Correspondence (letter to the editor): Consider Ineffectiveness

The article presents an algorithm to facilitate treatment planning in patients with neuropathic pain (1). It is stated that this approach leads to realistic treatment goals with pain reduction of approximately >30–50%. In reality, however, this recommendation does not apply to the most common types of neuropathic pain in epidemiological studies, even though they are listed under the indication groups in the article: Anticonvulsants and antidepressants are ineffective in the treatment of radiculopathies (2). Adding local and regional back pain—summarized in the article under “mixed pain“—to this, this algorithm does not apply to an even greater group of pain patients (3).

To the contrary: These concepts—partly introduced with support of the pharmaceutical industry—have led to another drug misuse epidemic, on top of the misuse of opioids to treat non-tumor pain: the pregabalin epidemic. And this, despite the fact that more than half of the patients with neuropathies do not achieve significant pain alleviation (4). For the sake of honesty, such limitations should be mentioned in articles like this that serve educational purposes.