This Evidence Summary is based on the following systematic review:
Finnerup NB, Attal N, Haroutounian S, et al. Pharmacotherapy for neuropathic pain in adults: a systematic review and meta-analysis. Lancet Neurol. 2015;14:162-73.
In adults with painful nerve damage (neuropathic pain), which drugs reduce pain?
Neuropathic pain happens when there are problems with the nerves and they send pain signals to the brain. It is different from pain from injuries or burns, and there are several causes. Neuropathic pain could result from an injury or a disease that affects the nervous system like shingles or diabetes. Several oral and topical (creams or lotions applied to affected areas of skin) drugs can reduce pain.
The researchers did a systematic review, searching for randomized controlled trials published in journals or reported in trial registries up to January 2014.
They found 229 randomized controlled trials.
The key features of the studies were:
127 of the trials studied people with diabetic painful polyneuropathy or postherpetic neuralgia.
There was low to high quality evidence on the efficacy of the drugs to reduce pain.
The cause of neuropathic pain did not affect the benefit.
The authors recommended:
Many drug treatments reduce pain in people with neuropathic pain.
Effect of drug treatments versus placebo on pain relief in people with neuropathic pain
|Treatment||Number of trials (number of people)||Rate of pain relief with active treatment*||Rate of pain relief with placebo*||Absolute effect of treatment|
|Tricyclic antidepressants||15 trials (948 people)||46%||18%||About 28 more people out of 100 had less pain|
|Serotonin-noradrenaline reuptake inhibitors||10 trials (2541 people)||43%||28%||About 15 more people out of 100 had less pain|
|Pregabalin||25 trials (5940 people)||38%||24%||About 14 more people out of 100 had less pain|
|Gabapentin or gabapentin extended-release and enacarbil||14 trials (3503 people)||35%||20%||About 15 more people out of 100 had less pain|
|Tramadol||6 trials (741 people)||46%||27%||About 19 more people out of 100 had less pain|
|Strong opioids||7 trials (838 people)||49%||26%||About 23 more people out of 100 had less pain|
|Capsaicin 8%||6 trials (2073 people)||36%||27%||About 9 more people out of 100 had less pain|
|Botulinum toxin A||4 trials (137 people)||60%||6%||About 54 more people out of 100 had less pa|
*The event rate refers to the proportion of people who had at least a 50% reduction in pain after treatment.
This Evidence Summary was originally prepared for the McMaster Optimal Aging Portal.
Published: Friday, July 28, 2017