title: A qualitative systematic review of head-to-head randomized controlled trials of oral analgesics in neuropathic pain.
abstract: BACKGROUND
  Neuropathic pain (NP) encompasses many difficult-to-treat disorders. There are few head-to-head, comparative, randomized controlled trials (RCTs) of drugs for NP in different analgesic categories, or of different drugs within a category, despite many placebo-controlled RCTs for individual agents. Well-designed head-to-head comparative trials are an effective way to determine the relative efficacy and safety of a new drug.
  
  
  OBJECTIVE
  To perform a systematic review of head-to-head RCTs of oral analgesics in NP.
  
  
  METHODS
  A systematic review of RCTs involving NP patients was performed, of which head-to-head comparative trials were selected. Reference lists from published systematic reviews were searched. These studies were rated according to the Jadad scale for quality.
  
  
  CONCLUSIONS
  Twenty-seven such trials were identified. Seventeen were comparisons of different analgesics, and 10 were of different drugs within an analgesic class. Important information was obtained about the relative efficacy and safety of drugs in different categories and within a category. Some significant differences between active treatments were reported. Trial inadequacies were identified. More and improved head-to-head RCTs are needed to inform clinical choices.
authors.affiliation: University of Toronto, Toronto, Ontario, Canada. peter.watson@utoronto.ca
authors.forename: C Peter N
authors.initials: CP
authors.lastname: Watson
authors.forename: Ian
authors.initials: I
authors.lastname: Gilron
authors.forename: Jana
authors.initials: J
authors.lastname: Sawynok
mesh_terms: D000284:Administration, Oral; D000700:Analgesics / Q000008:administration & dosage*; D016022:Case-Control Studies; D016208:Databases, Factual / Q000706:statistics & numerical data; D006801:Humans; D009437:Neuralgia / Q000188:drug therapy*; D015995:Prevalence; D016032:Randomized Controlled Trials as Topic
chemical_list: D000700:Analgesics