|
| Indications | Comments | Ref. |
|
Interventional therapies |
Nerve blockade | Drug-refractory NP | Local anaesthetics or combination with opioids, clonidine, or steroids; inconclusive recommendation | [2, 79, 80] |
|
Epidural corticosteroid injection | Drug-refractory painful radiculopathy | Methylprednisolone, triamcinolone, betamethasone, dexamethasone; moderate quality of evidence; weak strength of recommendation | [2, 79, 80] |
|
Sympathetic nerve/ganglion treatment | Intractable NP | Blockade, neurolysis, or neuroablation | [2, 79–81] |
|
Intrathecal drug delivery | Drug-resistant NP | Morphine, ziconotide | [2, 80, 82, 83] |
|
Peripheral nerve/field stimulation | Intractable low back pain | Subcutaneous application | [84–87] |
|
Transcutaneous electrical nerve stimulation (TENS) | Intractable NP | Very low level of evidence | [87–89] |
|
Dorsal root ganglion stimulation | Drug-refractory CRPS and causalgia of the lower limb | High level of evidence | [87, 91] |
|
Spinal cord stimulation (SCS) | Drug-refractory painful diabetic neuropathy, truncal PHN, SCI-associated NP, CPSP, FBSS with radiculopathy, CRPS I and II | Weak recommendation | [80, 87, 92] |
|
Epidural motor cortex stimulation | Intractable NP | Weak recommendation | [87, 92] |
|
Repetitive transcranial magnetic stimulation (rTMS) of the primary motor cortex | Intractable NP | Weak recommendation | [87, 92] |
|
Transcranial direct current stimulation (tDCS) of the primary motor cortex | Intractable NP | Weak recommendation | [87, 92] |
|
Deep brain stimulation (DBS); repetitive transcranial magnetic stimulation (rTMS) of the dorsolateral prefrontal cortex; transcranial direct current stimulation (tDCS) of the dorsolateral prefrontal cortex | Intractable NP | Inconclusive | [87, 92] |
|
Transcranial direct current stimulation (tDCS) of the primary motor cortex | Intractable spinal cord injury-associated NP | Inconclusive | [87, 92] |
|
Physical therapies |
Heat and cold applications, fluidotherapy, whirlpool, massage, ultrasound, short-wave diathermy, low-frequency currents (e.g., TENS, diadynamic currents and interferential currents), high-voltage galvanic stimulation, laser | Spinal cord injury-associated NP, chronic postsurgical pain, painful radiculopathies, and painful diabetic neuropathy | Inconclusive | [93] |
|
Rehabilitation techniques (relaxation techniques, acupuncture, mirror therapy, graded motor imagery, visual illusion) | Spinal cord injury-associated NP, phantom pain, CRPS, and chronic poststroke NP | Not well-established | [2, 93] |
|
Exercise training | All types of NP | Beneficial effect | [94] |
|
Exercise therapy combined with psychological therapy | Painful diabetic neuropathy | Moderate effect | [95] |
|
Psychological therapies |
Cognitive behavioural therapy (CBT) | Chronic NP; painful diabetic neuropathy, cancer-associated NP, HIV-associated NP | Effective in improving mood and catastrophizing outcomes; good practice point | [2, 96, 101] |
|
Internet-delivered psychological therapies | Nonheadache chronic pain | Similar effect to that of conventional face-to-face psychological intervention | [97] |
|
Hypnosis | Chronic phantom limb pain, spinal cord injury-related NP, and multiple sclerosis-associated NP | Low level of evidence | [101] |
|