The evidence for pharmacological treatment of neuropathic pain.
Randomized, double-blind, placebo-controlled trials on neuropathic pain treatment are accumulating, so an updated review of the available evidence is needed. Studies were identified using MEDLINE and EMBASE searches. Numbers needed to treat (NNT) and numbers needed to harm (NNH) values were used to compare the efficacy and safety of different treatments for a number of neuropathic pain conditions. One hundred and seventy-four studies were included, representing a 66% increase in published randomized, placebo-controlled trials in the last 5 years. Painful poly-neuropathy (most often due to diabetes) was examined in 69 studies, postherpetic neuralgia in 23, while peripheral nerve injury, central pain, HIV neuropathy, and trigeminal neuralgia were less often studied. Tricyclic antidepressants, serotonin noradrenaline reuptake inhibitors, the anticonvulsants gabapentin and pregabalin, and opioids are the drug classes for which there is the best evidence for a clinical relevant effect. Despite a 66% increase in published trials only a limited improvement of neuropathic pain treatment has been obtained. A large proportion of neuropathic pain patients are left with insufficient pain relief. This fact calls for other treatment options to target chronic neuropathic pain. Large-scale drug trials that aim to identify possible subgroups of patients who are likely to respond to specific drugs are needed to test the hypothesis that a mechanism-based classification may help improve treatment of the individual patients.
Finnerup
Nanna Brix
NB
Department of Neurology and Danish Pain Research Center, Aarhus University Hospital, Aarhus, Denmark Department of Neurology, Odense University Hospital, Odense, Denmark.
Sindrup
Søren Hein
SH
Jensen
Troels Staehelin
TS
D000701:Analgesics, Opioid / Q000627:therapeutic use*; D000927:Anticonvulsants / Q000627:therapeutic use*; D000928:Antidepressive Agents / Q000627:therapeutic use*; D016208:Databases, Factual / Q000706:statistics & numerical data; D004311:Double-Blind Method; D004359:Drug Therapy, Combination; D006801:Humans; D009437:Neuralgia / Q000188:drug therapy* / Q000209:etiology; D016032:Randomized Controlled Trials as Topic / Q000379:methods
D000701:Analgesics, Opioid; D000927:Anticonvulsants; D000928:Antidepressive Agents