Are Opioids first line treatment for neuropathic pain
False. The adverse and complex psychosocial effects of opioids and existence of other more targeted therapies makes the role of opioids unclear. Some double-blind, randomized, controlled trials of opioids have shown efficacy for treatment of neuropathic pain. If opioid therapy is deemed appropriate, there are multimechanism mu-opioid agonists that may be especially worth considering. Tramadol inhibits serotonin and norepinephrine reuptake and has proven useful in DPN and polyneuropathy. Similarly, tapentadol also inhibits norepinephrine reuptake. Studies have shown benefit from the extended-release formulation in diabetic painful neuropathy. Methadone is well known for its NMDA antagonism and has been shown to be beneficial at a 10- to 20-mg total daily dose in various types of neuropathy.