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Related Experiment Videos

Opioids for neuropathic pain.

E Eisenberg1, E McNicol, D B Carr

  • 1New England Medical Center, Pharmacy and Anesthesia, Box #420, 750 Washington Street, Boston, MA 02111, USA. ewanmcnicol@comcast.net

The Cochrane Database of Systematic Reviews
|July 21, 2006
PubMed
Summary

Opioid agonists show significant efficacy for intermediate-term treatment of neuropathic pain, with common side effects like nausea and constipation. Further research is needed to confirm long-term benefits and safety.

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Area of Science:

  • Neurology
  • Pain Management
  • Pharmacology

Background:

  • The efficacy and long-term risk-benefit profile of opioid agonists for neuropathic pain management remain subjects of ongoing debate.
  • Existing studies are often small and provide inconclusive results regarding opioid effectiveness and safety.

Purpose of the Study:

  • To systematically evaluate the efficacy and safety of opioid agonists in treating neuropathic pain.
  • To synthesize evidence from controlled trials to inform clinical practice and future research.

Main Methods:

  • A comprehensive literature search was conducted across major databases (Cochrane, MEDLINE, EMBASE) up to June 2005.
  • Included were randomized controlled trials (RCTs) of opioid agonists for neuropathic pain, excluding combination therapies or non-oral routes.

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  • Data on efficacy and adverse events were extracted by two independent investigators.

    • Main Results:

    • Twenty-three trials were analyzed, categorized into short-term (<24 hours) and intermediate-term (median 28 days).
    • Short-term trials yielded contradictory findings, while all nine intermediate-term trials demonstrated opioid efficacy for spontaneous neuropathic pain.
    • Meta-analysis of intermediate-term studies showed a significant reduction in pain intensity (13 points on VAS) with opioids versus placebo (P < 0.00001).
    • Common adverse events included nausea (33%), constipation (33%), drowsiness (29%), dizziness (21%), and vomiting (15%), leading to withdrawal in 11% of participants.

    Conclusions:

    • Intermediate-term studies indicate clinically significant efficacy of opioid agonists for neuropathic pain compared to placebo.
    • Adverse events are frequent but generally not life-threatening.
    • Further RCTs are essential to determine long-term efficacy, safety, addiction potential, and impact on quality of life.