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Pain Research and Management
Volume 12, Issue 1, Pages 13-21
Special Article

Pharmacological Management of Chronic Neuropathic Pain – Consensus Statement and Guidelines from the Canadian Pain Society

DE Moulin,1 AJ Clark,2 I Gilron,3 MA Ware,4 CPN Watson,5 BJ Sessle,5 T Coderre,4 PK Morley-Forster,1 J Stinson,6 A Boulanger,7 P Peng,5,8 GA Finley,9,10 P Taenzer,2 P Squire,11 D Dion,7 A Cholkan,12 A Gilani,13 A Gordon,5,12 J Henry,13 R Jovey,5 M Lynch,9 A Mailis-Gagnon,5 A Panju,13 GB Rollman,1 and A Velly14

1University of Western Ontario, London, Ontario, Canada
2University of Calgary, Calgary, Alberta, Canada
3Queen’s University, Kingston, Canada
4McGill University, Montreal, Canada
5University of Toronto, Canada
6The Hospital for Sick Children, Toronto, Ontario, Canada
7Universite de Montreal, Montreal, Quebec, Canada
8University Health Network, Toronto, Ontario, Canada
9Dalhousie University, Canada
10IWK Health Centre, Halifax, Nova Scotia, Canada
11University of British Columbia, Vancouver, British Columbia, Canada
12Wasser Pain Management Centre, Mount Sinai Hospital, Toronto, Ontario, Canada
13McMaster University, Hamilton, Ontario, Canada
14University of Minnesota, Minneapolis, Minnesota, USA

Copyright © 2007 Hindawi Publishing Corporation. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


Neuropathic pain (NeP), generated by disorders of the peripheral and central nervous system, can be particularly severe and disabling. Prevalence estimates indicate that 2% to 3% of the population in the developed world suffer from NeP, which suggests that up to one million Canadians have this disabling condition. Evidence-based guidelines for the pharmacological management of NeP are therefore urgently needed. Randomized, controlled trials, systematic reviews and existing guidelines focusing on the pharmacological management of NeP were evaluated at a consensus meeting. Medications are recommended in the guidelines if their analgesic efficacy was supported by at least one methodologically sound, randomized, controlled trial showing significant benefit relative to placebo or another relevant control group. Recommendations for treatment are based on degree of evidence of analgesic efficacy, safety, ease of use and cost-effectiveness. Analgesic agents recommended for first-line treatments are certain antidepressants (tricyclics) and anticonvulsants (gabapentin and pregabalin). Second-line treatments recommended are serotonin noradrenaline reuptake inhibitors and topical lidocaine. Tramadol and controlled-release opioid analgesics are recommended as third-line treatments for moderate to severe pain. Recommended fourth-line treatments include cannabinoids, methadone and anticonvulsants with lesser evidence of efficacy, such as lamotrigine, topiramate and valproic acid. Treatment must be individualized for each patient based on efficacy, side-effect profile and drug accessibility, including cost. Further studies are required to examine head-to-head comparisons among analgesics, combinations of analgesics, long-term outcomes, and treatment of pediatric and central NeP.