Guideline registry — neuropathic pain¶
Last checked: 2026-10-21 (periodic sweep: PubMed guideline/consensus searches for records entered 2026-08-28 to 2026-10-21 and a Europe PMC guideline-title query found no new or updated neuropathic-pain society guideline; NICE CG173 re-fetched, still published 20 November 2013 and last updated 22 September 2020; ASCO, MASCC and IASP/NeuPSIG web pages returned HTTP 403 to automated requests and could not be checked directly; one external quality appraisal of zoster/PHN guidelines added to the gaps table). Previously, 2026-09-30 (periodic sweep: PubMed guideline/consensus searches for records entered since 2026-08-28 found no new society guideline; NICE CG173 re-fetched; one missing 2025 document added). PMIDs were resolved live through PubMed E-utilities during the build or sweep that added them; web-only documents are excluded pending a dedicated URL-verification sweep. “Consensus” denotes expert-panel methodology and is not treated as equivalent to a formally graded guideline.
Master table¶
| Body | Year | Region | Scope | Citation | Status |
|---|---|---|---|---|---|
| NeuPSIG/IASP | 2015 | International | Pharmacotherapy | PMID 25575710 | Foundational; recommendations revised → NeuPSIG 2025 (PMID 40252663) |
| NeuPSIG/IASP | 2025 | International | Pharmacotherapy and non-invasive neuromodulation | PMID 40252663 | Current |
| EFNS | 2010 | Europe | Pharmacotherapy | PMID 20402746 | Superseded in parts → newer national/NeuPSIG guidance |
| EAN–EFIC–NeuPSIG | 2023 | Europe/international | Assessment | PMID 37253688 | Current |
| French expert group | 2020/2021 | France | Drug, non-drug and intervention | PMID 32276788; 34332778 | Current |
| AAN | 2022 | United States | Painful diabetic polyneuropathy | PMID 34965987 | Current |
| Canadian Pain Society | 2014 | Canada | Chronic neuropathic pain drugs | PMID 25479151 | Current; update watch |
| ASCO | 2020 | International/US | CIPN | PMID 32663120 | Current |
| EAN | 2019 | Europe | Trigeminal neuralgia | PMID 30860637 | Current |
| AAPT | 2017 | International/US | Central neuropathic pain criteria | PMID 28666966 | Current criteria |
| EFNS/PNS | 2010 | Europe/international | Skin biopsy in small-fiber neuropathy | PMID 20642627 | Current foundational method |
| European expert panel | 2020 | Europe | rTMS | PMID 31901449 | Current update |
| Canadian SCI synthesis | 2016 | Canada | Pharmacologic SCI pain | PMID 26797114 | Update watch |
| German Society of Neurology (DGN) | 2019/2020 | Germany | Diagnosis and non-interventional treatment | PMID 33324922 | Current published summary; update watch |
| Brazilian Academy of Neurology | 2020 | Brazil | Central neuropathic pain pharmacotherapy | PMID 33331468 | Current consensus; limited central-pain evidence |
| Italian Neurological Society Neuropathic Pain SIG | 2019 | Italy | Definition of pharmacoresistant neuropathic pain | PMID 30941628 | Current Delphi consensus |
| Chinese Association for the Study of Pain | 2021 | China | Ion-channel drugs | PMID 33850929 | Current expert consensus |
| PEER | 2022 | Canada | Primary-care chronic pain, including neuropathic pain | PMID 35292455 | Current guideline; broad chronic-pain scope |
| Spanish Pain Society Neuropathic Pain Task Force | 2022 | Spain | Interventional management | PMID 35630044 | Current Delphi consensus |
| Change Pain Latin America panel | 2018 | Latin America | Regional adaptation/selection of neuropathic-pain guidance | PMID 29025132 | Regional consensus; endorses NeuPSIG 2015 |
| Chinese Association of Rehabilitation Medicine panel | 2021 | China | Exercise across neuropathic-pain etiologies | PMID 34901069 | Expert consensus built from 8 reviews and 21 RCTs |
| NICE CG173 | 2013; updated 2020 | United Kingdom | Pharmacotherapy in non-specialist settings | PMID 20335333; NICE CG173, accessed 2026-08-30 | Current; replaced CG96; safety links updated subsequently |
| NeuPSIG/IASP | 2013 | International | Interventional management | PMID 23748119 | Foundational; update needed |
| South African expert panel | 2012 | South Africa | Diagnosis and multimodal treatment | PMID 22554341 | Regional consensus; update needed |
| Polish Association for the Study of Pain / Polish Neurological Society | 2014 | Poland | Diagnosis and treatment (two parts) | PMID 25168326; 25482254 | Regional recommendations; update needed |
| Japanese Society of Pain Clinicians | 2018 | Japan | Pharmacotherapy, second edition | PMID 29737410 | Current published English summary; update watch |
| CanPainSCI | 2021/2022 | Canada | SCI screening, diagnosis, treatment and models of care | PMID 35124700 | Current update; supersedes 2016 series |
Per-guideline notes¶
- NeuPSIG 2015: 229 trials; first-line TCAs, SNRIs, gabapentin and pregabalin; modest NNTs and publication-bias concern (PMID 25575710).
