Topical analgesics for neuropathic pain: An evidence-informed guide for the practicing clinician

Dear Editor, We thank Dr Alcántara Montero for his thoughtful letter. We appreciate your perspective on our article and share your interest in topical analgesics as an important therapeutic option for patients living with chronic pain.1 We also value your recommended caution in drawing conclusions from limited data, as well as your call for further research to strengthen the evidence base in this off-label application. The Systemic review and meta-analysis recommendations from the Neuropathic Pain Special Interest Group of the International Association for the Study is a meaningful contribution to the evidence base guiding clinical treatment selection. It is essential for clinicians to have access to such comprehensive reviews of the literature to help guide evidence-based practice. This review recommends as first-line agents for treatment of neuropathic pain α2δ -ligands, tricyclic antidepressants (TCAs), and serotonin and norepinephrine reuptake inhibitors (SNRIs), and recommends as second-line agents lidocaine 5% plaster and capsaicin 8% patches, and does not consider or recommend other topical analgesics.2 The findings of this systematic review and meta-analysis do not invalidate the conclusions of our review.