Year 2018 / Volume 25 / Number 6

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Review

Evidence-based recommendations for the management of neuropathic pain (review of the literature)

Rev. Soc. Esp. Dolor. 2018; 25(6): 349-358 / DOI: 10.20986/resed.2018.3673/2018

Andrea María Rincón Carvajal, Camilo Andrés Olaya Osorio, Susan Martínez Rojas, Linda Ibatá Bernal


ABSTRACT

Objective: To synthesize, through a literature review, the current recommendations in the management of neuropathic pain.
Methodology: Thematic review based on a highly sensitive literature search for the identification of clinical practice guidelines and systematic reviews, focused on diagnosis and management of neuropathic pain, from 2012 to 2017. From the included references, it was obtained information related to definitions, relevant considerations, indications and objectives of treatment, both pharmacological and non-pharmacological, as well as remission criteria.
Results: We included 34 relevant clinical practice guidelines for the management of neuropathic pain. The synthesis of relevant aspects focused on: 1) the screening tools available for identification and classification of neuropathic pain; 2) diagnosis and follow-up of confirmation tests; 3) pain management principles, as well as pharmacological and non-pharmacological management as first, second and third line, according to the location of lesions; and 4) follow-up. The most commonly recommended first-line treatments include tricyclic antidepressants, α2δ-ligands (pregabalin and gabapentin), and selective serotonin / noradrenaline reuptake inhibitors.
Conclusion: Neuropathic pain is a common condition in clinical practice, where the non-pain specialist will perform the diagnosis based on a detailed clinical history and directed physical exam. The treatment must be multidisciplinary and begin early with first-line drugs.



RESUMEN

Objetivo: Sintetizar, mediante una revisión de la literatura, las recomendaciones actuales en el manejo del dolor neuropático.
Metodología: Revisión temática basada en una búsqueda de literatura altamente sensible para la identificación de guías de práctica clínica y revisiones sistémicas de la literatura enfocadas en diagnóstico y manejo del dolor neuropático, desde 2012 a 2017. De las referencias incluidas, se obtuvo información relacionada con definiciones, consideraciones relevantes, indicaciones y objetivos del tratamiento, tanto farmacológico como no farmacológico y criterios de remisión.
Resultados: Se incluyeron 34 guías de práctica clínica relevantes para el manejo del dolor neuropático. Se realizó una síntesis de aspectos relevantes enfocados en: 1) las herramientas de tamización disponibles para la identificación y clasificación del dolor neuropático; 2) el diagnóstico y seguimiento de las pruebas de confirmación; 3) principios del manejo del dolor, así como el manejo farmacológico y no farmacológico de primera, segunda y tercera línea, de acuerdo con la localización de las lesiones; y 4) seguimiento. Los tratamientos de primera línea más comúnmente recomendados influyen los antidepresivos tricíclicos, α2δ-ligandos (pregabalina y gabapentina) y los inhibidores selectivos de la recaptación de serotonina/noradrenalina.
Conclusión: El dolor neuropático es una condición común en la práctica clínica, donde el médico no especialista en dolor realizará el diagnóstico basado en una historia clínica detallada y examen físico dirigido. El tratamiento debe ser multidisciplinario e iniciarse precozmente con fármacos de primera línea.


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Rincón Carvajal A, Olaya Osorio C, Martínez Rojas S, Ibatá Bernal L. Evidence-based recommendations for the management of neuropathic pain (review of the literature). Rev Soc Esp Dolor 2018; 25(6): 349-358 / DOI: 1020986/resed20183673/2018


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Ficha Técnica

Recibido: 16/03/2018

Aceptado: 20/06/2018

Prepublicado: 29/06/2018

Publicado: 13/12/2018

Tiempo de revisión del artículo: 92 días

Tiempo de prepublicación: 105 días

Tiempo de edición del artículo: 272 días


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