Systematic reviews including this primary study

loading
7 articles (7 References) loading Revert Studify

Systematic review

Unclassified

Systematic Review of Pharmacologic Treatments of Pain After Spinal Cord Injury: An Update.

blocked
Journal Archives of physical medicine and rehabilitation
Year 2016
Links Pubmed DOI

This article includes 35 Primary studies 35 Primary studies (35 references)

Loading references information
OBJECTIVE: To update a systematic review of published research on pharmacotherapy for pain post-spinal cord injury (SCI). DATA SOURCES: PubMed/MEDLINE, CINAHL, Embase, and PsycINFO databases were searched for articles from 2009 to September 2015 examining treatment of pain post-SCI. STUDY SELECTION: Studies were included for analysis if they met the following 4 a priori criteria: (1) written in the English language; (2) ≥50% of subjects had an SCI, unless results were stratified by population type; (3) participants included ≥3 subjects with an SCI; and (4) any intervention involving pharmacologic treatment for the improvement of pain. DATA EXTRACTION: Randomized controlled trials were assessed for methodologic quality using the Physiotherapy Evidence Database scoring system. All research designs were given a level of evidence according to a modified Sackett Scale. DATA SYNTHESIS: Seven new studies met our inclusion criteria. The new studies fell into the following categories: analgesics (n=1), anticonvulsants (n=2), antidepressants (n=2), antispastics (n=1), and cannabinoids (n=1). There was evidence for 5 new pharmacotherapies among the SCI population; these included the following: oxycodone, duloxetine, venlafaxine, phenol block, and dronabinol. Levels of evidence for all therapy modalities were updated based on the new evidence. CONCLUSIONS: Anticonvulsants remain the most studied and supported pharmacotherapy for neuropathic pain post-SCI. Antidepressants showed reduction in pain only among those with comorbid depression. Botulinum toxin and phenol blocks were supported for the reduction of mixed pain post-SCI.

Systematic review

Unclassified

Opioids in chronic neuropathic pain: A systematic review and meta-analysis of efficacy, tolerability and safety in randomized placebo-controlled studies of at least 4 weeks duration

blocked
Journal Schmerz (Berlin, Germany)
Year 2015
Links Pubmed DOI

This article is included in 1 Broad synthesis 12 Broad syntheses (1 reference)

This article includes 12 Primary studies 12 Primary studies (12 references)

Loading references information
Methods: We screened MEDLINE, Scopus and the Cochrane Central Register of Controlled Trials (CENTRAL) up until October 2013, as well as the reference sections of original studies and systematic reviews of randomized controlled trials (RCTs) of opioids in CNP. We included double-blind randomized placebo-controlled studies of at least 4 weeks duration. Using a random effects model, absolute risk differences (RD) were calculated for categorical data and standardized mean differences (SMD) for continuous variables. Results: We included 12 RCTs with 1192 participants. The included diagnostic entities were painful diabetic neuropathy (four studies), postherpetic neuralgia (three studies), mixed polyneuropathic pain (two studies), and lumbar root, spinal cord injury and postamputation pain (one study each). Mean study duration was 6 (4–12) weeks. Four studies tested morphine, three studies tramadol, two studies oxycodone and one study tapentadol. These are the pooled results of studies with a parallel or cross-over design: opioids were superior to placebo in reducing pain intensity (SMD − 0.64 [95 % confidence interval, CI − 0.81, − 0.46], p < 0.0001; 11 studies with 1040 participants). Opioids were not superior to placebo in 50 % pain reduction (RD 0.16 [95 % CI − 0.04, 0.35], p = 0.11; one study with 93 participants). Opioids were not superior to placebo in reports of much or very much improved pain (RD 0.17 [95 % CI − 0.01, 0.36], p = 0.07; one study with 53 participants). Opioids were superior to placebo in improving physical functioning (SMD − 0.28 [95 % CI − 0.43, − 0.13], p < 0.0001; seven studies with 680 participants). Patients dropped out less frequently due to lack of efficacy with opioids than with placebo (RD − 0.07 [95 % CI − 0.13, − 0.02], p = 0.008; six studies with 656 participants). Patients dropped out due to adverse events more frequently with opioids than with placebo (RD 0.08 [95 % CI 0.05, 0.12], p < 0.0001; ten studies with 1018 participants; number needed to harm 11 [95 % CI 8–17]). There was no significant difference between opioids and placebo in terms of the frequency of serious adverse events (SAE) or deaths. Background: The efficacy and safety of opioid therapy in chronic neuropathic pain (CNP) is under debate. We updated a recent Cochrane systematic review on the efficacy, tolerability and safety of opioids in CNP. Conclusion: In short-term studies (4–12 weeks) in CNP, opioids were superior to placebo in terms of efficacy and inferior in terms of tolerability. Opioids and placebo did not differ in terms of safety. The conclusion relating to the safety of opioids compared to placebo in CNP is limited by the low number of SAE and deaths. Short-term opioid therapy may be considered in selected CNP patients. The English full-text version of this article is freely available at SpringerLink (under “Supplementary Material”).

