RT Journal Article
SR Electronic
T1 PEER systematic review of randomized controlled trials
JF Canadian Family Physician
JO Can Fam Physician
FD The College of Family Physicians of Canada
SP e130
OP e140
DO 10.46747/cfp.6705e130
VO 67
IS 5
A1 Jamison Falk
A1 Betsy Thomas
A1 Jessica Kirkwood
A1 Christina S. Korownyk
A1 Adrienne J. Lindblad
A1 Joey Ton
A1 Samantha Moe
A1 G. Michael Allan
A1 James McCormack
A1 Scott Garrison
A1 Nicolas Dugré
A1 Karenn Chan
A1 Michael R. Kolber
A1 Anthony Train
A1 Liesbeth Froentjes
A1 Logan Sept
A1 Michael Wollin
A1 Rodger Craig
A1 Danielle Perry
YR 2021
UL http://www.cfp.ca/content/67/5/e130.abstract
AB Objective To determine the proportion of patients with neuropathic pain who achieve a clinically meaningful improvement in their pain with the use of different pharmacologic and nonpharmacologic treatments.Data sources MEDLINE, EMBASE, the Cochrane Library, and a gray literature search.Study selection Randomized controlled trials that reported a responder analysis of adults with neuropathic pain—specifically diabetic neuropathy, postherpetic neuralgia, or trigeminal neuralgia—treated with any of the following 8 treatments: exercise, acupuncture, serotonin-norepinephrine reuptake inhibitors (SNRIs), tricyclic antidepressants (TCAs), topical rubefacients, opioids, anticonvulsant medications, and topical lidocaine.Synthesis A total of 67 randomized controlled trials were included. There was moderate certainty of evidence that anticonvulsant medications (risk ratio of 1.54; 95% CI 1.45 to 1.63; number needed to treat [NNT] of 7) and SNRIs (risk ratio of 1.45; 95% CI 1.33 to 1.59; NNT = 7) might provide a clinically meaningful benefit to patients with neuropathic pain. There was low certainty of evidence for a clinically meaningful benefit for rubefacients (ie, capsaicin; NNT = 7) and opioids (NNT = 8), and very low certainty of evidence for TCAs. Very low-quality evidence demonstrated that acupuncture was ineffective. All drug classes, except TCAs, had a greater likelihood of deriving a clinically meaningful benefit than having withdrawals due to adverse events (number needed to harm between 12 and 15). No trials met the inclusion criteria for exercise or lidocaine, nor were any trials identified for trigeminal neuralgia.Conclusion There is moderate certainty of evidence that anticonvulsant medications and SNRIs provide a clinically meaningful reduction in pain in those with neuropathic pain, with lower certainty of evidence for rubefacients and opioids, and very low certainty of evidence for TCAs. Owing to low-quality evidence for many interventions, future high-quality trials that report responder analyses will be important to strengthen understanding of the relative benefits and harms of treatments in patients with neuropathic pain.