From data to decision: critical appraisal of the 2025 NeuPSIG review and recommendations on neuropathic pain treatments

Abstract

The 2025 recommendations of the Neuropathic Pain Special Interest Group (NeuPSIG) constitute a methodologically rigorous update on the management of neuropathic pain, integrating a large-scale meta-analysis of pharmacological treatments and neuromodulation intervention. Yet, they also expose persistent challenges: under-representation of common aetiologies, a narrow scope of neuromodulation, reliance on placebo-controlled designs, and conflicts of interest that might affect the perception of neutrality. Addressing these issues requires not only transparency, but also broader inclusion of neglected conditions, adaptation of methods to nonpharmacological interventions, and attention to diverse healthcare contexts. We aim to both to critically appraise the current guidelines and to encourage broader reflection on how future research and guideline development could foster greater relevance and generalisation.

Keywords: evidence synthesis; guidelines; neuromodulation; neuropathic pain; publication bias.