Systematic review

Unclassified

Pharmacotherapy for neuropathic pain in adults: a systematic review and meta-analysis.

blocked
Journal The Lancet. Neurology
Year 2015
Links Pubmed DOI PubMed Central www.epistemonikos.org

This article is included in 2 Broad syntheses 228 Broad syntheses (2 references)

This article includes 230 Primary studies 228 Primary studies (230 references)

Loading references information
BACKGROUND: New drug treatments, clinical trials, and standards of quality for assessment of evidence justify an update of evidence-based recommendations for the pharmacological treatment of neuropathic pain. Using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE), we revised the Special Interest Group on Neuropathic Pain (NeuPSIG) recommendations for the pharmacotherapy of neuropathic pain based on the results of a systematic review and meta-analysis. METHODS: Between April, 2013, and January, 2014, NeuPSIG of the International Association for the Study of Pain did a systematic review and meta-analysis of randomised, double-blind studies of oral and topical pharmacotherapy for neuropathic pain, including studies published in peer-reviewed journals since January, 1966, and unpublished trials retrieved from ClinicalTrials.gov and websites of pharmaceutical companies. We used number needed to treat (NNT) for 50% pain relief as a primary measure and assessed publication bias; NNT was calculated with the fixed-effects Mantel-Haenszel method. FINDINGS: 229 studies were included in the meta-analysis. Analysis of publication bias suggested a 10% overstatement of treatment effects. Studies published in peer-reviewed journals reported greater effects than did unpublished studies (r(2) 9·3%, p=0·009). Trial outcomes were generally modest: in particular, combined NNTs were 6·4 (95% CI 5·2-8·4) for serotonin-noradrenaline reuptake inhibitors, mainly including duloxetine (nine of 14 studies); 7·7 (6·5-9·4) for pregabalin; 7·2 (5·9-9·21) for gabapentin, including gabapentin extended release and enacarbil; and 10·6 (7·4-19·0) for capsaicin high-concentration patches. NNTs were lower for tricyclic antidepressants, strong opioids, tramadol, and botulinum toxin A, and undetermined for lidocaine patches. Based on GRADE, final quality of evidence was moderate or high for all treatments apart from lidocaine patches; tolerability and safety, and values and preferences were higher for topical drugs; and cost was lower for tricyclic antidepressants and tramadol. These findings permitted a strong recommendation for use and proposal as first-line treatment in neuropathic pain for tricyclic antidepressants, serotonin-noradrenaline reuptake inhibitors, pregabalin, and gabapentin; a weak recommendation for use and proposal as second line for lidocaine patches, capsaicin high-concentration patches, and tramadol; and a weak recommendation for use and proposal as third line for strong opioids and botulinum toxin A. Topical agents and botulinum toxin A are recommended for peripheral neuropathic pain only. INTERPRETATION: Our results support a revision of the NeuPSIG recommendations for the pharmacotherapy of neuropathic pain. Inadequate response to drug treatments constitutes a substantial unmet need in patients with neuropathic pain. Modest efficacy, large placebo responses, heterogeneous diagnostic criteria, and poor phenotypic profiling probably account for moderate trial outcomes and should be taken into account in future studies. FUNDING: NeuPSIG of the International Association for the Study of Pain.

