Clonazepam for neuropathic pain and fibromyalgia in adults Stable (no update expected for reasons given in 'What's new')

Abstract

Abstract Background

Antiepileptic drugs have been used in pain management since the 1960s; some have shown efficacy in treating different neuropathic pain conditions. Clonazepam, a benzodiazepine, is an established antiepileptic drug, but its place in the treatment of neuropathic pain is unclear.

Objectives

To assess the analgesic efficacy and adverse effects of the antiepileptic drug clonazepam in neuropathic pain and fibromyalgia.

Search methods

We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2012, Issue 2). MEDLINE, and EMBASE to 28 February 2012, together with reference lists of retrieved papers and reviews, and ClinicalTrials.gov.

Selection criteria

We planned to include randomised, double‐blind studies of eight weeks duration or longer, comparing clonazepam with placebo or another active treatment in chronic neuropathic pain or fibromyalgia.

Data collection and analysis

Two review authors would independently extract data for efficacy and adverse events, and examine issues of study quality.

Main results

We did not identify any studies that satisfied the inclusion criteria.

Authors' conclusions

This review uncovered no evidence of sufficient quality to support the use of clonazepam in chronic neuropathic pain or fibromyalgia.

Author(s)

Ruth Corrigan, Sheena Derry, Philip J Wiffen, R Andrew Moore

Abstract

Plain language summary

Clonazepam for neuropathic pain and fibromyalgia in adults

Nerves which have been damaged by injury or disease can continue to produce pain. This type of pain is called neuropathic pain. Some antiepileptic medications can help neuropathic pain. Clonazepam is an antiepileptic medication, and the aim of this review was to assess how effective clonazepam is for neuropathic pain and fibromyalgia. We identified no good quality studies of clonazepam used in this situation. Dependence and tolerance may occur with prolonged use, although it is less of a problem with clonazepam than many other drugs from the same class (benzodiazepines), and behavioural disinhibition has been reported in a few patients with psychiatric problems. Based on current evidence, clonazepam cannot be recommended for treating neuropathic pain. Other antiepileptic drugs such as pregabalin, gabapentin, and carbamazepine have been shown to be of value in neuropathic pain.

Author(s)

Ruth Corrigan, Sheena Derry, Philip J Wiffen, R Andrew Moore

Reviewer's Conclusions

Authors' conclusions

Implications for practice

This review has uncovered no evidence of sufficient quality to support a rationale for the use of clonazepam in chronic neuropathic pain and fibromyalgia, and the possibility of adverse effects is likely to curtail any potential use in these conditions. Other antiepileptic drugs such as pregabalin, gabapentin, and carbamazepine have been shown to be of value in neuropathic pain, and should be used in preference.

Implications for research

If clonazepam is to be considered for use in this context, high‐quality, randomised, double‐blinded, placebo‐controlled trials need to be carried out to build a base of evidence supporting its use or confirming it to be ineffective. Clonazepam is an old drug and this seems unlikely to occur due to the cost of such studies and the lack of financial incentive behind them, in this case because clonazepam is out of patent and there would be little or no profit to justify the large trial costs.

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