Combination Pharmacotherapy for Neuropathic Pain: Is it Better than Monotherapy?

Neuropathic pain comprises a wide variety of conditions including diabetic neuropathic pain, postherpetic neuralgia, HIV-associated polyneuropathy, low back pain with a neuropathic component, complex regional pain syndrome, and neuropathic cancer pain. Neuropathic pain is among the most difficult forms of chronic pain to manage successfully. Research indicates that only 40%-60% of patients with neuropathic pain receive clinically significant pain relief from any single analgesic medication.

In clinical practice, more than 50% of patients with neuropathic pain appear to be receiving at least 2 analgesic medications with combinations of antidepressants, anticonvulsants, and opioids being the most common. A recent systematic review and meta-analysis sought to determine if the literature indicates that patients may receive better analgesia if combinations of medications are utilized compared to each of the medications alone. Below, find key takeaways for primary care clinicians.

References:

1. Balanaser M, Carley M, Baron R, et al. Combination pharmacotherapy for the treatment of neuropathic pain in adults: Systematic review and meta-analysis. Pain. 2023;164:230-251.
2. Kalso E. Systematic review on combination pharmacotherapy: methodological rigor but no pharmacology. Pain. 2023;164:221-222.