNS) in multiple sclerosis, dronabinol. Conclusions: Studies that address the treatment of CNS are scarce and heterogeneous, and a significant part of the recommendations is based on experts opinions. The CNP approach must be individualized, taking into account the availability of medication, the profile of adverse effects, including addiction risk, and patients' comorbidities.Academia Brasileira de Neurologia - ABNEURO2020-11-01info:eu-repo/semantics/articleinfo:eu-repo/semantics/publishedVersiontext/htmlhttp://old.scielo.br/scielo.php?script=sci_arttext&pid=S0004-282X2020001100741Arquivos de Neuro-Psiquiatria v.78 n.11 2020reponame:Arquivos de neuro-psiquiatria (Online)instname:Academia Brasileira de Neurologiainstacron:ABNEURO10.1590/0004-282x20200166info:eu-repo/semantics/openAccessOliveira,Rogério Adas Ayres deBaptista,Abrahão FontesSá,Katia NunesBarbosa,Luciana MendonçaNascimento,Osvaldo José Moreira doListik,ClariceMoisset,XavierTeixeira,Manoel JacobsenAndrade,Daniel Ciampi deeng2020-12-16T00:00:00Zoai:scielo:S0004-282X2020001100741Revistahttp://www.scielo.br/anphttps://old.scielo.br/oai/scielo-oai.php||revista.arquivos@abneuro.org1678-42270004-282Xopendoar:2020-12-16T00:00Arquivos de neuro-psiquiatria (Online) - Academia Brasileira de Neurologiafalse
dc.title.none.fl_str_mv Pharmacological treatment of central neuropathic pain: consensus of the Brazilian Academy of Neurology
title Pharmacological treatment of central neuropathic pain: consensus of the Brazilian Academy of Neurology
spellingShingle Pharmacological treatment of central neuropathic pain: consensus of the Brazilian Academy of Neurology
Oliveira,Rogério Adas Ayres de
Pain
Pain management
Neuropathic pain
Drug therapy
Consensus
title_short Pharmacological treatment of central neuropathic pain: consensus of the Brazilian Academy of Neurology
title_full Pharmacological treatment of central neuropathic pain: consensus of the Brazilian Academy of Neurology
title_fullStr Pharmacological treatment of central neuropathic pain: consensus of the Brazilian Academy of Neurology
title_full_unstemmed Pharmacological treatment of central neuropathic pain: consensus of the Brazilian Academy of Neurology
title_sort Pharmacological treatment of central neuropathic pain: consensus of the Brazilian Academy of Neurology
author Oliveira,Rogério Adas Ayres de
author_facet Oliveira,Rogério Adas Ayres de
Baptista,Abrahão Fontes
Sá,Katia Nunes
Barbosa,Luciana Mendonça
Nascimento,Osvaldo José Moreira do
Listik,Clarice
Moisset,Xavier
Teixeira,Manoel Jacobsen
Andrade,Daniel Ciampi de
author_role author
author2 Baptista,Abrahão Fontes
Sá,Katia Nunes
Barbosa,Luciana Mendonça
Nascimento,Osvaldo José Moreira do
Listik,Clarice
Moisset,Xavier
Teixeira,Manoel Jacobsen
Andrade,Daniel Ciampi de
author2_role author
author
author
author
author
author
author
author
dc.contributor.author.fl_str_mv Oliveira,Rogério Adas Ayres de
Baptista,Abrahão Fontes
Sá,Katia Nunes
Barbosa,Luciana Mendonça
Nascimento,Osvaldo José Moreira do
Listik,Clarice
Moisset,Xavier
Teixeira,Manoel Jacobsen
Andrade,Daniel Ciampi de
dc.subject.por.fl_str_mv Pain
Pain management
Neuropathic pain
Drug therapy
Consensus
topic Pain
Pain management
Neuropathic pain
Drug therapy
Consensus
description ABSTRACT Background: Central neuropathic pain (CNP) is often refractory to available therapeutic strategies and there are few evidence-based treatment options. Many patients with neuropathic pain are not diagnosed or treated properly. Thus, consensus-based recommendations, adapted to the available drugs in the country, are necessary to guide clinical decisions. Objective: To develop recommendations for the treatment of CNP in Brazil. Methods: Systematic review, meta-analysis, and specialists opinions considering efficacy, adverse events profile, cost, and drug availability in public health. Results: Forty-four studies on CNP treatment were found, 20 were included in the qualitative analysis, and 15 in the quantitative analysis. Medications were classified as first-, second-, and third-line treatment based on systematic review, meta-analysis, and expert opinion. As first-line treatment, gabapentin, duloxetine, and tricyclic antidepressants were included. As second-line, venlafaxine, pregabalin for CND secondary to spinal cord injury, lamotrigine for CNP after stroke, and, in association with first-line drugs, weak opioids, in particular tramadol. For refractory patients, strong opioids (methadone and oxycodone), cannabidiol/delta-9-tetrahydrocannabinol, were classified as third-line of treatment, in combination with first or second-line drugs and, for central nervous system (CNS) in multiple sclerosis, dronabinol. Conclusions: Studies that address the treatment of CNS are scarce and heterogeneous, and a significant part of the recommendations is based on experts opinions. The CNP approach must be individualized, taking into account the availability of medication, the profile of adverse effects, including addiction risk, and patients' comorbidities.
publishDate 2020
dc.date.none.fl_str_mv 2020-11-01
dc.type.driver.fl_str_mv info:eu-repo/semantics/article
dc.type.status.fl_str_mv info:eu-repo/semantics/publishedVersion
format article
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dc.identifier.uri.fl_str_mv http://old.scielo.br/scielo.php?script=sci_arttext&pid=S0004-282X2020001100741
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dc.language.iso.fl_str_mv eng
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dc.relation.none.fl_str_mv 10.1590/0004-282x20200166
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dc.publisher.none.fl_str_mv Academia Brasileira de Neurologia - ABNEURO
publisher.none.fl_str_mv Academia Brasileira de Neurologia - ABNEURO
dc.source.none.fl_str_mv Arquivos de Neuro-Psiquiatria v.78 n.11 2020
reponame:Arquivos de neuro-psiquiatria (Online)
instname:Academia Brasileira de Neurologia
instacron:ABNEURO
instname_str Academia Brasileira de Neurologia
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institution ABNEURO
reponame_str Arquivos de neuro-psiquiatria (Online)
collection Arquivos de neuro-psiquiatria (Online)
repository.name.fl_str_mv Arquivos de neuro-psiquiatria (Online) - Academia Brasileira de Neurologia
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