Pharmacotherapy for neuropathic pain in adults: a systematic review and meta-analysis.
Nanna B. Finnerup,Nadine Attal,Simon Haroutounian,Ewan D McNicol,Ralf Baron,Robert H. Dworkin,Ian Gilron,Maija Haanpää,Per Hansson,Per Hansson,Troels S. Jensen,Troels S. Jensen,Peter R. Kamerman,Karen Lund,Andrew Moore,Srinivasa N. Raja,Andrew S.C. Rice,Andrew S.C. Rice,Michael C. Rowbotham,Emily S. Sena,Emily S. Sena,Philip J. Siddall,Philip J. Siddall,Blair H. Smith,Mark S. Wallace +24 more
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TLDR
The results support a revision of the NeuPSIG recommendations for the pharmacotherapy of neuropathic pain and allow a strong recommendation for use and proposal as first-line treatment in neuropathicPain for tricyclic antidepressants, serotonin-noradrenaline reuptake inhibitors, pregabalin, and gabapentin.Abstract:
Summary 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 E valuation (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pharmacotherapy for neuropathic pain, including studies published in peer-reviewed journals since January , 1966, and unpublished trials retrieved from ClinicalTrials.gov and websites of pharmaceutical companies.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 fi xed-eff ects Mantel-Haenszel method. Findings 229 studies were included in the meta-analysis. Analysis of publication bias suggested a 10% overstatement of treatment eff ects. Studies published in peer-reviewed journals reported greater eff ects than did unpublished studies (r² 9·3%, p=0·009). T rial 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, fi nal 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 fi ndings permitted a strong recommendation for use and proposal as fi rst-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 effi cacy, large placebo responses, heterogeneous diagnostic criteria, and poor phenotypic profi ling 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.read more
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Evaluation of Treatment Patterns and Direct Costs Associated with the Management of Neuropathic Pain
Manuel Enrique Machado-Duque,Andrés Gaviria-Mendoza,Jorge Enrique Machado-Alba,Natalia Castano +3 more
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Bicyclic Heterocyclic Replacement of an Aryl Amide Leading to Potent and Kinase-Selective Adaptor Protein 2-Associated Kinase 1 Inhibitors.
Richard A. Hartz,Vijaykamal Ahuja,Susheel J. Nara,Cholleti Vijay Kumar,Raju K V L P Manepalli,Sarat Kumar Sarvasiddhi,Swarnamba Honkhambe,VL Patankar,Bireshwar Dasgupta,Ramkumar Rajamani,Jodi K. Muckelbauer,Daniel M. Camac,Kaushik Ghosh,Matthew Pokross,Susan E. Kiefer,Jeffrey M. Brown,Lisa Hunihan,Michael Gulianello,Martin A. Lewis,Jonathan Lippy,Neha Surti,Brian D. Hamman,Jason Allen,Walter A. Kostich,Joanne J. Bronson,John E. Macor,Carolyn Diane Dzierba +26 more
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Antitumoral Effects of Tricyclic Antidepressants: Beyond Neuropathic Pain Treatment
Antonio Asensi-Cantó,María Dolores López-Abellán,Verónica Castillo-Guardiola,Ana Maria Hurtado,M. Martínez-Penella,Ginés Luengo-Gil,Pablo Conesa-Zamora +6 more
TL;DR: The TCAs’ safety and their central effects against neuropathic pain in cancer, and the antitumoral effects of TCAs in in vitro and preclinical studies, as well as in the clinical setting are discussed.
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Efficacy and safety of mirogabalin treatment in patients with diabetic peripheral neuropathic pain: A systematic review and meta-analysis of randomised controlled trials.
Reem A. Al-Youbi,Aysha A. Alshareef,Saud Musaab Aldughaither,Abeer Mahdi Aljaroudi,Alwaleed A. Alabdulwahed,Faisal Muhammed Alduraibi,Ahmed Taher Masoud,Ahmed Abu-Zaid,Ahmed Abu-Zaid +8 more
TL;DR: A systematic review and meta‐analysis was performed to examine the efficacy and safety of mirogabalin in patients with diabetic peripheral neuropathic pain and found it to be safe and efficacious.
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