treatmentsiasp

GabapentinMSFnoticestheproposalofInternationalAssociationfortheStudyofPain(IASP),NeuropathicPainSpecialInterestGroupoftheIASP,andInternationalAssociationforHospiceandPalliativeCaretoincludegabapentinintheWHOModelListofEssentialMedicines,asananalgesicmedicineforthemanagementofneuropathicpain(centralandperipheral)inadults.
Neuropathicpainiscommonlyassociatedwithpost-surgicalpain,HIV-AIDS,herpeszoster,diabetes,backpain.
MSFwouldliketodrawtheattentionoftheExpertCommitteetothefollowingpoints:-Forthetreatmentofneuropathicpain,onlyamitriptyline,recommendedasfirst-linetherapy,isincludedintheWHOModelListofEssentialMedicines(section2.
3"Medicinesforothercommonsymptomsinpalliativecare").
-Forthetreatmentofneuropathicpain,mostofthecountrieslistedmorphine,includedintheWHOModelListofEssentialMedicines(section2"Medicinesforpainandpalliativecare",2.
2"opioidsanalgesics").
Butstrongopioidsarerecommendedasthird-linetreatmentsforneuropathicpain,fortheevidencesupportingtheuseofmorphineandstrongopioidsinneuropathicpainisoflowquality,andquestionsabouttheirsafety(adverseeffects,dependence)remain.
-Gabapentinisrecommendedasafirst-linetreatmentforneuropathicpaininnationalandinternationalguidelines,includingNationalInstituteforHealthandCareExcellence(NICE,2013updated2017),EuropeanFederationofNeurologicalSocieties(EFNS)guidelinesonthepharmacologicaltreatmentofneuropathicpain(2010revision),Pharmacologicalmanagementofchronicneuropathicpain:revisedconsensusstatementfromtheCanadianPainSociety(2014).
-GabapentingrantedFDAandEMEAapprovalforepilepsy,FDAapprovalforpost-herpeticneuralgiaandEMEAapprovalforneuropathicpain.
-Misuseandabuseofgabapentinaredescribed:ADecadeofGabapentinoidMisuse:"AnAnalysisoftheEuropeanMedicinesAgency's"SuspectedAdverseDrugReactions"Database",Chiappini,S.
,Schifano,F.
(2016);"AbuseandMisuseofPregabalinandGabapentin",Evoy,K.
E.
,Morrison,M.
D.
,Saklad,S.
R.
(2017);"Gabapentinandpregabalin:abuseandaddiction",PrescrireInt2012.
InternationalOfficeRuedeLausanne78CP1161211Geneva21SwitzerlandPhone:+41(0)228498400Fax:+41(0)228498404www.
msf.
org-Publicationbiasesinstudiesaredescribed,andoff-labelpromotionledtolawsuitsundertheUSFalseClaimsAct:"ReportingandotherbiasesinstudiesofNeurontinformigraine,psychiatric/bipolardisorders,nociceptivepain,andneuropathicpain",KayDickersin,2008;"TheNeurontinLegacy-MarketingthroughMisinformationandManipulation",C.
SethLandefeld,MichaelA.
Steinman,NEJM,2009.
Inlightofalltheseelements,MSFwouldliketoemphasizethatacomprehensivereviewofefficacy,safety,misuseandabusepotentialofgabapentinisrequiredtoascertainitsplaceinthetreatmentofneuropathicpain.
ForMédecinsSansFrontièresMyriamHenkens,MD,MPHInternationalMedicalCoordinator