A Delphi consensus statement of the Neuropathic Pain Special Interest Group of the Italian Neurological Society on pharmacoresistant neuropathic pain

  • P. Ciaramitaro
  • G. Cruccu
  • M. de Tommaso
  • G. Devigili
  • D. Fornasari
  • P. Geppetti
  • M. Lacerenza
  • G. Lauria
  • S. Mameli
  • P. Marchettini
  • M. Nolano
  • E. Polati
  • V. Provitera
  • M. Romano
  • C. Solaro
  • S. Tamburin
  • V. Tugnoli
  • M. Valeriani
  • Andrea TruiniEmail author
  • On behalf of the Neuropathic Pain Special Interest Group of the Italian Neurological Society
Original Article


To improve patient care and help clinical research, the Neuropathic Pain Special Interest Group of the Italian Neurological Society appointed a task force to elaborate a consensus statement on pharmacoresistant neuropathic pain. The task force included 19 experts in neuropathic pain. These experts participated in a Delphi survey consisting of three consecutive rounds of questions and a face-to-face meeting, designed to achieve a consensus definition of pharmacoresistant neuropathic pain. In the three rounds of questions, the participants identified and described the main distinguishing features of pharmacoresistance. In the face-to-face meeting the participants discussed the clinical features determining pharmacoresistance. They finally agreed that neuropathic pain is pharmacoresistant when “the patient does not reach the 50% reduction of pain or an improvement of at least 2 points in the Patient Global Impression of Change, having used all drug classes indicated as first, second, or third line in the most recent and widely agreed international guidelines, for at least 1 month after titration to the highest tolerable dose.” Our consensus statement might be useful for identifying eligible patients for invasive treatments, and selecting patients in pharmacological trials, thus improving patient care and helping clinical research.


Neuropathic pain Pharmacoresistance Painful neuropathy Refractory pain 



Giorgio Cruccu received received honoraria as speaker, member of advisory boards, or consultant from Alfasigma, Angelini, Biogen, and Lilly.

Pierangelo Geppetti received honoraria for consultancy or speaking at symposia and research financial support from Amgen Allergan, Chiesi, Elettrocore, IBSA, Menarini, Novartis, Pfizer, Sanofi, and TEVA.

Marina de Tommaso received honoraria for speaking at symposia or research financial supports from Allergan, Novartis, and Mundipharma.

Diego Fornasari has received honoraria as speaker, member of advisory boards, or consultant from Angelini, Alfasigma, Abiogen, Grunenthal, Pfeizer, and SPA.

Paolo Marchettini received honoraria for speaking at symposia and training the field force from Angelini, Chiesi, Epitech, Eli Lilly, and Pfizer.

Enrico Polati received honoraria for speaking at symposia from Grunenthal.

Claudio Solaro served as advisory board the following companies: Biogen Idec, Merck Serono, Almirall, and GW Pharma. He received speaking honoraria from Biogen Idec, Merck Serono. He received research grants and support by the FISM (Fondazione Italiana Sclerosi Multipla).

Stefano Tamburin received honoraria for speaking at symposia or research financial support from Epitech, FB Health, Mundipharma, and Pfizer.

Andrea Truini received honoraria for speaking at symposia or research financial supports from Alpha-Sigma, Angelini, Epitech, FB Health, and Pfizer.

The other authors reported no conflict of interest to declare.

The face-to-face meeting was held during the congress of the Italian Society of Clinical Neurophysiology, receiving an unconditioned support by Pfizer.


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Copyright information

© Fondazione Società Italiana di Neurologia 2019

Authors and Affiliations

  • P. Ciaramitaro
    • 1
  • G. Cruccu
    • 2
  • M. de Tommaso
    • 3
  • G. Devigili
    • 4
  • D. Fornasari
    • 5
  • P. Geppetti
    • 6
  • M. Lacerenza
    • 7
  • G. Lauria
    • 8
    • 9
  • S. Mameli
    • 10
  • P. Marchettini
    • 6
    • 11
    • 12
  • M. Nolano
    • 13
    • 14
  • E. Polati
    • 15
  • V. Provitera
    • 16
  • M. Romano
    • 17
  • C. Solaro
    • 18
  • S. Tamburin
    • 19
  • V. Tugnoli
    • 20
  • M. Valeriani
    • 21
    • 22
  • Andrea Truini
    • 2
    Email author
  • On behalf of the Neuropathic Pain Special Interest Group of the Italian Neurological Society
  1. 1.Clinical Neurophysiology, Neuroscience DepartmentAOU Città della Salute e della Scienza di TorinoTorinoItaly
  2. 2.Department of Human NeuroscienceUniversity SapienzaRomeItaly
  3. 3.Applied Neurophysiology and Pain Unit, Basic Medical Science, Neuroscience and Sensory System-SMBNOS-DepartmentAldo Moro UniversityBariItaly
  4. 4.Neurological Unit 1, Fondazione I.R.C.C.S. Istituto Neurologico Carlo BestaMilanItaly
  5. 5.Department of Medical Biotechnology and Translational MedicineUniversità degli Studi di MilanoMilanItaly
  6. 6.Department of Health Sciences, Section of Clinical Pharmacology and Headache CenterUniversity of FlorenceFlorenceItaly
  7. 7.Neurology and Pain Medicine Center, Humanitas, San Pio X ClinicMilanItaly
  8. 8.Neuroalgology Unit, IRCCS Foundation, “Carlo Besta” Neurological InstituteMilanItaly
  9. 9.Department of Biomedical and Clinical Sciences “Luigi Sacco”University of MilanMilanItaly
  10. 10.Pain Therapy Unit, “A. Businco” HospitalCagliariItaly
  11. 11.Pain Medicine CentreOspedale San RaffaeleMilanItaly
  12. 12.University of Applied Science of Southern Switzerland, Pain Pathophysiology and Therapy ProgrammeMannoSwitzerland
  13. 13.Neurology Department, Skin Biopsy LaboratoryIstituti Clinici Scientifici Maugeri IRCCSPaviaItaly
  14. 14.Department of Neurosciences, Reproductive Sciences and OdontostomatologyUniversity Federico II of NaplesNaplesItaly
  15. 15.Department of Surgery, Dentistry, Maternal and Infant Sciences, Pain Therapy CentreVerona University HospitalVeronaItaly
  16. 16.Istituti Clinici Scientifici Maugeri IRCCSInstitute of Telese Terme (BN)Telese TermeItaly
  17. 17.Neurology Unit, Azienda Ospedaliera Ospedali Riuniti Villa Sofia CervelloPalermoItaly
  18. 18.CRRF Mons L Novarese Moncrivello (VC)MoncrivelloItaly
  19. 19.Department of Neurosciences, Biomedicine and Movement SciencesUniversity of VeronaVeronaItaly
  20. 20.Neurology Unit, Azienda Ospedaliero-UniversitariaFerraraItaly
  21. 21.Division of Neurology, Ospedale Pediatrico Bambino Gesú, IRCCSRomeItaly
  22. 22.Center for Sensory-Motor InteractionAalborg UniversityAalborgDenmark

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