Major Update to Chronic Pain: Neuropathic Pain

19 Aug Major Update to Chronic Pain: Neuropathic Pain

All TreatGx users now have access to the updated Chronic Pain – Neuropathic Pain treatment algorithm. Finding the optimal therapy to meet goals for chronic pain management can be challenging. This major update not only brings together information from multiple sources but enables it to be customized for the individual patient. Health professionals will appreciate having comprehensive information at their fingertips to help review treatment options for their patients. Information in this update comes from  neuropathic pain guidelines and reviews, including: Canadian Pain Society [1], Comprehensive Algorithm for Management of Neuropathic Pain by Bates et al. [2], Neuropathic Pain Special Interest Group of the International Association for Study of Pain with systematic review and meta-analysis by Finnerup et al. [3], European Federation of Neurological Societies Task Force [4], National Institute for Health and Care Excellence [5], and Scottish Intercollegiate Guidelines Network. [6]

In addition to the TreatGx standard of providing personalized dosing based on pharmacogenetics, kidney function, liver function, and drug interactions, the comprehensive update includes other new features that will help personalize medication therapy:

• Addition of Number Needed to Treat and Number Needed to Harm for each medication option
• Addition of the most common side effects for all options, and side effect comparison notes amongst medications in the TCA and SNRI classes
• Evidence-based guidance on combination drug therapy options
• Addition of several new medication options beyond first-line choices: opioids (tramadol, tapentadol, morphine, oxycodone, hydromorphone); and for the US: topical analgesic patches (capsaicin and lidocaine) and extended-release formulations for gabapentinoids
• Guidance on cautious opioid dosing from the Canadian Guideline for Opioids for Chronic Non-Cancer Pain [7] and the CDC Guideline for Prescribing Opioids for Chronic Pain [8]
• Information on medication effectiveness for various neuropathic pain conditions, notably diabetic peripheral neuropathy and post-herpetic neuralgia
• Notes on off-label use and official indications per Health Canada and FDA product labels

References:

1. Mu A, Weinberg E, Moulin DE, Clarke H: Pharmacologic management of chronic neuropathic pain: Review of the Canadian Pain Society consensus statement. Can Fam Physician 2017, 63(11):844-852.
2. Bates D, Schultheis BC, Hanes MC, Jolly SM, Chakravarthy KV, Deer TR, Levy RM, Hunter CW: A Comprehensive Algorithm for Management of Neuropathic Pain. Pain medicine (Malden, Mass) 2019, 20(Suppl 1):S2-S12.
3. Finnerup NB, Attal N, Haroutounian S, McNicol E, Baron R, Dworkin RH, Gilron I, Haanpaa M, Hansson P, Jensen TS et al: Pharmacotherapy for neuropathic pain in adults: a systematic review and meta-analysis. The Lancet Neurology 2015, 14(2):162-173.
4. Attal N, Cruccu G, Baron R, Haanpää M, Hansson P, Jensen TS, Nurmikko T: EFNS guidelines on the pharmacological treatment of neuropathic pain: 2010 revision. European journal of neurology 2010, 17(9):1113-e1188.
5. National Institute for Health and Care Excellence: The pharmacological management of neuropathic pain in adults in non-specialist settings [NICE Guideline CG173]. In: National Institute for Health and Care Excellence (UK). London; 2013.
6. Scottish Intercollegiate Guidelines Network: Management of chronic pain [SIGN 136]. In: SIGN UK. Edinburgh; 2013.
7. Busse J: The 2017 Canadian Guideline for Opioids for Chronic Non-Cancer Pain. In: National Pain Center. Hamilton, ON: McMaster University; 2017.
8. Dowell D HT, Chou R: CDC Guideline for Prescribing Opioids for Chronic Pain. In: National Center for Injury Prevention and Control, CDC. Atlanta, GA; 2016.