After reviewing available evidence the Neuropathic Pain Special Interest Group could only recommend:

1. Epidural injections for herpes zoster neuropathic pain.
2. Steroid injections for radiculopathy.
3. Spinal cord stimulator for failed back surgery syndrome or Complex Regional Pain Syndrome type 1

summary

• Robert H Dworkin, Alec B O'Connor, Joel Kent, Sean C Mackey, Srinivasa N Raja, Brett R Stacey, Robert M Levy, Miroslav Backonja, Ralf Baron, Henning Harke, John D Loeser, Rolf-Detlef Treede, Dennis C Turk, Christopher D Wells, and International Association for the Study of Pain Neuropathic Pain Special Interest Group.
• Department of Anesthesiology, University of Rochester School of Medicine and Dentistry, Rochester, NY 14642, USA; Department of Neurology, Center for Human Experimental Therapeutics, University of Rochester School of Medicine and Dentistry, Rochester, NY 14642, USA. Electronic address: robert_dworkin@urmc.rochester.edu.
• Pain. 2013 Nov 1;154(11):2249-61.

AbstractNeuropathic pain (NP) is often refractory to pharmacologic and noninterventional treatment. On behalf of the International Association for the Study of Pain Neuropathic Pain Special Interest Group, the authors evaluated systematic reviews, clinical trials, and existing guidelines for the interventional management of NP. Evidence is summarized and presented for neural blockade, spinal cord stimulation (SCS), intrathecal medication, and neurosurgical interventions in patients with the following peripheral and central NP conditions: herpes zoster and postherpetic neuralgia (PHN); painful diabetic and other peripheral neuropathies; spinal cord injury NP; central poststroke pain; radiculopathy and failed back surgery syndrome (FBSS); complex regional pain syndrome (CRPS); and trigeminal neuralgia and neuropathy. Due to the paucity of high-quality clinical trials, no strong recommendations can be made. Four weak recommendations based on the amount and consistency of evidence, including degree of efficacy and safety, are: 1) epidural injections for herpes zoster; 2) steroid injections for radiculopathy; 3) SCS for FBSS; and 4) SCS for CRPS type 1. Based on the available data, we recommend not to use sympathetic blocks for PHN nor radiofrequency lesions for radiculopathy. No other conclusive recommendations can be made due to the poor quality of available data. Whenever possible, these interventions should either be part of randomized clinical trials or documented in pain registries. Priorities for future research include randomized clinical trials, long-term studies, and head-to-head comparisons among different interventional and noninterventional treatments.Copyright © 2013 International Association for the Study of Pain. Published by Elsevier B.V. All rights reserved.

This article appears in the collections: Chronic pain and Meta-analyses.

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