title: Pharmacological treatment of painful HIV-associated sensory neuropathy: a systematic review and meta-analysis of randomised controlled trials.
abstract: BACKGROUND
  Significant pain from HIV-associated sensory neuropathy (HIV-SN) affects ∼40% of HIV infected individuals treated with antiretroviral therapy (ART). The prevalence of HIV-SN has increased despite the more widespread use of ART. With the global HIV prevalence estimated at 33 million, and with infected individuals gaining increased access to ART, painful HIV-SN represents a large and expanding world health problem. There is an urgent need to develop effective pain management strategies for this condition.
  
  
  RESULTS
  
  
  
  OBJECTIVE
  To evaluate the clinical effectiveness of analgesics in treating painful HIV-SN.
  
  
  METHODS
  Systematic review and meta-analysis.
  
  
  METHODS
  Medline, Cochrane central register of controlled trials, www.clinicaltrials.gov, www.controlled-trials.com and the reference lists of retrieved articles.
  
  
  METHODS
  Prospective, double-blinded, randomised controlled trials (RCTs) investigating the pharmacological treatment of painful HIV-SN with sufficient quality assessed using a modified Jadad scoring method.
  
  
  METHODS
  Four authors assessed the eligibility of articles for inclusion. Agreement of inclusion was reached by consensus and arbitration. Two authors conducted data extraction and analysis. Dichotomous outcome measures (≥ 30% and ≥ 50% pain reduction) were sought from RCTs reporting interventions with statistically significant efficacies greater than placebo. These data were used to calculate RR and NNT values.
  
  
  RESULTS
  Of 44 studies identified, 19 were RCTs. Of these, 14 fulfilled the inclusion criteria. Interventions demonstrating greater efficacy than placebo were smoked cannabis NNT 3.38 95%CI(1.38 to 4.10), topical capsaicin 8%, and recombinant human nerve growth factor (rhNGF). No superiority over placebo was reported in RCTs that examined amitriptyline (100mg/day), gabapentin (2.4 g/day), pregabalin (1200 mg/day), prosaptide (16 mg/day), peptide-T (6 mg/day), acetyl-L-carnitine (1g/day), mexilitine (600 mg/day), lamotrigine (600 mg/day) and topical capsaicin (0.075% q.d.s.).
  
  
  CONCLUSIONS
  Evidence of efficacy exists only for capsaicin 8%, smoked cannabis and rhNGF. However,rhNGF is clinically unavailable and smoked cannabis cannot be recommended as routine therapy. Evaluation of novel management strategies for painful HIV-SN is urgently needed.
authors.affiliation: Department of Anaesthetics, Pain Medicine and Intensive Care, Imperial College London, Chelsea and Westminster Hospital Campus, London, United Kingdom.
authors.forename: Tudor J C
authors.initials: TJ
authors.lastname: Phillips
authors.forename: Catherine L
authors.initials: CL
authors.lastname: Cherry
authors.forename: Sarah
authors.initials: S
authors.lastname: Cox
authors.forename: Sarah J
authors.initials: SJ
authors.lastname: Marshall
authors.forename: Andrew S C
authors.initials: AS
authors.lastname: Rice
mesh_terms: D000700:Analgesics / Q000627:therapeutic use*; D044966:Anti-Retroviral Agents / Q000494:pharmacology; D002188:Cannabis; D002211:Capsaicin / Q000627:therapeutic use; D015658:HIV Infections / Q000150:complications / Q000188:drug therapy*; D006801:Humans; D020932:Nerve Growth Factor / Q000627:therapeutic use; D010523:Peripheral Nervous System Diseases / Q000150:complications / Q000188:drug therapy* / Q000209:etiology*; D010919:Placebos; D010936:Plant Extracts / Q000627:therapeutic use; D016032:Randomized Controlled Trials as Topic; D012107:Research Design; D012306:Risk; D016896:Treatment Outcome
chemical_list: D000700:Analgesics; D044966:Anti-Retroviral Agents; D010919:Placebos; D010936:Plant Extracts; D020932:Nerve Growth Factor; D002211:Capsaicin