Efficacy of pharmacological treatments of neuropathic pain: An update and effect related to mechanism of drug action
Humans; Animals; Antidepressive Agents; Non-U.S. Gov't; Research Support; Pain/drug therapy/etiology; Randomized Controlled Trials; Narcotics/therapeutic use; Analgesics/therapeutic use; Carbamazepine/therapeutic use; Diabetic Neuropathies/complications; N-Methylaspartate/antagonists & inhibitors/therapeutic use; Neuralgia/drug therapy; Polyneuropathies/complications; Serotonin Uptake Inhibitors/therapeutic use; Tricyclic/therapeutic use
Tricyclic antidepressants and carbamazepine have become the mainstay in the treatment of neuropathic pain. Within the last decade, controlled trials have shown that numerous other drugs relieve such pain. We identified all placebo-controlled trials and calculated numbers needed to treat (NNT) to obtain one patient with more than 50% pain relief in order to compare the efficacy with the current treatments, and to search for relations between mechanism of pain and drug action. In diabetic neuropathy, NNT was 1.4 in a study with optimal doses of the tricyclic antidepressant imipramine as compared to 2.4 in other studies on tricyclics. The NNT was 6.7 for selective serotonin reuptake inhibitors, 3.3 for carbamazepine, 10.0 for mexiletine, 3.7 for gabapentin, 1.9 for dextromethorphan, 3.4 for tramadol and levodopa and 5.9 for capsaicin. In postherpetic neuralgia, the NNT was 2.3 for tricyclics, 3.2 for gabapentin, 2.5 for oxycodone and 5.3 for capsaicin, whereas dextromethorphan was inactive. In peripheral nerve injury, NNT was 2.5 for tricyclics and 3.5 for capsaicin. In central pain, NNT was 2.5 for tricyclics and 3. 4 for carbamazepine, whereas selective serotonin reuptake inhibitors, mexiletine and dextromethorphan were inactive. There were no clear relations between mechanism of action of the drugs and the effect in distinct pain conditions or for single drug classes and different pain conditions. It is concluded that tricyclic antidepressants in optimal doses appear to be the most efficient treatment of neuropathic pain, but some of the other treatments may be important due to their better tolerability. Relations between drug and pain mechanisms may be elucidated by studies focusing on specific neuropathic pain phenomena such as pain paroxysms and touch-evoked pain.
1999
Sindrup SH; Jensen TS
Pain
1999
Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s).
Journal Article
<a href="http://doi.org/10.1016/s0304-3959(99)00154-2" target="_blank" rel="noreferrer">10.1016/s0304-3959(99)00154-2</a>
Pain and symptom control in terminally ill children
Child; Palliative Care; Pain Measurement; Adult; Analgesics; Antidepressive Agents; Preschool; infant; Comparative Study; Human; Opioid/therapeutic use; Tricyclic/therapeutic use; HIV Seropositivity/psychology; Anesthetics/therapeutic use; Depression/drug therapy/etiology; Gastrointestinal Diseases/therapy; Histamine H1 Antagonists/therapeutic use; Neoplasms/complications/psychology; Pain/diagnosis/drug therapy/etiology; Terminally Ill/psychology
The management of pain in terminally ill pediatric patients has incalculable benefits to patients, their families, and physicians and nurses. A therapeutic management plan is dependent on a thorough understanding of the causes of pain in these patients, on pain assessment, and on the myriad drugs and drug strategies that are essential in pain treatment. Aggressive symptom control of treatment- related side effects can ensure successful implementation of such a plan.
2000
Galloway KS; Yaster M
Pediatric Clinics Of North America
2000
Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s).
Journal Article