Table 4 Summary of recommendation of stepwise therapeutic agents
From: Clinical practice guidelines for the management of neuropathic pain: a systematic review
Recommendation level | Mechanism | Drug | |||||||
|---|---|---|---|---|---|---|---|---|---|
IASP (2007) | CPS (2007) | Latin Amercian (2009) | NICE (2010) | MER (2010) | SA (2013) | Fench (2010) | Danish (2010) | ||
First-line analgesics | Anti-epileptics (anticonvulsants) | Gabapentin | Pregabalin | Pregabalin | Pregabalin | Pregabalin | Pregabalin | Pregabalin | |
Pregabalin | Gabapentin | Gabapentin | Gabapentin | Gabapentin | Gabapentin | ||||
TCAs | Nortriptyline | TCAs | Nortriptyline | Amitriptyline | Nortriptyline | Low-dose amitriptyline | TCAs | TCAs | |
Desipramine | Desipramine | Desipramine | Other TCA | ||||||
Amitriptyline | |||||||||
Topical treatments | lidocaine patch 5 % | Topical lidocaine | Topical lidocaine | Topical lidocaine | Topical lidocaine | ||||
SNRIs | Duloxetine | Duloxetine | Duloxetine | ||||||
Venlafaxine | Venlafaxine | ||||||||
Opioid analgesics | Tramadol | ||||||||
Seconds-line analgesics | SNRIs | Venlafaxine | Gabapentin | Duloxetine | Either increasing the dose of the current drug or adding a drug from a different class. For combination treatment, pregabalin with either an SNRI or amitriptyline. | Venlafaxine | Tramadol Opioids combination therapy | ||
Duloxetine | Pregabalin | Venlafaxine | |||||||
Topical treatments | Topical lidocaine | ||||||||
Opioid analgesics | Morphine | Tramadol | Oxycodone | Tramadol | |||||
Oxycodone | Morphine | Tramadol | |||||||
Methadone | Oxycodone | ||||||||
Levorphanol | |||||||||
Tramadol | |||||||||
TCAs | Maprotiline | ||||||||
Third-line analgesics | Opioid analgesics | Tramadol | Tramadol recommended followed by strong opioids, or combination of first-line options with opioids. | ||||||
Morphine | |||||||||
Oxycodone | |||||||||
Methadone | |||||||||
Levorphanol | |||||||||
Anti-epileptics (anticonvulsants) | carbamazepine | ||||||||
lamotrigine | |||||||||
oxcarbazepine | |||||||||
SSRIs | citalopram | ||||||||
paroxetine | |||||||||
sodium channel blocker | Mexiletine | ||||||||
NMDA receptor antagonists | Dextromethorphan | ||||||||
Memantine | |||||||||
Topical treatments | Topical capsaicin | ||||||||
SNRIs | Duloxetine | ||||||||
Venlafaxine | |||||||||
Fourth-line analgesics | Cannabinoids | Cannabinoids | Cannabinoids | ||||||
SSRIs | Citalopram | ||||||||
paroxetine | |||||||||
Anti-epileptics (anticonvulsants) | Lamotrigine | Lamotrigine | |||||||
Clonidine | carbamazepine | ||||||||
sodium channel blocker | mexiletine | ||||||||
Synthetic opioid | Methadone | ||||||||