Call for other treatment options! 

Most studies focussed on painful polyneuropathy most often due to diabetes, and a good number 2 was was postherpetic neuralgia.

Most often tricyclic antidepressants, serotonin noradrenaline reuptake inhibitors, the anticonvulsants gabapentin and pregabalin, and opioids were studied and these drugs are proven to be of use.

However...despite the 66% increase in published trials only a limited improvement of neuropathic pain treatment has been obtained.

Most neuropathic pain patients are still left with insufficient pain relief.

The authors conluded:

This fact calls for other treatment options to target chronic neuropathic pain.

Pharmacological treatment still represents the main option for treating chronic neuropathic pain. Our understanding of neuropathic pain-generating mechanisms has grown considerably with in the last few decades, but unfortunately this research has not been matched by a similar improvement in treatment efficacy.

We are still limited in our efforts in managing neuropathic pain by relying on treating the symptoms of pain rather than identifying the underlying disease mechanisms causing the pain.

Although 69 new randomized controlled trials have been published in the past 5 years compared with 105 published trials published in the pre- ceding 39 years, only a marginal improvement in the treatment of the patients with neuropathic pain has been achieved..... ^[1]

Critics on neuropathic pain trials 

The authors point out that the clinical recommendations how to treat neuropathic pain usually depend on the simple assessments of the patients’ pain intensity and functionality without taking the possible underlying mechanisms into account. 

The authors also datamined in the database for finished clinical trials to identify negative trials and found some interesting facts: 

In addition to the published trials, this database pre- sented one trial examining gabapentin 3600 mg, which relieved painful polyneuropathy with an NNT of 7.0 (4.3–20), and four positive and three negative trials with pregabalin, revealing a combined NNT of 9.5 (6.8–16.0) 

A NNT of 9.5 for pregabeline...Lyrica, is quite something different than the usual 3-5 based on published data... 

Our Institute: creating new treatment options for neuropathic pain

This is exactly were we step in. In our institute we develop new treatment modalities, based on topical creams and rational supplements, hand in hand with low dose multipharmacology. We are glad that this new approach helps many patients finding the way to our institute in adequate pain relief and improved quality of life! 

August 2010: Jan M. Keppel Hesselink, MD, PhD

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