- NeuPSIG 2025: 313 placebo-controlled trials (284 pharmacological, 29 neuromodulation; search to 12 February 2024); strong first-line recommendation for TCAs, α2δ-ligands and SNRIs; weak second-line for capsaicin 8% patches, capsaicin cream and lidocaine 5% plasters; weak third-line for botulinum toxin A, rTMS and opioids; GRADE certainty moderate for the first-line classes, low for opioids and rTMS, very low for capsaicin cream and lidocaine plasters (PMID 40252663). Added in the 2026-09-30 sweep: the record was already in the bibliography but had not been registered as the revision of NeuPSIG 2015.
- EAN–EFIC–NeuPSIG 2023: lesion-based history/examination with targeted neurophysiology, imaging, biopsy and QST (PMID 37253688).
- French guidance: places pregabalin and combinations later than NeuPSIG and integrates TENS, psychotherapy, rTMS and SCS (PMID 32276788).
- AAN diabetic guideline: choose among effective classes, switch class after failure and avoid opioids (PMID 34965987).
- ASCO CIPN: no established preventive drug; duloxetine for painful established CIPN; consider chemotherapy modification for functional toxicity (PMID 32663120).
- DGN 2019/2020: combines lesion confirmation with small-fiber tests; lists pregabalin, gabapentin, duloxetine and amitriptyline first-line, topical capsaicin/lidocaine second-line or initial options for focal pain, and opioids third-line (PMID 33324922).
- Brazilian central-pain consensus: 44 studies were identified, 20 qualitatively synthesized and 15 meta-analyzed; gabapentin, duloxetine and TCAs were placed first-line, with condition-specific roles for pregabalin after SCI and lamotrigine after stroke, but the panel states that much guidance rests on expert opinion (PMID 33331468).
- Italian pharmacoresistance consensus: defines resistance as failing to reach 50% pain reduction or a ≥2-point Patient Global Impression of Change improvement after all recommended drug classes, each used for at least one month after titration to the highest tolerated dose (PMID 30941628).
- Chinese ion-channel consensus: provides drug-specific practice recommendations for carbamazepine, oxcarbazepine, lidocaine, bulleyaconitine A, pregabalin and gabapentin; its consensus design and country-specific formulary context limit transferability (PMID 33850929).
- PEER 2022: used three reviews covering 285 RCTs and required responder outcomes; unlike neuropathic-pain-specific panels, it treats several chronic-pain conditions together and judges exercise benefit unclear specifically for neuropathic pain while advising that opioid/cannabinoid harms likely outweigh benefits for most covered conditions (PMID 35292455).
- Spanish interventional consensus: 35 experts entered round 1 and 29 round 2; consensus was reached for 20/26 statements, supporting graded escalation while explicitly describing the evidence as sparse and fragmented (PMID 35630044).
- Latin American adaptation: screened 674 neuropathic-pain guideline records, shortlisted 14 and endorsed NeuPSIG 2015 as the best regional fit, supplemented by implementation considerations rather than a new evidence synthesis (PMID 29025132).
- Exercise consensus: 8 systematic reviews and 21 RCTs informed ten etiology-specific statements, but its broad recommendation for exercise contrasts with PEER’s conclusion that benefit is unclear for neuropathic pain (PMID 34901069; PMID 35292455).
- NICE CG173: offers amitriptyline, duloxetine, gabapentin or pregabalin initially for neuropathic pain other than trigeminal neuralgia, requires early and regular review of pain, participation, wellbeing and harms, and advises tapering when switching or withdrawing. The guideline was published in 2013, last substantively updated in 2020, and has received later safety-link amendments ([NICE — “Neuropathic pain in adults: pharmacological management in non-specialist settings”, https://www.nice.org.uk/guidance/cg173, accessed 2026-08-30; PMID 20335333).
- NeuPSIG interventional 2013: found no basis for a strong recommendation; made weak recommendations for epidural injection in herpes zoster, steroid injection for radiculopathy and SCS for failed-back-surgery syndrome or CRPS-I, while recommending against sympathetic blocks for PHN and radiofrequency lesions for radiculopathy (PMID 23748119).
- South African panel: recommends gabapentinoids, low-dose TCAs and SNRIs first-line for peripheral pain, switching or combining after an insufficient 2–4-week response, reserving opioids for later, and prioritizing trials in painful HIV-associated sensory neuropathy (PMID 22554341).
