Interventional management of neuropathic pain: NeuPSIG recommendations

Robert H. Dworkin, Alec B. O'Connor, Joel Kent, Sean C. Mackey, Srinivasa N. Raja, Brett R. Stacey, Robert M. Levy, Miroslav Backonja, Ralf Baron, Henning Harke, John D. Loeser, Rolf Detlef Treede, Dennis C. Turk, Christopher D. Wells

Research output: Contribution to journalReview article

Abstract

Neuropathic pain (NP) is often refractory to pharmacologic and noninterventional treatment. On behalf of the International Association for the Study of Pain Neuropathic Pain Special Interest Group, the authors evaluated systematic reviews, clinical trials, and existing guidelines for the interventional management of NP. Evidence is summarized and presented for neural blockade, spinal cord stimulation (SCS), intrathecal medication, and neurosurgical interventions in patients with the following peripheral and central NP conditions: herpes zoster and postherpetic neuralgia (PHN); painful diabetic and other peripheral neuropathies; spinal cord injury NP; central poststroke pain; radiculopathy and failed back surgery syndrome (FBSS); complex regional pain syndrome (CRPS); and trigeminal neuralgia and neuropathy. Due to the paucity of high-quality clinical trials, no strong recommendations can be made. Four weak recommendations based on the amount and consistency of evidence, including degree of efficacy and safety, are: 1) epidural injections for herpes zoster; 2) steroid injections for radiculopathy; 3) SCS for FBSS; and 4) SCS for CRPS type 1. Based on the available data, we recommend not to use sympathetic blocks for PHN nor radiofrequency lesions for radiculopathy. No other conclusive recommendations can be made due to the poor quality of available data. Whenever possible, these interventions should either be part of randomized clinical trials or documented in pain registries. Priorities for future research include randomized clinical trials, long-term studies, and head-to-head comparisons among different interventional and noninterventional treatments.

Original languageEnglish (US)
Pages (from-to)2249-2261
Number of pages13
JournalPain
Volume154
Issue number11
DOIs
StatePublished - Nov 2013

Keywords

  • Clinical trials
  • Evidence-based recommendations
  • Intrathecal medication
  • Neural blockade
  • Neuropathic pain
  • Neurosurgery
  • Spinal cord stimulation

ASJC Scopus subject areas

  • Neurology
  • Clinical Neurology
  • Anesthesiology and Pain Medicine

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  • Cite this

    Dworkin, R. H., O'Connor, A. B., Kent, J., Mackey, S. C., Raja, S. N., Stacey, B. R., Levy, R. M., Backonja, M., Baron, R., Harke, H., Loeser, J. D., Treede, R. D., Turk, D. C., & Wells, C. D. (2013). Interventional management of neuropathic pain: NeuPSIG recommendations. Pain, 154(11), 2249-2261. https://doi.org/10.1016/j.pain.2013.06.004