No relevant changes in the neuropathic pain treatment landscape

In the 2017 Review of the Canadian Pain Society, the consensus statement regarded the therapy of neuropathic pain we can see how disappointing the progress in this field is. Nothing new, only slight shifts in recommendations. Although many pharmacological treatment modalities exist for the treatment of neuropathic pain, nothing new emerged since the entry of the lidocaine plaster. The recommended first line therapies are still based on gabapentinoids and antidepressants. How sad. Both products are troublesome in the elderly due to negative side effects on cognition and behavior. Antidepressants have also been associated with tachycardia and myocardial infarction, while Somnolence, dizziness, edema, and weight gain are common side effects of gabapentin and pregabalin.

Opioids are promoted to second line choices and the only little positive shift is that cannabinoids have been moved from a fourth-line to a third-line treatment option for neuropathic pain. The fact that opioids including tramadol have been moved from third-line to second-line treatment is a sad one indeed, given the massive problems opioids induce, especially in the elderly.

TI hopes to contribute to a shift in the way we think about treatment of treating neuropathic pain, and are confident, based on new POP that phenytoin cream will become a viable treatment option in the near future. Trial design discussions for phase IIb in 2 academic centers are ongoing. Phase II is scheduled to start in 2018.

Source: Alex Mu, Erica Weinberg, Dwight E. Moulin and Hance Clarke.  Canadian Family Physician, November 2017, 63 (11) 844-852;