Abstract
Antinociceptive therapy for chronic neuropathic pain is anecdotal in nature based on a physician's preference. However, evidence-based therapy is expected, following the chronic pain guideline established in 2021, supported by 10 pain-associated Japanese medical societies. The guideline strongly recommends the use of Ca2+-channel α2δ ligands (pregabalin, gabapentin, and mirogabalin) and duloxetine for pain relief. International guidelines also recommend administration of tricyclic antidepressants as first-line agents. Recent studies have described three classes of medicines that show comparable antinociceptive effects in painful diabetic neuropathy. Furthermore, a combination of first-line agents can improve efficacy. Antinociceptive medical therapy should be individualized based on the patient's condition and adverse effect profile of each medication.
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