TRAMADOL AND NEUROPATHIC PAIN
BACKGROUND: Neuropathic pain syndrome includes a series of symptoms, including burning or shooting sensations, abnormal sensitivity to what would generally be pain-less
stimuli, or a greatly raised sensitivity to painful stimuli. A wide range of disorders
can cause neuropathic pain, nerve damage being the only common factor.
OBJECTIVES: The aim was to carefully review the evidence from randomized controlled
trials for the ability of tramadol to treat neuropathic pain effectively.
SEARCH STRATEGY: We searched the Cochrane Neuromuscular Disease Group trials
register (July 2002), MEDLINE (January 1966 to July 2002), EMBASE
(January 1980 to July 2002), for
randomized and quasi-randomized controlled trials. We also searched
biblio. of public trials.
SELECTION CRITERIA: We included randomized and quasi-randomized controlled
trials comparing tramadol with placebo, other pain relieving treatment,
or no treatment in people and all ages and genders with neuropathic pain, with
varying degrees of severity. DATA COLLECTION AND ANALYSIS: Two reviewers
extracted data and scored trial quality. We calculated relative risks and
numbers needed to treat for effectiveness and adverse effects.
MAIN RESULTS: We identified five eligible trials, comparing tramadol with
placebo, one comparing tramadol with clomipramine, and one comparing tramadol
with morphine. All three trials comparing tramadol with placebo showed a
notable reduction in neuropathic pain with tramadol. Two of the trials
that compared tramadol to placebo (total 161 participants) were combined
in a meta-analysis. The number needed to treat with tramadol compared to
placebo to reach at least 50% pain relief was 3.5 (95% confidence interval
2.4 to 5.9). There were insufficient data to draw conclusions about the
effectiveness of tramadol compared to either clomipramine or morphine.
Only one trial considered subcategories of neuropathic pain. It found a
significant therapeutic effect of tramadol on paraesthesiae, allodynia,
and touch-evoked pain.Numbers needed to harm were calculated for side
effects resulting in withdrawal from the placebo-controlled trials.
Two trials provided these data, and the combined number needed to harm was
7.7 (95% confidence interval 4.6 to 20).
REVIEWERS' CONCLUSIONS: Tramadol is an effective medicine for neuropathic pain.
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