Real-world data for the evaluation of analgesic treatments for chronic neuropathic pain
Chronic neuropathic pain (NP) is now recognised as a separate entity in the ICD-11. The classification differentiates between NP of peripheral (e.g., postherpetic neuralgia) and central origin (e.g., central post-stroke pain). Even though not considered chronic NP in ICD-11, neuropathic pain mechanisms are also frequently involved in a number of mixed pain conditions such as low back pain.
Peripheral neuropathic pain (PNP) is caused by a lesion or disease of the peripheral somatosensory nervous system; the pain can be spontaneous (burning, throbbing, and shooting pain) and/or stimulus-evoked (allodynia and hyperalgesia). The prevalence of PNP among chronic pain patients is high. Moreover, the burden associated with PNP is considerable and it has a profound impact on quality of life.
In addition to non-pharmacological treatments, international guidelines generally recommend oral systemic medications such as tricyclic antidepressants, the antiepileptics pregabalin and gabapentin, and the selective serotonin-norepinephrine reuptake inhibitors duloxetine and venlafaxine as first-line pharmacological treatments for PNP. The topical agents lidocaine 700 mg medicated plaster and capsaicin 179 mg patch are generally recommended as second-line treatment whereas opioids are reserved as third line treatment options. Nevertheless, treatment recommendations vary across countries.
This Pain Management collection compiles articles focusing on the contribution of real-world evidence for the evaluation of pharmacological treatments for PNP and on the comparison of various PNP treatments in order to improve outcomes for patients in routine clinical practice.