NEUROPATHIC PAIN CALCULATOR FAQ
About This Calculator
Why should I use this calculator?
Using this calculator allows patients and healthcare providers to make an informed decision on treatment and to have a tool to discuss:
- How many people are expected to experience a reduction in their pain with the chosen treatment compared to no treatment.
- Typical side effects of each treatment.
- Other things to consider, such as duration of therapy and costs of medication.
How do I use the calculator?
To use the calculator, select a medication or therapy from the left-hand side of the screen.
After clicking on a therapy, information regarding the treatment will appear on the right-hand side of the screen. The smiley-face graphic will give you an idea of how many people benefit from the therapy, the side effects of the medication and other things you should consider before starting this therapy (eg. cost).
What does the smiley-face graphic tell me?
- Represents the percent (%) of people who have about a 30% improvement in their pain because of the selected therapy.
- Represents the percent (%) of people who will have improvement in their pain because of fluctuation or the ‘placebo' effect. This improvement is not due to the selected therapy.
- Represents the percent (%) of people who will not achieve improvement in their pain, regardless of treatment or placebo effects.
Why do 25-30% of people get better without therapy? What does this mean?
Individuals who see improvement in their pain without therapy may be experiencing a natural change in their health condition or something called a “placebo effect”. In addition, an improvement in pain control may be due to a number of factors, including the support of friends, family and your healthcare team.
What does "meaningful pain relief" mean?
With continued treatment, people living with neuropathic pain can expect to achieve a reduction in their pain, often around 25-30%, that may allow them to experience improved sleep, function, ability to work, and mood. The goal of treatment is to improve quality of life.
What happens if the treatment I choose doesn't work?
For many people living with chronic pain conditions, one medication or the first medication tried may not work very well. In this case, a second or third therapy can be tried.
It’s important to remember that a ‘one size fits all’ approach does not work for treating neuropathic pain. It may take a few tries to find a treatment that works well for each individual.
Where do the estimated benefits come from?
To better understand how much a person will improve on a therapy, over and above what is expected in the placebo group, we recalculated all treatment effects to reflect a 25% response from placebo. We chose 25% because it was the approximate placebo response from a variety of studies on treatments for neuropathic pain.
We calculated the treatment response using the following formula:
(Relative Benefit) x (Placebo Response)
By recalculating all treatment effects to reflect a 25% placebo response rate, it allows for a comparison between therapies when patients and physicians talk about what therapies are the best option for treating a patient’s neuropathic pain.
The calculator can be adjusted for a different placebo rate ranging from 20% to 35%. The table below shows the effect of a different placebo rate.
| Placebo Response Rate | ||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 20% | 25% | 30% | 35% | |||||||||
| Amitriptyline Elavil® | 20% | 20% | 60% | 25% | 25% | 50% | 30% | 30% | 40% | 35% | 35% | 30% |
| Cannabinoids Nabiximols, Nabilone, medical marijuana | 7% | 20% | 73% | 9% | 25% | 66% | 11% | 30% | 59% | 13% | 35% | 52% |
| Duloxetine Cymbalta® | 11% | 20% | 69% | 13% | 25% | 62% | 16% | 30% | 54% | 19% | 35% | 46% |
| Gabapentin Neurotin® | 15% | 20% | 65% | 18% | 25% | 57% | 22% | 30% | 48% | 26% | 35% | 39% |
| High-Dose Opioids morphine, oxycodone | 14% | 20% | 66% | 18% | 25% | 57% | 21% | 30% | 49% | 25% | 35% | 40% |
| Pregabalin Lyrica® | 13% | 20% | 67% | 16% | 25% | 59% | 19% | 30% | 51% | 23% | 35% | 42% |
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Improve with
treatment -
Improve with
control -
Do not
improve
Where does the information in the "Things to Consider" section come from? What does it mean?
This information came from sources, including RxFiles and the interactive drug benefit list, provided by Alberta Blue Cross.
This information is not meant to replace advice or instructions provided from a health professional. This information is simply a tool that can help when deciding what medication or treatment to try for treating neuropathic pain.
For example: If two medications worked equally well and both had few side effects, cost may be a factor in determining which medication is right for you. Also, it might be important when you take a medication if it causes a person to feel sleepy (take at night) or awake (take during the day).
Conflicts of Interest
Authors do not have any commercial conflicts of interest to declare.
