Li Mei1, Mu Fengqun2, Zuo Zhengyao1, Fan Mingming1, Wang Qing1, Liu Xiaozhuo1, Su Dongpo1, Han Qian1, Chen Tong3. 1. Department of Neurosurgery, North China University of Science and Technology Affiliated Hospital, Tangshan, 063000, Hebei Province, China. 2. Department of Neurology, Gongren Hospital, Tangshan, 063000, Hebei Province, China. 3. Department of Neurosurgery, North China University of Science and Technology Affiliated Hospital, Tangshan, 063000, Hebei Province, China. ct.1973@163.com.
Abstract
STUDY DESIGN: Systematic review with network meta-analysis. OBJECTIVE: We explored the efficacy and safety of different drug treatments in patients with spinal-cord injury (SCI)-related neuropathic pain. We investigated which treatment is most suitable for such patients by judging the efficacy and safety of these drugs. METHODS: We searched the PubMed, Medline, Embase and Cochrane databases from inception to 31 August 2020. The quality of the included studies was assessed. We selected the proportion of patients whose pain was reduced by ≥50% and the prevalence of adverse effects as the outcome indicators of efficacy and safety, respectively. RESULTS: We included 15 randomized controlled clinical trials involving five interventions (anticonvulsants, antidepressants, anesthetics, opioids and botulinum toxin A). Based on the proportion of patients with pain reduction ≥50%, the order (from highest to lowest) was anticonvulsants > anesthetics > antidepressants > botulinum toxin A > opioids > placebo. With regard to the prevalence of adverse effects, the order of safety (from highest to lowest) was placebo > antidepressants > botulinum toxin A > anticonvulsants > opioids > anesthetics. Analyzes of efficacy and safety revealed that anticonvulsant, antidepressant and botulinum toxin A have good efficacy and safety. CONCLUSION: The efficacy of anticonvulsants, anesthetics, antidepressants, opioids and botulinum toxin A was greater than that of placebo for treatment of SCI-related neuropathic pain. However, the prevalence of adverse effects associated with use of these drugs was also higher than that of placebo. Further analyses based on efficacy and safety revealed anticonvulsants to be more suitable for such patients. In addition, antidepressant and botulinum toxin A may be promising treatments for SCI-related neuropathic pain, however, their effects still need to be further explored due to the small sample size.
STUDY DESIGN: Systematic review with network meta-analysis. OBJECTIVE: We explored the efficacy and safety of different drug treatments in patients with spinal-cord injury (SCI)-related neuropathic pain. We investigated which treatment is most suitable for such patients by judging the efficacy and safety of these drugs. METHODS: We searched the PubMed, Medline, Embase and Cochrane databases from inception to 31 August 2020. The quality of the included studies was assessed. We selected the proportion of patients whose pain was reduced by ≥50% and the prevalence of adverse effects as the outcome indicators of efficacy and safety, respectively. RESULTS: We included 15 randomized controlled clinical trials involving five interventions (anticonvulsants, antidepressants, anesthetics, opioids and botulinum toxin A). Based on the proportion of patients with pain reduction ≥50%, the order (from highest to lowest) was anticonvulsants > anesthetics > antidepressants > botulinum toxin A > opioids > placebo. With regard to the prevalence of adverse effects, the order of safety (from highest to lowest) was placebo > antidepressants > botulinum toxin A > anticonvulsants > opioids > anesthetics. Analyzes of efficacy and safety revealed that anticonvulsant, antidepressant and botulinum toxin A have good efficacy and safety. CONCLUSION: The efficacy of anticonvulsants, anesthetics, antidepressants, opioids and botulinum toxin A was greater than that of placebo for treatment of SCI-related neuropathic pain. However, the prevalence of adverse effects associated with use of these drugs was also higher than that of placebo. Further analyses based on efficacy and safety revealed anticonvulsants to be more suitable for such patients. In addition, antidepressant and botulinum toxin A may be promising treatments for SCI-related neuropathic pain, however, their effects still need to be further explored due to the small sample size.
Authors: Rudolf Martin Duehmke; Sheena Derry; Philip J Wiffen; Rae F Bell; Dominic Aldington; R Andrew Moore Journal: Cochrane Database Syst Rev Date: 2017-06-15
Authors: Dyveke T Demant; Karen Lund; Jan Vollert; Christoph Maier; Märtha Segerdahl; Nanna B Finnerup; Troels S Jensen; Søren H Sindrup Journal: Pain Date: 2014-08-17 Impact factor: 6.961
Authors: N B Finnerup; J Grydehøj; J Bing; I L Johannesen; F Biering-Sørensen; S H Sindrup; T S Jensen Journal: Spinal Cord Date: 2009-06-09 Impact factor: 2.772