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DolorneuropáticoGuiaNICE.pdf

DolorneuropáticoGuiaNICE.pdf

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Published by: David Ochoa on May 18, 2013
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 Issue date: March 2010
NICE clinical guideline 96
Developed by the Centre for Clinical Practice at NICE
Neuropathic pain
The pharmacological managementof neuropathic pain in adults innon-specialist settings
 
NICE clinical guideline 96Neuropathic pain: the pharmacological management of neuropathic painin adults in non-specialist settingsOrdering information
 You can download the following documents fromwww.nice.org.uk/guidance/CG96
The full guideline (this document) – all the recommendations, details of howthey were developed, and reviews of the evidence they were based on.
A quick reference guide – a summary of the recommendations forhealthcare professionals.
‘Understanding NICE guidance’ a summary for patients and carers.For printed copies of the quick reference guide or ‘Understanding NICEguidance’, phone NICE publications on 0845 003 7783 or emailpublications@nice.org.uk and quote:
N2115 (quick reference guide)
N2116 (‘Understanding NICE guidance’).NICE clinical guidelines are recommendations about the treatment and care of people with specific diseases and conditions in the NHS in England andWales. This guidance represents the view of NICE, which was arrived at after carefulconsideration of the evidence available. Healthcare professionals areexpected to take it fully into account when exercising their clinical judgement.However, the guidance does not override the individual responsibility of healthcare professionals to make decisions appropriate to the circumstancesof the individual patient, in consultation with the patient and/or guardian orcarer, and informed by the summary of product characteristics of any drugsthey are considering.Implementation of this guidance is the responsibility of local commissionersand/or providers. Commissioners and providers are reminded that it is theirresponsibility to implement the guidance, in their local context, in light of theirduties to avoid unlawful discrimination and to have regard to promotingequality of opportunity. Nothing in this guidance should be interpreted in a waythat would be inconsistent with compliance with those duties.
National Institute for Health and Clinical Excellence
MidCity Place71 High HolbornLondon WC1V 6NAwww.nice.org.uk
©National Institute for Health and Clinical Excellence, 2010. All rights reserved. This materialmay be freely reproduced for educational and not-for-profit purposes. No reproduction by orfor commercial organisations, or for commercial purposes, is allowed without the expresswritten permission of NICE.
 
 
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 2.1 Introduction ...................................................................................... 252.1.1 Pharmacological treatments, key outcomes and analysis ............ 252.1.2 Health economics......................................................................... 322.1.3 Summaries of included studies .................................................... 332.2 Evidence statements ....................................................................... 392.2.1 Antidepressants ........................................................................... 392.2.2 Anti-epileptics ............................................................................... 422.2.3 Opioids ......................................................................................... 472.2.4 Topical treatments........................................................................ 492.2.5 Comparative trials and combination therapy ................................ 512.2.6 Health economics evidence statements ....................................... 582.3 Clinical evidence reviews ................................................................. 592.3.1 Antidepressants as monotherapy for neuropathic pain ................ 592.3.2 Anti-epileptics as monotherapy for neuropathic pain.................... 652.3.3 Opioid analgesics as monotherapy for neuropathic pain.............. 772.3.4 Topical capsaicin and topical lidocaine as monotherapy forneuropathic pain ..................................................................................... 822.3.5 Comparative trials on pharmacological treatments and combinationtherapy for neuropathic pain ................................................................... 872.4 Health economics evidence review ............................................... 1012.4.1 HTA report: methods .................................................................. 1032.4.2 HTA report: results ..................................................................... 1082.4.3 Discussion .................................................................................. 1112.5 Evidence to recommendations ...................................................... 1182.5.1 Antidepressants ......................................................................... 1182.5.2 Anti-epileptics ............................................................................. 1212.5.3 Opioids ....................................................................................... 1242.5.4 Topical treatments...................................................................... 1262.5.5 Comparative and combination trials ........................................... 1272.5.6 Key principles of care ................................................................. 1292.6 Recommendations ......................................................................... 130
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