Medications for Managing Central Neuropathic Pain as a Result of Underlying Conditions—A Systematic Review

TL;DR

This review compares how well current pain medications work for central neuropathic pain caused by different neurological conditions.

Contribution

It evaluates the effectiveness of algorithm-recommended drugs versus non-recommended ones for specific underlying conditions.

Findings

Current treatment algorithms for central neuropathic pain are generally effective and safe.

Patient response to medications varies depending on the underlying neurological condition.

Thirty-eight RCTs were analyzed to assess drug effectiveness across different CNS disorders.

Abstract

Background: This systematic review assessed the current literature regarding the analgesic treatment of central neuropathic pain (CNP) in central nervous system (CNS) conditions, such as spinal cord injuries, multiple sclerosis, post-stroke disorders, and Parkinson’s disease. The aim of this systematic review was to compare the current algorithmic treatment of CNP, which generally does not discriminate among underlying conditions, with RCTs investigating algorithm-recommended and non-algorithm-recommended drugs for differing underlying conditions. Methods: The PubMed and EMBASE databases were used to identify relevant randomized control trials (RCTs). MeSH terms and EmTree terms were searched as well as free text words in the title/abstract of the studies. A risk of bias tool was used to assess all included studies. Results: A total of 903 RCTs were identified from the initial search. Thirty-eight RCTs published between January 2002 and November 2024 fulfilled all the inclusion criteria and none of the exclusion criteria. The review investigated progressive and stable neurological diseases and conditions with associated CNP. Conclusions: From the majority of the included studies, the current recommended treatment algorithm seems to be effective and safe; however, the underlying condition seems to influence how the patient responds to tier-appropriate medication.

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