Update in the pharmacological treatment of neuropathic pain

We provide an updated review of the pharmacological treatment of neuropathic pain, with emphasis on the latest evidence-based recommendations. Drugs proposed as first line include tricyclic antidepressants (particularly amitriptyline), serotonin-noradrenaline reuptake inhibitors (particularly duloxetine), pregabalin and gabapentin. Second-line treatments include 5% lidocaine medicated plasters and capsaicin 8% patches, only for peripheral neuropathic pain and tramadol; whereas potent opioids and botulinum toxin A (for peripheral neuropathic pain) are considered third-line treatments. Future perspectives include the development of new drugs and a more personalised therapeutic approach, which is made possible by recent progress in the assessment and understanding of neuropathic pain. (C) 2019 Sociedad Espanola de Medicos de Atencion Primaria (SEMERGEN). Published by Elsevier Espana, S.L.U. All rights reserved.