Therapeutic Approaches for Peripheral and Central Neuropathic Pain

Table 3

Pharmacological therapeutic options for neuropathic pain.

	Indications	Recommended dosage	Side effects	Comments	Ref.
First-line drugs
TCAs	All types of NP	Amitriptyline: 10-150 mg/day	Dry mouth, constipation, urinary retention, orthostatic hypotension	Moderate quality of evidence; strong recommendation	[2, 12, 13, 36, 74]
Gabapentinoids	All types of NP	Gabapentin: 300-3600 mg/day; Pregabalin: 150-600 mg/day	Dizziness, sedation, peripheral swelling	High quality of evidence; strong recommendation	[2, 12, 13, 36, 74]
SNRIs	All types of NP	Duloxetine: 20-120 mg/day; Venlafaxine: 150-225 mg/day	Nausea	High quality of evidence; strong recommendation	[2, 12, 13, 36, 74]
Anticonvulsants (sodium ion channel blockers)	Trigeminal neuralgia	Carbamazepine: 200-400 mg/day; Oxcarbazepine: 300-600 mg/day	Sedation, hepatotoxicity, hyponatraemia	GRADE recommendation is not applicable	[2, 12, 13, 36, 74]
Second-line drugs
Weak opioids	All types of NP	Tramadol: 25-400 mg/day; Tapentadol: 50-600 mg/day	Nausea, vomiting, constipation	Moderate quality of evidence; weak recommendation	[2, 12, 13, 36, 74]
Topical agents	Peripheral NP	Lidocaine (5%) plaster; Capsaicin (8%) patch	Erythema, itching	Lidocaine (5%) plaster: low quality of evidence; weak recommendation; capsaicin (8%) patch: high quality of evidence; weak recommendation	[2, 12, 13, 36, 74]
Third-line drugs
Strong opioids	All types of NP	Morphine: 10-120 mg/day; Oxycodone: 10-120 mg/day	Nausea, vomiting, constipation	Moderate quality of evidence; weak recommendation	[2, 12, 13, 36, 74]
Neurotoxin	Peripheral NP	Botulinum toxin type A	Pain at injection site	Low quality of evidence; weak recommendation	[2, 12, 13, 36, 74]

Abbreviations: NP = neuropathic pain; SNRI = serotonin norepinephrine reuptake inhibitor; TCA = tricyclic antidepressant.