Oxycodone for neuropathic pain in adults.

Area of Science:

• Pain Management
• Pharmacology
• Clinical Trials

Background:

• This review focuses exclusively on oxycodone for neuropathic pain, updating previous reviews that included fibromyalgia and other opioids.
• Oxycodone is a commonly prescribed opioid for neuropathic pain, with varying professional opinions on its efficacy.

Purpose of the Study:

• To evaluate the analgesic effectiveness of oxycodone for chronic neuropathic pain in adults.
• To assess the safety and adverse events associated with oxycodone treatment in this patient population.

Main Methods:

• Systematic review of randomized, double-blind studies of at least two weeks' duration comparing oxycodone with placebo or active treatments.
• Searches included multiple databases (CENTRAL, MEDLINE, EMBASE) and clinical trial registries up to December 2015.
• Included studies with oxycodone alone, in combination with naloxone, or as add-on therapy to stable treatments.

Main Results:

• Five studies involving 687 participants (painful diabetic neuropathy and postherpetic neuralgia) were included.
• Moderate benefit (≥30% pain relief) was observed in 44% of participants on oxycodone versus 27% on placebo (NNT 5.7).
• Adverse events were more common with oxycodone (86%) than placebo (63%) (NNH 4.3), though serious adverse events and withdrawals did not differ significantly.

Conclusions:

• The evidence supporting oxycodone's value for painful diabetic neuropathy and postherpetic neuralgia is of very low quality.
• No evidence was found for efficacy in other neuropathic pain conditions.
• Opioid-typical adverse events are common with oxycodone treatment.