As a result of the meta-analysis, NeuPSIG has updated its recommendations for the treatment of non-cancer associated neuropathic pain in adults. With the exception of trigeminal neuralgia, there were no data identifying that any particular drug was superior to another in any particular disease state.4
The guidelines recommend tricyclic antidepressants, gabapentin or pregabalin, and the SNRIs venlafaxine or duloxetine as first line.4
Second-line treatments include tramadol. Topical lidocaine (lignocaine) or high-concentration capsaicin may be considered for neuropathic pain when there is a presumed local generator.4
The consensus is that opioids can no longer be recommended as first-line treatment, and there is general agreement that they should only be considered as third line, with appropriate monitoring for safety and efficacy.4 It is increasingly recognised that the harms of opioids, in particular addiction, cannot be adequately identified in short-term studies. Also, these short-term studies could not identify if any benefit persists or is lost as tolerance develops.