Skip to main content
SpringerLink
Log in

Management of central neuropathic pain involves many drugs but few have proven efficacy

  • Disease Management
  • Published:
Drugs & Therapy Perspectives Aims and scope Submit manuscript

Abstract

Central neuropathic pain (CNP) from injury to the central somatosensory pathways can be difficult to treat. Of the treatments generally considered front-line for neuropathic pain, pregabalin is useful for treating spinal cord injury-related CNP and duloxetine for multiple sclerosis-related CNP. There is also weak evidence supporting amitriptyline and gabapentin use for CNP. A number of other treatment approaches show some promise in a small number of studies but require further investigation.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Gurba KN, Chaudhry R, Haroutounian S. Central neuropathic pain syndromes: current and emerging pharmacological strategies. CNS Drugs. 2022;36(5):483–516.

    Article  CAS  Google Scholar 

  2. Bates D, Schultheis BC, Hanes MC, et al. A comprehensive algorithm for management of neuropathic pain. Pain Med. 2019;20(Suppl 1):1–12.

    Google Scholar 

  3. Greater Manchester Medicines Management Group. Neuropathic pain in adults - guideline for primary care (March 22, version 8.2). 2022. https://gmmmg.nhs.uk. Accessed 27 Oct 2022.

  4. Schlereth T. Guideline “diagnosis and non interventional therapy of neuropathic pain” of the German Society of Neurology (deutsche Gesellschaft fur Neurologie). Neurol Res Pract. 2020;2:16.

    Article  Google Scholar 

  5. Giovannini S, Coraci D, Brau F, et al. Neuropathic pain in the elderly. Diagnostics (Basel). 2021;11(4):613.

    Article  CAS  Google Scholar 

  6. Onder G, Giovannini S, Sganga F, et al. Interactions between drugs and geriatric syndromes in nursing home and home care: results from Shelter and IBenC projects. Aging Clin Exp Res. 2018;30(9):1015–21.

    Article  Google Scholar 

  7. Staudt MD, Clark AJ, Gordon AS, et al. Long-term outcomes in the management of central neuropathic pain syndromes: a prospective observational cohort study. Can J Neurol Sci. 2018;45(5):545–52.

    Article  Google Scholar 

  8. Leijon G, Boivie J. Central post-stroke pain–a controlled trial of amitriptyline and carbamazepine. Pain. 1989;36(1):27–36.

    Article  CAS  Google Scholar 

  9. Kim NY, Lee SC, Kim YW. Effect of duloxetine for the treatment of chronic central poststroke pain. Clin Neuropharmacol. 2019;42(3):73–6.

    Article  CAS  Google Scholar 

  10. Shimodozono M, Kawahira K, Kamishita T, et al. Reduction of central poststroke pain with the selective serotonin reuptake inhibitor fluvoxamine. Int J Neurosci. 2002;112(10):1173–81.

    Article  Google Scholar 

  11. Hesami O, Gharagozli K, Beladimoghadam N, et al. The efficacy of gabapentin in patients with central post-stroke pain. Iran J Pharm Res. 2015;14(Suppl):95–101.

    CAS  Google Scholar 

  12. Levendoglu F, Ogun CO, Ozerbil O, et al. Gabapentin is a first line drug for the treatment of neuropathic pain in spinal cord injury. Spine (Phila Pa 1976). 2004;29(7):743–51.

    Article  Google Scholar 

  13. To TP, Lim TC, Hill ST, et al. Gabapentin for neuropathic pain following spinal cord injury. Spinal Cord. 2002;40(6):282–5.

    Article  Google Scholar 

  14. Tai Q, Kirshblum S, Chen B, et al. Gabapentin in the treatment of neuropathic pain after spinal cord injury: a prospective, randomized, double-blind, crossover trial. J Spinal Cord Med. 2002;25(2):100–5.

    Article  Google Scholar 

  15. Houtchens MK, Richert JR, Sami A, et al. Open label gabapentin treatment for pain in multiple sclerosis. Mult Scler. 1997;3(4):250–3.

    Article  CAS  Google Scholar 

  16. Kalita J, Chandra S, Misra UK. Pregabalin and lamotrigine in central poststroke pain: a pilot study. Neurol India. 2017;65(3):506–11.

    Article  Google Scholar 

  17. Onouchi K, Koga H, Yokoyama K, et al. An open-label, long-term study examining the safety and tolerability of pregabalin in Japanese patients with central neuropathic pain. J Pain Res. 2014;7:439–47.

    Article  Google Scholar 

  18. Rintala DH, Holmes SA, Courtade D, et al. Comparison of the effectiveness of amitriptyline and gabapentin on chronic neuropathic pain in persons with spinal cord injury. Arch Phys Med Rehabil. 2007;88(12):1547–60.

    Article  Google Scholar 

  19. Cardenas DD, Warms CA, Turner JA, et al. Efficacy of amitriptyline for relief of pain in spinal cord injury: results of a randomized controlled trial. Pain. 2002;96(3):365–73.

    Article  CAS  Google Scholar 

  20. Vranken JH, Hollmann MW, van der Vegt MH, et al. Duloxetine in patients with central neuropathic pain caused by spinal cord injury or stroke: a randomized, double-blind, placebo-controlled trial. Pain. 2011;152(2):267–73.

    Article  CAS  Google Scholar 

  21. Brown TR, Slee A. A randomized placebo-controlled trial of duloxetine for central pain in multiple sclerosis. Int J MS Care. 2015;17(2):83–9.

    Article  Google Scholar 

  22. Vollmer TL, Robinson MJ, Risser RC, et al. A randomized, double-blind, placebo-controlled trial of duloxetine for the treatment of pain in patients with multiple sclerosis. Pain Pract. 2014;14(8):732–44.

