Evidence map›Paper›PMID 31152178›Full record

ReviewPain medicine (Malden, Mass.)2019

A Comprehensive Algorithm for Management of Neuropathic Pain.

Daniel Bates, B Carsten Schultheis, Michael C Hanes, Suneil M Jolly, Krishnan V Chakravarthy, Timothy R Deer, Robert M Levy, Corey W Hunter

Erratum issuedOpen access · hybridAbstract readReview
PubMed Full text at PMC Publisher
In one paragraph

Review in Pain medicine (Malden, Mass.), 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. An erratum has been issued. Cited by 177 papers, 11 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
177citing papers in PubMed, 11 pooled it
20.6field-weighted citation impact, top 1% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

177 citing papers in PubMed, 11 syntheses or guidelines pooled it, 387 citations in OpenAlex.

  1. Pooled it
  2. Pooled it
  3. Pooled it
  4. Pooled it
  5. Pooled it
  6. Pooled it
  7. Pooled it
  8. Topical clonidine for neuropathic pain in adults.The Cochrane database of systematic reviews · 2022
    Pooled it
  9. Pooled it
  10. Pooled it
  11. Pooled it
  12. Trial
  13. Trial
  14. Trial
  15. Trial
  16. Trial
  17. Article
  18. Review
  19. Review
  20. Review

117 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

8 authors at 7 institutions in 3 countries.

Daniel BatesMetro Pain Group, Victoria, Australia.
B Carsten SchultheisMuskuloskelettales Zentrum - Interventionelle Schmerztherapie, Krankenhaus Neuwerk "Maria von den Aposteln," Mönchengladbach, Germany.
Michael C HanesJax Spine & Pain Centers, Jacksonville, Florida.
Suneil M JollyLouisiana Pain Specialists, New Orleans, Louisiana.
Krishnan V ChakravarthyDepartment of Anesthesiology and Pain Medicine, University of California San Diego Health Sciences, La Jolla, California.
Timothy R DeerThe Spine and Nerve Center of the Virginias, Charleston, West Virginia.
Robert M LevyInstitute for Neuromodulation, Boca Raton, Florida.
Corey W HunterAinsworth Institute of Pain Management, New York, New York, USA.
Ainsworth Institute of Pain Management · USEast Jefferson General Hospital · USInternational Neuromodulation Society · USKrankenhaus Neuwerk "Maria von den Aposteln" · DEMetro South Health · AUThe Spine & Nerve Centers of the Virginias · USUniversity of California San Diego · US

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundThe objective of this review was to merge current treatment guidelines and best practice recommendations for management of neuropathic pain into a comprehensive algorithm for primary physicians. The algorithm covers assessment, multidisciplinary conservative care, nonopioid pharmacological management, interventional therapies, neurostimulation, low-dose opioid treatment, and targeted drug delivery therapy.

methodsAvailable literature was identified through a search of the US National Library of Medicine's Medline database, PubMed.gov. References from identified published articles also were reviewed for relevant citations.

resultsThe algorithm provides a comprehensive treatment pathway from assessment to the provision of first- through sixth-line therapies for primary care physicians. Clear indicators for progression of therapy from firstline to sixth-line are provided. Multidisciplinary conservative care and nonopioid medications (tricyclic antidepressants, serotonin norepinephrine reuptake inhibitors, gabapentanoids, topicals, and transdermal substances) are recommended as firstline therapy; combination therapy (firstline medications) and tramadol and tapentadol are recommended as secondline; serotonin-specific reuptake inhibitors/anticonvulsants/NMDA antagonists and interventional therapies as third-line; neurostimulation as a fourth-line treatment; low-dose opioids (no greater than 90 morphine equivalent units) are fifth-line; and finally, targeted drug delivery is the last-line therapy for patients with refractory pain.

conclusionsThe presented treatment algorithm provides clear-cut tools for the assessment and treatment of neuropathic pain based on international guidelines, published data, and best practice recommendations. It defines the benefits and limitations of the current treatments at our disposal. Additionally, it provides an easy-to-follow visual guide of the recommended steps in the algorithm for primary care and family practitioners to utilize.

Indexed as

AlgorithmsHumansNeuralgiaPain ManagementNeuromodulationNeuropathic PainPharmacological TreatmentSpinal Cord StimulationTargeted Drug Delivery

Identifiers

PMID31152178
PMCPMC6544553
OpenAlexW2947586542

What OpenQuestion holds

Textmetadata
LicenceCC BY-NC
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.