References and Additional Resources
References for FAQ
- Taylor D. Neuropathic Pain. https://www.emedicinehealth.com/neuropathic_pain_nerve_pain/page2_em.htm. Updated November 2017. Accessed January 13, 2018.
- Moore RA, Derry S, Aldington D, Cole P, Wiffen PJ. Amitriptyline for neuropathic pain in adults. Cochrane Database Syst Rev. 2015 Jul 6;(7):CD008242.
- Watson P. Neuropathic Pain. https://www-e-therapeutics-ca.login.ezproxy.library.ualberta.ca/search. Updated May 2017. Accessed January 13, 2018.
- Miller F, Colloca L, Kaptchuk T. The placebo effect: illness and interpersonal healing. Perspect Biol Med. 2009;52(4):518-39.
- Moore A, Derry S, Eccleston C, Kalso E. Expect analgesic failure; pursue analgesic success. BMJ. 2013;346.
- Alberta Health. Interactive Drug Benefit List https://idbl.ab.bluecross.ca/idbl/load.do. Updated January 2018. Accessed on January 14th, 2018.
- RxFiles Drug Comparison Charts – 11th Edition. Editors Brent Jensen, Loren Regier, Lynette Kosar. Saskatoon, SK: Saskatoon Health Region; Mar 2017. Available from www.RxFiles.ca.
- Lexicomp Online, Wolters Kluwer Clinical Drug Information, Inc,; 2018; December 14, 2017
What else should be done if a person is experiencing a lot of pain?
Always take medication as prescribed by a healthcare provider. Speak to a healthcare provider if a treatment is not helping.
Other non-pharmacological therapies (e.g. exercise or counselling) may work with medications to help improve and manage pain symptoms.
Are other resources for chronic pain available?
One of the programs for management of chronic pain available in Alberta is called “Better Choices, Better Health”. This program involves free workshops for people living with chronic pain.
Link: https://www.albertahealthservices.ca/info/service.aspx?id=1008382 (Free workshops for people living with chronic pain)
Pain Connection Live Conference Calls are free conference calls held for people living with chronic pain, health care providers, caregivers or interested individuals. These calls cover different topics on how to successfully cope and live with chronic pain.
Afternoon calls: First Thursday of every month, 1:30-2:30 PM EST
Evening calls: Second Thursday of every month, 7:00-8:00 PM EST
Link: http://www.painconnection.org/blog/pain-connection-live
Online resource for people living with neuropathic pain.
Link: https://www.painhq.org
Online resources for articles about various pain types and management.
Guidelines used to Determine Therapies for Evidence Review
- NICE Neuropathic pain in adults: pharmacological management in non-specialist settings. National Institute for Health and Care Excellence. 20 Nov 2013 (Updated Feb 2017).
- D Moulin, A Boulanger, Aj Clark, Clark H, Dao T, Finley GA, et al. Pharmacological management of chronic neuropathic pain: Revised consensus statement from the Canadian Pain Society. Pain Res Manag 2014 Nov-Dec;19(6):328-335.
- Attal N, Cruccu G, Baron R, Haanpaa M, Hansson P, Jensen TS, et al. European Federation of Neurological Societies. EFNS guidelines on the pharmacological treatment of neuropathic pain: 2010 revision. Eur J Neurol 2010 Sep;17(9):1113-e88.
Treatment-Specific References
Amitriptyline
- Moore RA, Derry S, Aldington D, Cole P, Wiffen PJ. Amitriptyline for neuropathic pain in adults. Cochrane Database Syst Rev. 2015 Jul 6;(7):CD008242.
- Vrethem M, Boivie J, Arnqvist H, Holmgren H, Lindström T, Thorell LH. A comparison a amitriptyline and maprotiline in the treatment of painful polyneuropathy in diabetics and nondiabetics. Clin J Pain. 1997 Dec;13(4):313-23.
Botox
Finnerup NB, Attal N, Haroutounian S, McNicol E, Baron R, Dworkin RH, et al. Pharmacotherapy for neuropathic pain in adults: a systematic review and meta-analysis. Lancet Neurol. 2015 Feb 7; 162-73.
Cannabinoids
Allan et al. 2018 Can Fam Physician (Submitted)
Capsaicin
Derry S, Moore RA. Topical capsaicin (low concentration) for chronic neuropathic pain in adults. Cochrane Database Syst Rev. 2012 Sep 12;(9):CD010111.
