Executive summary of the Clinical Guidelines of Pharmacotherapy for Neuropathic Pain: second edition by the Japanese Society of Pain Clinicians

doi:10.1007/s00540-018-2501-0

Practice Guideline

. 2018 Jun;32(3):463-478.

doi: 10.1007/s00540-018-2501-0. Epub 2018 May 8.

Executive summary of the Clinical Guidelines of Pharmacotherapy for Neuropathic Pain: second edition by the Japanese Society of Pain Clinicians

Masahiko Sumitani¹, Tetsuya Sakai², Yoichi Matsuda³, Hiroaki Abe⁴, Shigeki Yamaguchi⁵, Toyoshi Hosokawa⁶, Sei Fukui⁷

Affiliations

¹ Department of Pain and Palliative Medicine, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan. sumitanim-ane@h.u-tokyo.ac.jp.
² Department of Pain Clinic and Anesthesia, Sasebo Kyosai Hospital, Sasebo, Japan.
³ Department of Anesthesiology and Intensive Care Medicine, Graduate School of Medicine, Osaka University, Suita, Japan.
⁴ Department of Pain and Palliative Medicine, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan.
⁵ Department of Anesthesiology, School of Medicine, Dokkyo Medical University, Mibu, Japan.
⁶ Department of Pain Management and Palliative Care Medicine, Kyoto Prefectural University of Medicine, Kyoto, Japan.
⁷ Pain Management Clinic, Shiga University of Medical Science Hospital, Otsu, Japan.

PMID: 29737410
PMCID: PMC5973958
DOI: 10.1007/s00540-018-2501-0

Practice Guideline

Executive summary of the Clinical Guidelines of Pharmacotherapy for Neuropathic Pain: second edition by the Japanese Society of Pain Clinicians

Masahiko Sumitani et al. J Anesth. 2018 Jun.

. 2018 Jun;32(3):463-478.

doi: 10.1007/s00540-018-2501-0. Epub 2018 May 8.

Authors

Masahiko Sumitani¹, Tetsuya Sakai², Yoichi Matsuda³, Hiroaki Abe⁴, Shigeki Yamaguchi⁵, Toyoshi Hosokawa⁶, Sei Fukui⁷

Affiliations

¹ Department of Pain and Palliative Medicine, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan. sumitanim-ane@h.u-tokyo.ac.jp.
² Department of Pain Clinic and Anesthesia, Sasebo Kyosai Hospital, Sasebo, Japan.
³ Department of Anesthesiology and Intensive Care Medicine, Graduate School of Medicine, Osaka University, Suita, Japan.
⁴ Department of Pain and Palliative Medicine, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan.
⁵ Department of Anesthesiology, School of Medicine, Dokkyo Medical University, Mibu, Japan.
⁶ Department of Pain Management and Palliative Care Medicine, Kyoto Prefectural University of Medicine, Kyoto, Japan.
⁷ Pain Management Clinic, Shiga University of Medical Science Hospital, Otsu, Japan.

PMID: 29737410
PMCID: PMC5973958
DOI: 10.1007/s00540-018-2501-0

Abstract

Neuropathic pain has a substantial effect on quality of life (QOL). The Japanese Society of Pain Clinicians (JSPC) has developed clinical guidelines of pharmacotherapy for neuropathic pain. These guidelines offer clarity on recommendations based on both the most recent scientific evidence and expert opinions. Understanding the concept, disease entity, and burden of neuropathic pain, as well as its screening and diagnosis are important steps before starting pharmacotherapy. As well as other guidelines, the guidelines propose several lines of pharmacotherapies in a step-wise manner. To name a few different points, our guidelines propose an extract from inflamed cutaneous tissue of rabbits inoculated with vaccinia virus, which has been found to be effective for post-herpetic neuralgia in Japan, as one of the second-line drugs. When prescribing opioid analgesics, proposed as the third-line drugs, for neuropathic pain, the guidelines recommend physicians continue evaluations on either abuse or addiction. The guidelines do not recommend concomitant use of nonsteroidal anti-inflammatory drugs and acetaminophen because of lack of clinical evidence of their efficacy. If patients do not respond well to pharmacotherapy, which is prescribed in a step-wise manner, other treatment strategies should be considered to improve patients' activities of daily living and QOL.

Keywords: Guidelines; Neuropathic pain; Pharmacotherapy.

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Conflict of interest statement

Members of the task force have conflicts of interest with respect to this work, but none of them received any financial support to develop these guidelines. Astellas, Abott Japan, Eisai, MSD Japan, Elliquence, Otsuka Pharmacetical, Ono Pharmacetical, Kyowa Hakko Kirin Co., LTD., Sato Healthcare Innovation, Shionogi & Co., LTD., Showa Yakuhin Kako Co., LTD., St. Jude Medical Japan, Daiichi-Sankyo, Daiken Medical Co. LTD., Taisho Toyama Pharmacetical, Sumitomo Dainippon Pharma, Taiho Pharma, Takeda Pharmacetical, Mitsubishi Tanabe Pharma, Tsumura & Co., Teikoku Seiyaku, Terumo, Torii Pharmaceutical, Toray, Drager Medical Japan, Nipro, Eli Lilly Japan, Nippon Kayaku, Nippon Shinyaku Co., LTD., Nippon Zoki, Boehringer Ingelheim Japan, Hisamitsu Pharmaceutical, Bitakain Seiyaku KK., B. Braun Aesculap Japan, Pfizer Japan, Fujifilm sonosite Japan, Boston Scientific Japan, Maruishi Pharmaceutical, Maruho, Mundipharma, Mochida Pharmaceutical, Janssen Pharmacetical KK.

