Table 3.

Summary of GRADE recommendations. Drug classes with recommendation for use.

	FIRST LINE DRUGS			SECOND LINE DRUGS			THIRD LINE DRUGS
	SNRIs duloxetine venlafaxine	TCAs	Pregabalin Gabapentin Gabapentin ER/enacarbil	Tramadol	Capsaicin 8% patches	Lidocaine patches*	Strong opioids	BTX-A
Quality of evidence
	High	Moderate	High	Moderate	High	Low*	Moderate	Low
Balance between desirable and undesirable effects
Effect size	Moderate	Moderate	Moderate	Moderate	Low	Unknown	Moderate	Moderate
Tolerability and safety**	Moderate	Low -Moderate	Moderate-high	Low-moderate	Moderate-high	High	Low-moderate	High
Values and preferences
	Low-moderate	Low-moderate	Low-moderate	Low-moderate	High	High	Low-moderate	High
Cost and resource allocation
	Low-moderate	Low	Low-moderate	Low	Moderate-high	Moderate-high	Low-moderate	Moderate-high
Strength of recommendation
	Strong	Strong	Strong	Weak	Weak	Weak	Weak	Weak
Neuropathic pain conditions	All	All	All	All	Peripheral	Peripheral	All	Peripheral

^*FDA and EMEA approval for the treatment of postherpetic neuralgia

^**Common side effects : antidepressants : somnolence, constipation, dry mouth (particularly TCAs), nausea (particularly duloxetine) ; pregabalin/gabapentin : somnolence, dizziness, weight gain; opioids (including tramadol) : constipation, nausea, vomiting, tiredness, somnolence, dizziness, dry mouth, itch ; lidocaine patches : local irritation ; capsaicin patches : local pain, edema, erythema ; botulinum toxin A : local pain.

Abbreviations : SNRIs=serotonin noradrenaline reuptake inhibitors. TCAs=tricyclic antidepressants ; BTX-A : botulinum toxin type A ; ER= extended realease.