OPTION FOR LNP BY THE EUROPEAN FEDERATION OF NEUROLOGICAL SOCIETIES (EFNS)1
Classification of evidence for drug treatments in post-herpetic neuralgia (PHN)
| Recommendations for first line | Recommendations for second or third line | Level A rating for Efficacy | Level B rating for Efficacy | Level A/B Rating for inefficacy or discrepant results |
| Gabapentin | Capsaicin | Capsaicin 8% patch** | Capsaicin cream | Benzydamide topical |
| Pregabalin | Opioids | Gabapentin | Valproate* | Dextromethorphan |
| TCA | Gabapentin ER** | Fluphenazine | ||
| 5% Lidocaine plastersa) | 5% Lidocaine plasters | Memantine | ||
| Opioidsb) | Lorazepam | |||
| Pregabalin | Mexiletine | |||
| TCAc) | COX-2 inhibitor** | |||
| Tramadol |
Only drugs used at repeated dosages are shown here (with the exception of treatments with longlasting effects such as capsaicin patches). a) Lidocaine is recommended in elderly patients: b) morphine, oxycodone, methadone; c) Anmitriptyline, notripyline, desipramine, Imipramine. *found effective in sindle class II or III studies and generally nor recommended; **not yet available use. TCA = Tricyclic antidepressants; ER = Extended release. Adapted from Attal N et al. Eur J Neurol 2010.
Topical treatments are recommended for peripheral neuropathic pain with presumed local pain generator, such as post-herpetic neuralgia, post-traumatic painful neuropathies, and painful polyneuropathies. In some circumstances – eg, when there are concerns because of side-effects or safety of first-line treatments, particularly in frail and elderly patients – lidocaine patches might be a first-line option.
| GUIDELINES/ GUIDANCE | LAST UPDATE | 1st LINE RECOMMENDATION | 2nd LINE RECOMMENDATION |
| Neuropathic Pain Special Interest Group of the International Association for the Study of Pain[2] | 2015 |
|
|
References
1 Attal et al. EFNS guidelines on the pharmacological treatment of neuropathic pain: 2010 revision. Eur J of Neurology 2010; 17:1113-23.
2 Finnerup, NB. et al. Lancet Neurol 2015; 162-73.
