A meta-analysis of analgesic efficacy of opioids in the treatment of neuropathic pain

Authors

  • Preethi A. Department of Pharmacology, Government Stanley Medical College, Chennai, Tamil Nadu, India
  • Kulandaiammal M. Department of Pharmacology, Government Stanley Medical College, Chennai, Tamil Nadu, India

DOI:

https://doi.org/10.18203/2319-2003.ijbcp20191111

Keywords:

Analgesia, Meta-analysis, Neuropathic pain, Opioid agonist

Abstract

Background: Neuropathic pain is the most common form of chronic pain often associated with impaired quality of life due to its poor management. Tricyclic antidepressants, serotonin and norepinephrine reuptake inhibitors and calcium channel alpha 2 ligand agonist are preferred as first line therapy for neuropathic pain. Lignocaine patches and transdermal patches of capsaicin are used as second line agents. Moderate efficacy opioids like tramadol and strong opioids are recommended as second line and third line therapy for neuropathic pain respectively. Previous meta-analysis and systematic review shows inconsistent data and lacks reliability in getting conclusive results in opioids use in neuropathic pain. So, author conducted a meta-analysis to reanalyse the analgesic efficacy of opioid agonist for the treatment of neuropathic pain.

Methods: Author searched Oxford pain relief data base, Google web, Embase, Medline and Cochrane library from February 2001 to November 2017 for articles related to analgesic efficacy of opioid agonist in neuropathic pain based on author’s selection criteria. Reference list of reviews were retrieved using Prisma Algorithm and analysed using REVIEW MANAGER 5 software.

Results: Among 1108 publications searched, only 5 trials met the inclusion criteria. Primary outcome measure was proportion of participants reporting 50% of pain relief or better. In five trials, 305 patients treated with opioids and placebo/standard treatment for neuropathic pain, the number per treatment group ranges from 31 to 170 (median 50±5). The overall point estimate of risk difference was 0.17 (95% CI 0.02 to 0.33, P=0.026) translating to number needed to treat (Benefit) of 5.9 (3.0 to 50.0).

Conclusions: In this meta-analysis, opioid agonist efficacy trials shown consistent analgesic efficacy and benefit over placebo/standard treatment in reducing neuropathic pain.

References

Christoph S, Andress K. Anesthesia and treatment of chronic pain. Section V – Adult subspeciality management. In : Miller RD, Eriksson LI , Fleisher LA , Wiener –kronish JP, young WL. Miller’s Anesthesia. Ch.58, 7th ed. Philadelphia: Churchill Livingstone .Elsevier, 2010p.1977.

Watson CPN. The phenomenon of pain. Pain Res Manag 2014;19:49-50.

Classification of chronic pain .Descriptions of chronic pain syndromes and definition of pain terms. Prepared by the International Association for the study of pain , subcommittee on taxonomy. Pain suppl1986;S1-226.

Willis WD, Westlund KN. Neuroanatomy of the pain system and of the pathways that modulate pain. J Clin Neurophysiol 1997;14:2-31

Welch SP, Martin BR. Opioid and Nonopioid Analgesics. In: Craig CR, Stitzel RE, editors. Modern Pharmacology with Clinical Applications. 6th ed. Philadelphia, USA: Lippincott William & Wilkins; 2004. p. 310-29

Manchikanti L, Fellows B, Ailinani H, Pampati V. Therapeutic use, abuse, and nonmedical use of opioids: A ten-year perspective. Pain Physician 2010;13:401-35.

Elon Eisenberg MD, Ewan D. McNicol RPh, Daniel B. Carr MD. Efficacy and Safety of Opioid Agonists in the Treatment of Neuropathic Pain of Nonmalignant Origin. A Systematic Review and Meta-analysis of Randomized Controlled Trials. JAMA. 2005;293(24):3043-52.

Trescot AM, Boswell MV, Atluri SL, Hansen HC, Deer TR, Abdi S, et al. Opioid guidelines in the management of chronic non-cancer pain. Pain Physician 2006;9:1-39.