Systematic review

Unclassified

Systematic review and comparison of pharmacologic therapies for neuropathic pain associated with spinal cord injury

Journal Journal of pain research
Year 2013
Links Pubmed DOI PubMed Central

This article is included in 2 Broad syntheses 9 Broad syntheses (2 references)

This article includes 9 Primary studies 9 Primary studies (9 references)

Loading references information
Background: Management of neuropathic pain (NeP) associated with spinal cord injury (SCI) is difficult. This report presents a systematic literature review and comparison of the efficacy and safety of pharmacologic therapies for treating SCI-associated NeP. Methods: Medline, Embase, Cochrane, and Database of Abstracts of Reviews of Effects were searched through December 2011 for randomized, blinded, and controlled clinical trials of SCI-associated NeP meeting predefined inclusion criteria. Efficacy outcomes of interest were pain reduction on the 11-point numeric rating scale (NRS) or 100 mm visual analog scale and proportion of patients achieving ≥30% or ≥50% pain reduction. Discontinuations and adverse events (AEs) were also assessed, for which Bayesian meta-analytic indirect comparisons were performed. Results: Of the nine studies included in the analysis, samples were <100 patients, except for one pregabalin study (n = 136). Standard errors for the NRS outcome were often not reported, precluding quantitative comparisons across treatments. Estimated 11-point NRS pain reduction relative to placebo was -1.72 for pregabalin, -1.65 for amitriptyline, -1.0 for duloxetine, -1 (median) for levetiracetam, -0.27 for gabapentin, 1 (median) for lamotrigine, and 2 for dronabinol. Risk ratios relative to placebo for 30% improvement were 0.71 for levetiracetam and 2.56 for pregabalin, and 0.94 and 2.91, respectively, for 50% improvement. Meta-analytic comparisons showed significantly more AEs with pregabalin and tramadol compared with placebo, and no differences between placebo and any treatment for discontinuations. Conclusions: Studies of SCI-associated NeP were few, small, and reported insufficient data for quantitative comparisons of efficacy. However, available data suggested pregabalin was associated with more favorable efficacy for all outcome measures examined, and that the risks of AEs and discontinuations were found to be similar among the therapies. © 2013 Snedecor et al, publisher and licensee Dove Medical Press Ltd.

Systematic review

Unclassified

A comparison between enriched and nonenriched enrollment randomized withdrawal trials of opioids for chronic noncancer pain.

Journal Pain research & management : the journal of the Canadian Pain Society = journal de la société canadienne pour le traitement de la douleur
Year 2011
Links Pubmed DOI PubMed Central

This article is included in 1 Structured summary of systematic reviews 57 Structured summaries of systematic reviews (1 reference)

This article includes 57 Primary studies 57 Primary studies (57 references)

Loading references information
BACKGROUND: An enriched enrollment randomized withdrawal (EERW) design excludes potential participants who are nonresponders or who cannot tolerate the experimental drug before random assignment. It is unclear whether EERW design has an influence on the efficacy and safety of opioids for chronic noncancer pain (CNCP). OBJECTIVES: The primary objective was to compare the results from EERW and non-EERW trials of opioids for CNCP. Secondary objectives were to compare weak versus strong opioids, subgroups of patients with different types of pain, and the efficacy of opiods compared with placebo versus other drugs. METHODS: MEDLINE, EMBASE and CENTRAL were searched up to July 2009, for randomized controlled trials of any opioid for CNCP. Metaanalyses and meta-regressions were conducted to compare the results. Treatment efficacy was assessed by effect sizes (small, medium and large) and the incidence of adverse effects was assessed by a clinically relevant mean difference of 10% or greater. RESULTS: Sixty-two randomized trials were included. In 61 trials, the duration was less than 16 weeks. There was no difference in efficacy between EERW and non-EERW trials for both pain (P=0.6) and function (P=0.3). However, EERW trials failed to detect a clinically relevant difference for nausea, vomiting, somnolence, dizziness and dry skin⁄itching compared with non-EERW. Opioids were more effective than placebo in patients with nociceptive pain (effect size=0.60, 95% CI 0.49 to 0.72) and neuropathic pain (effect size=0.56, 95% CI 0.38 to 0.73). CONCLUSION: EERW trial designs appear not to bias the results of efficacy, but they underestimate the adverse effects. The present updated meta- analysis shows that weak and strong opioids are effective for CNCP of both nociceptive and neuropathic origin.