    Article  Google Scholar 

  23. Vranken JH, Dijkgraaf MG, Kruis MR, et al. Pregabalin in patients with central neuropathic pain: a randomized, double-blind, placebo-controlled trial of a flexible-dose regimen. Pain. 2008;136(1–2):150–7.

    Article  CAS  Google Scholar 

  24. Siddall PJ, Cousins MJ, Otte A, et al. Pregabalin in central neuropathic pain associated with spinal cord injury: a placebo-controlled trial. Neurology. 2006;67(10):1792–800.

    Article  CAS  Google Scholar 

  25. Cardenas DD, Nieshoff EC, Suda K, et al. A randomized trial of pregabalin in patients with neuropathic pain due to spinal cord injury. Neurology. 2013;80(6):533–9.

    Article  CAS  Google Scholar 

  26. Kim JS, Bashford G, Murphy KT, et al. Safety and efficacy of pregabalin in patients with central post-stroke pain. Pain. 2011;152(5):1018–23.

    Article  CAS  Google Scholar 

  27. Vestergaard K, Andersen G, Gottrup H, et al. Lamotrigine for central poststroke pain: a randomized controlled trial. Neurology. 2001;56(2):184–90.

    Article  CAS  Google Scholar 

  28. Finnerup NB, Sindrup SH, Bach FW, et al. Lamotrigine in spinal cord injury pain: a randomized controlled trial. Pain. 2002;96(3):375–83.

    Article  CAS  Google Scholar 

  29. Silver M, Blum D, Grainger J, et al. Double-blind, placebo-controlled trial of lamotrigine in combination with other medications for neuropathic pain. J Pain Symptom Manag. 2007;34(4):446–54.

    Article  CAS  Google Scholar 

  30. Yang ML, Li JJ, So KF, et al. Efficacy and safety of lithium carbonate treatment of chronic spinal cord injuries: a double-blind, randomized, placebo-controlled clinical trial. Spinal Cord. 2012;50(2):141–6.

    Article  CAS  Google Scholar 

  31. Norrbrink C, Lundeberg T. Tramadol in neuropathic pain after spinal cord injury: a randomized, double-blind, placebo-controlled trial. Clin J Pain. 2009;25(3):177–84.

    Article  Google Scholar 

  32. Wilsey B, Marcotte TD, Deutsch R, et al. An exploratory human laboratory experiment evaluating vaporized cannabis in the treatment of neuropathic pain from spinal cord injury and disease. J Pain. 2016;17(9):982–1000.

    Article  CAS  Google Scholar 

  33. Langford RM, Mares J, Novotna A, et al. A double-blind, randomized, placebo-controlled, parallel-group study of THC/CBD oromucosal spray in combination with the existing treatment regimen, in the relief of central neuropathic pain in patients with multiple sclerosis. J Neurol. 2013;260(4):984–97.

    Article  CAS  Google Scholar 

  34. Rog DJ, Nurmikko TJ, Friede T, et al. Randomized, controlled trial of cannabis-based medicine in central pain in multiple sclerosis. Neurology. 2005;65(6):812–9.

    Article  Google Scholar 

  35. Sakurai M, Kanazawa I. Positive symptoms in multiple sclerosis: their treatment with sodium channel blockers, lidocaine and mexiletine. J Neurol Sci. 1999;162(2):162–8.

    Article  CAS  Google Scholar 

  36. Han ZA, Song DH, Oh HM, et al. Botulinum toxin type A for neuropathic pain in patients with spinal cord injury. Ann Neurol. 2016;79(4):569–78.

    Article  CAS  Google Scholar 

  37. Amr YM. Epidural ketamine in post spinal cord injury-related chronic pain. Anesth Essays Res. 2011;5(1):83–6.

    Article  Google Scholar 

  38. Rintala DH, Fiess RN, Tan G, et al. Effect of dronabinol on central neuropathic pain after spinal cord injury: a pilot study. Am J Phys Med Rehabil. 2010;89(10):840–8.

    Article  Google Scholar 

  39. Liampas A, Velidakis N, Georgiou T, et al. Prevalence and management challenges in central post-stroke neuropathic pain: a systematic review and meta-analysis. Adv Ther. 2020;37(7):3278–91.

    Article  Google Scholar 

  40. Zhang X, Zhu H, Tao W, et al. Motor cortex stimulation therapy for relief of central post-stroke pain: a retrospective study with neuropathic pain symptom inventory. Stereotact Funct Neurosurg. 2018;96(4):239–43.

    Article  Google Scholar 

  41. Viswanath O, Urits I, Burns J, et al. Central neuropathic mechanisms in pain signaling pathways: current evidence and recommendations. Adv Ther. 2020;37(5):1946–59.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Springer Nature, Private Bag 65901, Mairangi Bay, 0754, Auckland, New Zealand

    Simon Fung & Connie Kang

Authors
  1. Simon Fung
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Connie Kang
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Simon Fung.

Ethics declarations

Funding

The preparation of this review was not supported by any external funding.

Authorship and conflict of interest

S. Fung and C. Kang are salaried employees of Adis International Ltd/Springer Nature and declare no relevant conflicts of interest. All authors contributed to the review and are responsible for the article content.

Ethics approval, consent to participate, consent for publication, availability of data and material, code availability

 Not applicable.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Fung, S., Kang, C. Management of central neuropathic pain involves many drugs but few have proven efficacy. Drugs Ther Perspect 39, 1–7 (2023). https://doi.org/10.1007/s40267-022-00965-z

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s40267-022-00965-z

Search

Navigation