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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  
  1. TCAs tricyclic antidepressants, SNRIs serotonin–norepinephrine reuptake inhibitors, SSRIs selective serotonin reuptake inhibitors