Systematic review

Unclassified

A Systematic Review of Pharmacologic Treatments of Pain After Spinal Cord Injury

Journal Archives of physical medicine and rehabilitation
Year 2010
Links Pubmed DOI PubMed Central

This article is included in 1 Structured summary of systematic reviews 28 Structured summaries of systematic reviews (1 reference)

This article includes 28 Primary studies 28 Primary studies (28 references)

Loading references information
Teasell RW, Mehta S, Aubut JL, Foulon B, Wolfe DL, Hsieh JTC, Townson AF, Short C, the Spinal Cord Injury Rehabilitation Evidence Research Team. A systematic review of pharmacologic treatments of pain after spinal cord injury. Objective: To conduct a systematic review of published research on the pharmacologic treatment of pain after spinal cord injury (SCI). Data Sources: MEDLINE, CINAHL, EMBASE, and PsycINFO databases were searched for articles published 1980 to June 2009 addressing the treatment of pain post SCI. Randomized controlled trials (RCTs) were assessed for methodologic quality using the Physiotherapy Evidence Database (PEDro) assessment scale, whereas non-RCTs were assessed by using the Downs and Black (D&B) evaluation tool. A level of evidence was assigned to each intervention by using a modified Sackett scale. Study Selection: The review included RCTs and non-RCTs, which included prospective controlled trials, cohort, case series, case-control, pre-post studies, and post studies. Case studies were included only when there were no other studies found. Data Extraction: Data extracted included the PEDro or D&B score, the type of study, a brief summary of intervention outcomes, the type of pain, the type of pain scale, and the study findings. Data Synthesis: Articles selected for this particular review evaluated different interventions in the pharmacologic management of pain after SCI. Twenty-eight studies met inclusion criteria; there were 21 randomized controlled trials; of these, 19 had level 1 evidence. Treatments were divided into 5 categories: anticonvulsants, antidepressants, analgesics, cannabinoids, and antispasticity medications. Conclusions: Most studies did not specify participants' types of pain, making it difficult to identify the type of pain being targeted by the treatment. Anticonvulsant and analgesic drugs had the highest levels of evidence and were the drugs most often studied. Gabapentin and pregabalin had strong evidence (5 level 1 RCTs) for effectiveness in treating post-SCI neuropathic pain as did intravenous analgesics (lidocaine, ketamine, and morphine), but the latter only had short-term benefits. Tricyclic antidepressants only showed benefit for neuropathic pain in depressed persons. Intrathecal baclofen reduced musculoskeletal pain associated with spasticity; however, there was conflicting evidence for the reduction in neuropathic pain. Studies assessing the effectiveness of opioids were limited and revealed only small benefits. Cannabinoids showed conflicting evidence in improving spasticity-related pain. Clonidine and morphine when given together had a significant synergistic neuropathic pain-relieving effect. © 2010 American Congress of Rehabilitation Medicine.

Systematic review

Unclassified

The evidence for pharmacological treatment of neuropathic pain

Journal Pain
Year 2010
Links Pubmed DOI www.cochranelibrary.com

This article is included in 1 Structured summary of systematic reviews 174 Structured summaries of systematic reviews (1 reference) 2 Broad syntheses 174 Broad syntheses (2 references)

This article includes 174 Primary studies 174 Primary studies (174 references)

Loading references information
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. © 2010 International Association for the Study of Pain. Published by Elsevier B.V. All rights reserved.