Pharmacological management of neuropathic pain

Neuropathic pain is defined as pain caused by a lesion or a disease affecting the somatosensory nervous system. Development of neuropathic pain is induced by many pathophysiological mechanisms affecting pain pathways. Neuropathic pain has diverse origins, making its management difficult, hence, many patients with neuropathic pain do not receive appropriate treatment. In 2015, a revision of the Neuropathic Pain Special Interest Group's (NeuPSIG) previous recommendations, based on a systematic review and meta-analysis, evaluated the efficacy of systemic and topical treatments of neuropathic pain. Treatments lines were established using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE), which allows to rate the quality of evidence and the strength of recommendations. First line treatments are gabapentin and pregabalin, noradrenalin and serotonin reuptake inhibitors and tricyclic antidepressants. Capsaicin and lidocaine patches are second line treatments, tramadol and strong opioids are third line treatments. This work also highlighted molecules with inconclusive recommendations or non-recommended pharmacological treatments based on a low quality of evidence, a lack of efficacy or a bad safety profile. The objective of this paper is to present the different treatments and to detail their mechanisms of action. (C) 2019 Societe francaise de pharmacologie et de therapeutique. Published by Elsevier Masson SAS. All rights reserved.