Guidelines for the Management of Chronic Neuropathic Pain
Neuropathic pain (NP) is a chronic, severe pain which is resistant to over-the-counter analgesics, caused by damage or disease affecting the somatosensory nervous system. It comprises a wide range of heterogeneous conditions. Over millions of people around the globe are affected by this debilitating pain and its prevalence estimates in general population is as high as 7–8 percent.
However, neuropathic pain is very challenging to manage and many patients have pain that is refractory to existing treatments. Over the past several decades, European federation of Neurological Societies (EFNS), Canadian Pain Society Special Interest Group on Neuropathic Pain (NePSIG), Assessment Committee of the Neuropathic Pain Special Interest Group of the International Association for the Study of Pain (IASP), National Institute for Health and Care Excellence (NICE) as well as an expert panel of the Middle East region (MER), Latin American (LA) and South Africa (SA) have developed several Clinical Practice Guidelines (CPGs) for the management of NP. This present study was aimed to determine the quality of these CPGs.
In the present study, reviewers systematically reviewed the available CPGs for NP, focusing on their quality and consistency of the CPG recommendations with the help of Appraisal of Guidelines Research and Evaluation II (AGREE II) instrument to assist physicians in the selection of the appropriate recommendations.
Three reviewers evaluated the selected 16 included CPGs using the AGREE II instrument. None of these CPGs performed satisfactorily and scored lesser than 50% in all six AGREE II instrument domains. The highest score was obtained in the “Clarity and Presentation” domain, followed by the “Scope and Purpose”, “Editorial Independence”, “Rigor of Development”, “Stakeholder Involvement”, and “Applicability” domains. The lowest scores among all six AGREE II domains were obtained for the “Applicability” domain. However, these findings showed consistency in the recommendations stated in the 16 CPGs with respect to drug treatment.
Therefore, more efforts are required to improve the quality of development as well as the presentation of the CPGs and provide more efficacy evidence for the management of patients with neuropathic pain.