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A Delphi consensus statement of the Neuropathic Pain Special Interest Group of the Italian Neurological Society on pharmacoresistant neuropathic pain

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Abstract

To improve patient care and help clinical research, the Neuropathic Pain Special Interest Group of the Italian Neurological Society appointed a task force to elaborate a consensus statement on pharmacoresistant neuropathic pain. The task force included 19 experts in neuropathic pain. These experts participated in a Delphi survey consisting of three consecutive rounds of questions and a face-to-face meeting, designed to achieve a consensus definition of pharmacoresistant neuropathic pain. In the three rounds of questions, the participants identified and described the main distinguishing features of pharmacoresistance. In the face-to-face meeting the participants discussed the clinical features determining pharmacoresistance. They finally agreed that neuropathic pain is pharmacoresistant when “the patient does not reach the 50% reduction of pain or an improvement of at least 2 points in the Patient Global Impression of Change, having used all drug classes indicated as first, second, or third line in the most recent and widely agreed international guidelines, for at least 1 month after titration to the highest tolerable dose.” Our consensus statement might be useful for identifying eligible patients for invasive treatments, and selecting patients in pharmacological trials, thus improving patient care and helping clinical research.

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Acknowledgements

Giorgio Cruccu received received honoraria as speaker, member of advisory boards, or consultant from Alfasigma, Angelini, Biogen, and Lilly.

Pierangelo Geppetti received honoraria for consultancy or speaking at symposia and research financial support from Amgen Allergan, Chiesi, Elettrocore, IBSA, Menarini, Novartis, Pfizer, Sanofi, and TEVA.

Marina de Tommaso received honoraria for speaking at symposia or research financial supports from Allergan, Novartis, and Mundipharma.

Diego Fornasari has received honoraria as speaker, member of advisory boards, or consultant from Angelini, Alfasigma, Abiogen, Grunenthal, Pfeizer, and SPA.

Paolo Marchettini received honoraria for speaking at symposia and training the field force from Angelini, Chiesi, Epitech, Eli Lilly, and Pfizer.

Enrico Polati received honoraria for speaking at symposia from Grunenthal.

Claudio Solaro served as advisory board the following companies: Biogen Idec, Merck Serono, Almirall, and GW Pharma. He received speaking honoraria from Biogen Idec, Merck Serono. He received research grants and support by the FISM (Fondazione Italiana Sclerosi Multipla).

Stefano Tamburin received honoraria for speaking at symposia or research financial support from Epitech, FB Health, Mundipharma, and Pfizer.

Andrea Truini received honoraria for speaking at symposia or research financial supports from Alpha-Sigma, Angelini, Epitech, FB Health, and Pfizer.

The other authors reported no conflict of interest to declare.

The face-to-face meeting was held during the congress of the Italian Society of Clinical Neurophysiology, receiving an unconditioned support by Pfizer.

Author information

Authors and Affiliations

  1. Clinical Neurophysiology, Neuroscience Department, AOU Città della Salute e della Scienza di Torino, Torino, Italy

    P. Ciaramitaro

  2. Department of Human Neuroscience, University Sapienza, Viale Università 30, 00185, Rome, Italy

    G. Cruccu & Andrea Truini

  3. Applied Neurophysiology and Pain Unit, Basic Medical Science, Neuroscience and Sensory System-SMBNOS-Department, Aldo Moro University, Bari, Italy

    M. de Tommaso

  4. Neurological Unit 1, Fondazione I.R.C.C.S. Istituto Neurologico Carlo Besta, 20133, Milan, Italy

    G. Devigili

  5. Department of Medical Biotechnology and Translational Medicine, Università degli Studi di Milano, Milan, Italy

    D. Fornasari

  6. Department of Health Sciences, Section of Clinical Pharmacology and Headache Center, University of Florence, Florence, Italy

    P. Geppetti & P. Marchettini

  7. Neurology and Pain Medicine Center, Humanitas, San Pio X Clinic, Milan, Italy

    M. Lacerenza

  8. Neuroalgology Unit, IRCCS Foundation, “Carlo Besta” Neurological Institute, Milan, Italy

    G. Lauria

  9. Department of Biomedical and Clinical Sciences “Luigi Sacco”, University of Milan, Milan, Italy

    G. Lauria

  10. Pain Therapy Unit, “A. Businco” Hospital, ASL 8, 09134, Cagliari, Italy

    S. Mameli

  11. Pain Medicine Centre, Ospedale San Raffaele, Milan, Italy

    P. Marchettini

  12. University of Applied Science of Southern Switzerland, Pain Pathophysiology and Therapy Programme, Manno, Switzerland

    P. Marchettini

  13. Neurology Department, Skin Biopsy Laboratory, Istituti Clinici Scientifici Maugeri IRCCS, Via Maugeri, 4, 27100, Pavia, Italy

    M. Nolano

  14. Department of Neurosciences, Reproductive Sciences and Odontostomatology, University Federico II of Naples, Naples, Italy

    M. Nolano

  15. Department of Surgery, Dentistry, Maternal and Infant Sciences, Pain Therapy Centre, Verona University Hospital, Verona, Italy

    E. Polati

  16. Istituti Clinici Scientifici Maugeri IRCCS, Institute of Telese Terme (BN), Telese Terme, Italy

    V. Provitera

  17. Neurology Unit, Azienda Ospedaliera Ospedali Riuniti Villa Sofia Cervello, Palermo, Italy

    M. Romano

  18. CRRF Mons L Novarese Moncrivello (VC), Moncrivello, Italy

    C. Solaro

  19. Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy

    S. Tamburin

  20. Neurology Unit, Azienda Ospedaliero-Universitaria, Ferrara, Italy

    V. Tugnoli

  21. Division of Neurology, Ospedale Pediatrico Bambino Gesú, IRCCS, Rome, Italy

    M. Valeriani

  22. Center for Sensory-Motor Interaction, Aalborg University, Aalborg, Denmark

    M. Valeriani

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  1. P. Ciaramitaro
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  2. G. Cruccu
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On behalf of the Neuropathic Pain Special Interest Group of the Italian Neurological Society

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Correspondence to Andrea Truini.

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Ciaramitaro, P., Cruccu, G., de Tommaso, M. et al. A Delphi consensus statement of the Neuropathic Pain Special Interest Group of the Italian Neurological Society on pharmacoresistant neuropathic pain. Neurol Sci 40, 1425–1431 (2019). https://doi.org/10.1007/s10072-019-03870-y

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