Chou R, Turner JA, Devine EB, Hansen RN, Sullivan SD, Blazina I, et al. The effectiveness and risks of long-term opioid therapy for chronic pain: a systematic review for a National Institutes of Health Pathways to Prevention Workshop. Ann Intern Med 2015;162(4):276-86.

Alford DP. Opioid prescribing for chronic pain — achieving the right balance through education. N Engl J Med 2016;374:301-3.

Moher D, Liberati A, Tetzlaff J, Altman DG; PRISMA Group. Preferred reporting items for systematic reviews and meta‑analyses: The PRISMA statement. PLoS Med 2009;6:e1000097.

Glasziou P, Vanderbroucke J, Chalmers I. Assessing the quality of research. BMJ 2004;328:39‑41.

Cook DJ, Mulrow CD, Haynes RB. Systematic reviews: Synthesis of best evidence for clinical decisions. Ann Intern Med 1997;126:376‑80.

Clarke M. The cochrane collaboration and systematic reviews. Br J Surg 2007;94:391‑2.

American Academy of Pain Medicine. Definitions related to the use of opioids for the treatment of pain: a consensus document from the American Academy of Pain Medicine, the American Pain Society, and the American Society of addiction Medicine. Glenview, IL, Chevvy Chase, MD: American Academy of Pain Medicine, American Pain Society, and American Society of Addiction Medicine; 2001.

Huse E, Larbig W, Flor H, Birbaumer N. The effect of opioids on phantom limb pain and cortical reorganization. Pain 2001;90:47–55.

Watson CP, Moulin D, Watt-Watson J, Gordon A, Eisenhoffer J. Controlled-release oxycodone relieves neuropathic pain: a randomized controlled trial in painful diabetic neuropathy. Pain 2003;105:71–8.

Khoromi S, Cui L, Nackers L, Max MB. Morphine, nortriptyline and their combination vs. placebo in patients with chronic lumbar root pain. Pain 2007;130:66–75.

Wu CL, Agarwal S, Tella PK, Klick B, Clark MR, Haythornthwaite JA, et al. Morphine versus mexiletine for treatment of postamputation pain: a randomized, placebo controlled, crossover trial. Anesthesiology 2008;109:289–96

Zin CS, Nissen LM, O’Callaghan JP, Duffull SB, Smith MT, Moore BJ. A randomized, controlled trial of oxycodone versus placebo in patients with postherpetic neuralgia and painful diabetic neuropathy treated with pregabalin. Journal of Pain 2010;11:462–71.

Chou R, Carson S (2008) Drug Class Review on Long-Acting Opioid Analgesics: Final Report Update 5. Oregon Health & Science University: Portland, OR.Chou R, Ballantyne JC, Fanciullo GJ, Fine PG, Miaskowski C (2009a). Research gaps on use of opioids for chronic noncancer pain: findings from a review of the evidence for an American Pain Society and American Academy of Pain Medicine clinical practice guideline. J Pain 10: 147–159.

Chou R, Fanciullo GJ, Fine PG, Adler JA, Ballantyne JC, Davies P et al. (2009b). Clinical guidelines for the use of chronic opioid therapy in chronic noncancer pain. J Pain 10: 113–130.

Chaparro LE, Furlan AD, Deshpande A, Mailis-Gagnon A, Atlas S, Turk DC (2013). Opioids compared to placebo or other treatments for chronic low-back pain. Cochrane Database Syst Rev (8):CD004959.

McNicol ED, Midbari A, Eisenberg E (2013). Opioids for neuropathic pain. Cochrane Database Syst Rev (8): CD006146.

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Published

2019-03-23

How to Cite

A., P., & M., K. (2019). A meta-analysis of analgesic efficacy of opioids in the treatment of neuropathic pain. International Journal of Basic & Clinical Pharmacology, 8(4), 752–756. https://doi.org/10.18203/2319-2003.ijbcp20191111

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Original Research Articles