{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,9]],"date-time":"2026-07-09T17:58:12Z","timestamp":1783619892933,"version":"3.55.0"},"reference-count":71,"publisher":"FapUNIFESP (SciELO)","issue":"11","license":[{"start":{"date-parts":[[2020,11,1]],"date-time":"2020-11-01T00:00:00Z","timestamp":1604188800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2020,11,1]],"date-time":"2020-11-01T00:00:00Z","timestamp":1604188800000},"content-version":"am","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2020,11,1]],"date-time":"2020-11-01T00:00:00Z","timestamp":1604188800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Arq. Neuro-Psiquiatr."],"abstract":"<jats:p>ABSTRACT Background: Central neuropathic pain (CNP) is often refractory to available therapeutic strategies and there are few evidence-based treatment options. Many patients with neuropathic pain are not diagnosed or treated properly. Thus, consensus-based recommendations, adapted to the available drugs in the country, are necessary to guide clinical decisions. Objective: To develop recommendations for the treatment of CNP in Brazil. Methods: Systematic review, meta-analysis, and specialists opinions considering efficacy, adverse events profile, cost, and drug availability in public health. Results: Forty-four studies on CNP treatment were found, 20 were included in the qualitative analysis, and 15 in the quantitative analysis. Medications were classified as first-, second-, and third-line treatment based on systematic review, meta-analysis, and expert opinion. As first-line treatment, gabapentin, duloxetine, and tricyclic antidepressants were included. As second-line, venlafaxine, pregabalin for CND secondary to spinal cord injury, lamotrigine for CNP after stroke, and, in association with first-line drugs, weak opioids, in particular tramadol. For refractory patients, strong opioids (methadone and oxycodone), cannabidiol\/delta-9-tetrahydrocannabinol, were classified as third-line of treatment, in combination with first or second-line drugs and, for central nervous system (CNS) in multiple sclerosis, dronabinol. Conclusions: Studies that address the treatment of CNS are scarce and heterogeneous, and a significant part of the recommendations is based on experts opinions. The CNP approach must be individualized, taking into account the availability of medication, the profile of adverse effects, including addiction risk, and patients' comorbidities.<\/jats:p>","DOI":"10.1590\/0004-282x20200166","type":"journal-article","created":{"date-parts":[[2020,12,14]],"date-time":"2020-12-14T19:30:13Z","timestamp":1607974213000},"page":"741-752","source":"Crossref","is-referenced-by-count":20,"title":["Pharmacological treatment of central neuropathic pain: consensus of the Brazilian Academy of Neurology"],"prefix":"10.1590","volume":"78","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0254-8497","authenticated-orcid":false,"given":"Rog\u00e9rio Adas Ayres de","family":"Oliveira","sequence":"first","affiliation":[{"name":"Universidade de S\u00e3o Paulo, Brazil; Academia Brasileira de Neurologia, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7870-3820","authenticated-orcid":false,"given":"Abrah\u00e3o Fontes","family":"Baptista","sequence":"additional","affiliation":[{"name":"Universidade Federal do ABC, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0255-4379","authenticated-orcid":false,"given":"Katia Nunes","family":"S\u00e1","sequence":"additional","affiliation":[{"name":"Escola Bahiana de Medicina e Sa\u00fade P\u00fablica, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5239-5935","authenticated-orcid":false,"given":"Luciana Mendon\u00e7a","family":"Barbosa","sequence":"additional","affiliation":[{"name":"Universidade de S\u00e3o Paulo, Brazil; Academia Brasileira de Neurologia, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3516-485X","authenticated-orcid":false,"given":"Osvaldo Jos\u00e9 Moreira do","family":"Nascimento","sequence":"additional","affiliation":[{"name":"Academia Brasileira de Neurologia, Brazil; Universidade Federal Fluminense, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7660-3970","authenticated-orcid":false,"given":"Clarice","family":"Listik","sequence":"additional","affiliation":[{"name":"Universidade de S\u00e3o Paulo, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8799-0750","authenticated-orcid":false,"given":"Xavier","family":"Moisset","sequence":"additional","affiliation":[{"name":"Universit\u00e9 Clemont Auvergne, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7974-6045","authenticated-orcid":false,"given":"Manoel Jacobsen","family":"Teixeira","sequence":"additional","affiliation":[{"name":"Universidade de S\u00e3o Paulo, Brazil; Universidade de S\u00e3o Paulo, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3411-632X","authenticated-orcid":false,"given":"Daniel Ciampi de","family":"Andrade","sequence":"additional","affiliation":[{"name":"Universidade de S\u00e3o Paulo, Brazil; Academia Brasileira de Neurologia, Brazil; Universidade de S\u00e3o Paulo, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"530","published-online":{"date-parts":[[2020,11]]},"reference":[{"issue":"1","key":"ref1","doi-asserted-by":"crossref","first-page":"19","DOI":"10.1097\/j.pain.0000000000001384","article-title":"Chronic pain as a symptom or a disease: the IASP Classification of Chronic Pain for the International Classification of Diseases (ICD-11)","volume":"160","author":"Treede RD","year":"2019","journal-title":"Pain"},{"issue":"6","key":"ref2","article-title":"Prevalence of chronic pain in developing countries: systematic review and meta-analysis","volume":"4","author":"S\u00e1 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