Carbamazepine
Wiffen PJ, Derry S, Moore RA, Kalso EA. Carbamazepine for chronic neuropathic pain and fibromyalgia in adults. Cochrane Database Syst Rev. 2014 Apr 10;(4):CD005451.
Duloxetine
Lunn MPT, Hughes RAC, Wiffen PJ. Duloxetine for treating painful neuropathy, chronic pain or fibromyalgia. Cochrane Database Syst Rev. 2014, Issue 1. Art. No.: CD007115.
Gabapentin
Wiffen PJ, Derry S, Bell RF, Rice AS, Tölle TR, Phillips T, et al. Gabapentin for chronic neuropathic pain in adults. Cochrane Database Syst Rev. 2017 Jun 9;6:CD007938.
Opioids
McNicol ED, Midbari A, Eisenberg E. Opioids for neuropathic pain. Cochrane Database Syst Rev. 2013 Aug 29;(8):CD006146.
Pregabalin
Moore RA, Straube S, Wiffen PJ, Derry S, McQuay HJ. Pregabalin for acute and chronic pain in adults. Cochrane Database Syst Rev. 2009 Jul 8;(3):CD007076.
Tramadol
Duehmke RM, Derry S, Wiffen PJ, Bell RF, Aldington D, Moore RA. Tramadol for neuropathic pain in adults. Cochrane Database Syst Rev. 2017 Jun 15;(6):CD003726.
Venlafaxine
Saarto T, Wiffen PJ. Antidepressants for neuropathic pain. Cochrane Database Syst Rev. 2007 Oct 17;(4):CD005454.
Neuropathic Pain
Why doesn’t this calculator cover all treatment options available?
This online calculator does not cover all treatment options available for neuropathic pain. We only included the medication treatments that had the highest quality evidence. A healthcare provider may consider other options not listed in this calculator to manage symptoms, depending on specific needs.
Where can I find the evidence used to create this calculator?
The data used for this calculator can be found within the Neuropathic Pain Systematic Review
Additional tools created with this data can be found at Neuropathic Pain Decision Aid
What is neuropathic pain?11. Taylor D. Neuropathic Pain. https://www.emedicinehealth.com/neuropathic_pain_nerve_pain/page2_em.htm. Updated November 2017. Accessed January 13, 2018.
,22. Moore RA, Derry S, Aldington D, Cole P, Wiffen PJ. Amitriptyline for neuropathic pain in adults. Cochrane Database Syst Rev. 2015 Jul 6;(7):CD008242.
,33. Watson P. Neuropathic Pain. https://www-e-therapeutics-ca.login.ezproxy.library.ualberta.ca/search. Updated May 2017. Accessed January 13, 2018.
1. Taylor D. Neuropathic Pain. https://www.emedicinehealth.com/neuropathic_pain_nerve_pain/page2_em.htm. Updated November 2017. Accessed January 13, 2018.
2. Moore RA, Derry S, Aldington D, Cole P, Wiffen PJ. Amitriptyline for neuropathic pain in adults. Cochrane Database Syst Rev. 2015 Jul 6;(7):CD008242.
3. Watson P. Neuropathic Pain. https://www-e-therapeutics-ca.login.ezproxy.library.ualberta.ca/search. Updated May 2017. Accessed January 13, 2018.
Neuropathic pain is a type of pain generally caused by damaged nerves in the body. This damage may have resulted from a medical condition like diabetes, exposure to a toxin, alcohol, or previous surgery. Because the nerves are damaged, pain is not felt the same way as other types of pain.
Unlike pain from an injury, neuropathic pain can happen from normal, light touch, such as from clothing brushing against skin. This leads to feelings of pain that can be described as “burning”, “shooting” or “tingling”. Every person experiences neuropathic pain differently. Neuropathic pain can feel constant, come and go, or it can change in intensity.
Can neuropathic pain be treated or cured?33. Watson P. Neuropathic Pain. https://www-e-therapeutics-ca.login.ezproxy.library.ualberta.ca/search. Updated May 2017. Accessed January 13, 2018.
3. Watson P. Neuropathic Pain. https://www-e-therapeutics-ca.login.ezproxy.library.ualberta.ca/search. Updated May 2017. Accessed January 13, 2018.
In most cases, neuropathic pain cannot be cured. However, the pain can be managed.
The main goal of treating neuropathic pain is reducing pain to a realistic level that allows a patient to live comfortably. We are rarely able to eliminate the pain entirely.