Figures

**Fig. 1**
Neuropathic pain pharmacotherapy algorithm in the Japanese Society of Pain Clinicians

See this image and copyright information in PMC

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References

1. The committee for the Guidelines for the Pharmacologic Management of Neuropathic Pain . Guidelines for the Pharmacologic Management of Neuropathic Pain. 1. Tokyo: Shinko Trading Press; 2011. pp. 1–102.
1. The committee for the Clinical Guidelines of Pharmacotherapy for Neuropathic Pain . The Clinical Guidelines of Pharmacotherapy for Neuropathic Pain. 2. Tokyo: Shinko Trading Press; 2016. pp. 1–258.
1. Jensen TS, Baron R, Haanpaa M, Kalso E, Loeser JD, Rice AS, Treed RD. A new definition of neuropathic pain. Pain. 2011;152:2204–2205. doi: 10.1016/j.pain.2011.06.017. - DOI - PubMed
1. Meyer-Rosberg K, Kvamstrom A, Kinnman E, Gordh T, Nordfors LO, Kristofferson A. Peripheral neuropathic pain: a multidimensional burden for patients. Eur J Pain. 2001;5:379–389. doi: 10.1053/eujp.2001.0259. - DOI - PubMed
1. Leeuw M, Goossens MEJB, Linton SJ, Crombez G, Boersma K, Vlaeyen JW. The fear-avoidance model of musculoskeletal pain: Current state of scientific evidence. J Behav Med. 2007;30:77–94. doi: 10.1007/s10865-006-9085-0. - DOI - PubMed

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[1] The committee for the Guidelines for the Pharmacologic Management of Neuropathic Pain . Guidelines for the Pharmacologic Management of Neuropathic Pain. 1. Tokyo: Shinko Trading Press; 2011. pp. 1–102.

[2] The committee for the Guidelines for the Pharmacologic Management of Neuropathic Pain . Guidelines for the Pharmacologic Management of Neuropathic Pain. 1. Tokyo: Shinko Trading Press; 2011. pp. 1–102.

[3] The committee for the Clinical Guidelines of Pharmacotherapy for Neuropathic Pain . The Clinical Guidelines of Pharmacotherapy for Neuropathic Pain. 2. Tokyo: Shinko Trading Press; 2016. pp. 1–258.

[4] The committee for the Clinical Guidelines of Pharmacotherapy for Neuropathic Pain . The Clinical Guidelines of Pharmacotherapy for Neuropathic Pain. 2. Tokyo: Shinko Trading Press; 2016. pp. 1–258.

[5] Jensen TS, Baron R, Haanpaa M, Kalso E, Loeser JD, Rice AS, Treed RD. A new definition of neuropathic pain. Pain. 2011;152:2204–2205. doi: 10.1016/j.pain.2011.06.017. - DOI - PubMed

[6] Jensen TS, Baron R, Haanpaa M, Kalso E, Loeser JD, Rice AS, Treed RD. A new definition of neuropathic pain. Pain. 2011;152:2204–2205. doi: 10.1016/j.pain.2011.06.017. - DOI - PubMed

[7] Meyer-Rosberg K, Kvamstrom A, Kinnman E, Gordh T, Nordfors LO, Kristofferson A. Peripheral neuropathic pain: a multidimensional burden for patients. Eur J Pain. 2001;5:379–389. doi: 10.1053/eujp.2001.0259. - DOI - PubMed

[8] Meyer-Rosberg K, Kvamstrom A, Kinnman E, Gordh T, Nordfors LO, Kristofferson A. Peripheral neuropathic pain: a multidimensional burden for patients. Eur J Pain. 2001;5:379–389. doi: 10.1053/eujp.2001.0259. - DOI - PubMed

[9] Leeuw M, Goossens MEJB, Linton SJ, Crombez G, Boersma K, Vlaeyen JW. The fear-avoidance model of musculoskeletal pain: Current state of scientific evidence. J Behav Med. 2007;30:77–94. doi: 10.1007/s10865-006-9085-0. - DOI - PubMed

[10] Leeuw M, Goossens MEJB, Linton SJ, Crombez G, Boersma K, Vlaeyen JW. The fear-avoidance model of musculoskeletal pain: Current state of scientific evidence. J Behav Med. 2007;30:77–94. doi: 10.1007/s10865-006-9085-0. - DOI - PubMed

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Executive summary of the Clinical Guidelines of Pharmacotherapy for Neuropathic Pain: second edition by the Japanese Society of Pain Clinicians

Affiliations

Executive summary of the Clinical Guidelines of Pharmacotherapy for Neuropathic Pain: second edition by the Japanese Society of Pain Clinicians

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Conflict of interest statement

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