A pharmacological treatment algorithm for localised XXXX [LNP].

@entity1 @entity1931 @entity2682 @entity2951 @entity3303 @entity4480 @entity158 @entity1338 @entity906 @entity4481 @entity9
UNASSIGNED: @entity9 is caused by a lesion or disease affecting the somatosensory system and is difficult to manage, often proving refractory to existing treatments. In more than half of cases, it is localised and affects a specific, clearly circumscribed area of the body (localised @entity9 , or LNP). A recently developed screening tool enables @entity1 with probable @entity9 /LNP to be identified quickly and easily. In view of the conflicting current treatment recommendations, an advisory board of @entity158 specialists met in June 2015 to develop a complementary treatment guidance algorithm, for use in the primary care setting and by non- @entity158 specialists. The starting point of the algorithm is a diagnosis of LNP and there was consensus that first-line treatment should be a topical analgesic agent, because the benefit/risk ratios are far better than for systemic agents. Topical application offers site-specific delivery, a lower total systemic dose and avoidance of first-pass metabolism, reducing the risk of adverse events and drug/drug interactions. The 5% @entity3303 medicated plaster has most evidence supporting its use in LNP, producing effective analgesia and reducing the associated area of @entity1931 , but other topical agents include @entity2951 , @entity1338 and botulinum toxin type A. Treatment should be commenced with the topical agent of choice, and the @entity1 re-assessed after an appropriate period. Where the response is good the topical agent is continued, with a re-evaluation after 3 to 6 months. A systemic agent (e.g. @entity2682 , @entity4481 , @entity4480 , @entity906 ) is added if there is only a partial response, or substituted if there is no response, and the @entity1 re-assessed after a month. If there is a poor or no response to the systemic agent the @entity1 should be switched to an alternative one, and if this also proves ineffective referred to a @entity158 specialist.