- Polish two-part recommendations: place history and a somatosensory examination at the diagnostic core and acknowledge that scarcity of high-quality syndrome-specific trials weakens treatment recommendations; their inclusion of opioids among first-line options differs materially from NeuPSIG 2015 and more recent AAN/PEER positions (PMID 25168326; PMID 25482254).
- Japanese second edition: uses stepwise pharmacotherapy but includes a Japan-specific rabbit-skin extract for PHN as second-line, places opioids third-line with repeated abuse/addiction assessment, and does not recommend NSAIDs or acetaminophen for lack of efficacy evidence (PMID 29737410).
- CanPainSCI 2021 update: reviewed 46 additional articles, added three screening/diagnosis and eight treatment recommendations, and applied AGREE II and GRADE; it supersedes the 2016 CanPainSCI series for current SCI-specific practice (PMID 35124700).
Disagreements and gaps¶
| Topic | Disagreement/gap |
|---|---|
| Pregabalin | First-line in NeuPSIG 2015 and, as part of the α2δ-ligand class, in NeuPSIG 2025; second-line in French guidance |
| Topical lidocaine | Low evidence but favorable safety creates different placement |
| Opioids | Later-line wording differs; long-term evidence remains inadequate |
| Devices | Indications and certainty vary; long-term sham-controlled evidence sparse |
| Phenotyping | Encouraged for research; no validated prescribing algorithm |
| Combination therapy | OPTION-DM supports rescue, but most guidelines predate it; NeuPSIG 2025 postdates it but synthesized placebo-controlled trials only and makes no sequencing recommendation in its abstract |
| Exercise | Chinese rehabilitation consensus recommends appropriately prescribed exercise across etiologies; PEER finds neuropathic-pain benefit unclear |
| Pharmacoresistance | Italian Delphi definition requires failure across all recommended classes; other documents use looser “refractory” language or no operational definition |
| Central pain | Brazilian consensus offers condition-specific sequencing, but explicitly relies partly on expert opinion because trials are sparse and heterogeneous |
| Interventions | Spanish Delphi consensus supports graded escalation for selected syndromes; evidence grading and sham-controlled durability remain insufficient |
| Regional transfer | Latin American, Chinese, Brazilian and German recommendations reflect different availability, reimbursement and panel methods; apparent disagreement may be contextual rather than biological |
| Initial opioids | Polish 2014 recommendations included opioids among first-line drugs; NeuPSIG 2015, NICE, AAN and PEER place them later, restrict them, or judge harms to outweigh benefits |
| Intervention certainty | NeuPSIG 2013 could make only four weak positive recommendations; Spanish 2022 Delphi consensus is more permissive for selected syndromes but does not replace sham-controlled comparative evidence |
| Local products | Japanese guidance includes a country-specific rabbit-skin extract for PHN, illustrating why formulary-based recommendations do not automatically transfer internationally |
| Zoster/PHN guideline quality | An AGREE II appraisal of 11 herpes zoster/PHN guidelines (search to 2025-01-10; 10 Western, 1 traditional-medicine) rated only JASP 2021 high quality, 4 moderate and 6 low; Applicability scored lowest (10.9%), and Editorial Independence and Stakeholder Involvement scored below 30% (Hong 2026, PMID 42888535). The individual guidelines are not yet in this registry's master table. |
Watch list¶
- A NeuPSIG position on combination/sequencing evidence (OPTION-DM) and on implanted devices; the 2025 pharmacotherapy and non-invasive neuromodulation revision (PMID 40252663) covers neither.
- Any NeuPSIG working group or revision of the 2016 grading system following the 2026 critique and reply (PMID 42550034; PMID 42765589).
- Updated international CIPN prevention/treatment guidance. Two 2026 inputs now bear on ASCO 2020's “no established prevention”: CryoPac, a between-person cryotherapy RCT whose primary endpoint was not met (PMID 42838271), and a meta-analysis supporting planned reduction of oxaliplatin exposure (PMID 42801795).
- Living guidance on implanted stimulation, explant and long-term safety.
- Multisociety small-fiber neuropathy diagnostic harmonization.
- Formal evidence-graded updates of the 2019/2020 DGN, 2019 Italian pharmacoresistance and 2021 Chinese ion-channel documents.
- Reconciliation of the PEER and Chinese rehabilitation positions on exercise using etiology-specific responder and function outcomes.
- A current evidence-graded successor to NeuPSIG’s 2013 interventional recommendations, incorporating modern SCS waveforms, DRG stimulation, comparative harms, explant and cost.
- Updated English-accessible versions of South African, Polish and Japanese recommendations and an explicit map of which differences arise from evidence versus availability.