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|
|5% Lidocaine plastersa)||5% Lidocaine plasters||Memantine|
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||2015||
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.