Cochrane Abstracts
Buprenorphine for neuropathic pain in adults
Abstract
Background
Opioid drugs, including buprenorphine, are commonly used to treat neuropathic pain, and are considered effective by some professionals. Most reviews have examined all opioids together. This review sought evidence specifically for buprenorphine, at any dose, and by any route of administration. Other opioids are considered in separate reviews.
Objectives
To assess the analgesic efficacy of buprenorphine for chronic neuropathic pain in adults, and the adverse events associated with its use in clinical trials.
Search methods
We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, and EMBASE from inception to 11 June 2015, together with reference lists of retrieved papers and reviews, and two online study registries.
Selection criteria
We included randomised, double‐blind studies of two weeks' duration or longer, comparing any oral dose or formulation of buprenorphine with placebo or another active treatment in chronic neuropathic pain.
Data collection and analysis
Two review authors independently searched for studies, extracted efficacy and adverse event data, and examined issues of study quality. We did not carry out any pooled analyses.
Main results
Searches identified 10 published studies, and one study with results in ClinicalTrials.gov. None of these 11 studies satisfied our inclusion criteria, and so we included no studies in the review.
Authors' conclusions
There was insufficient evidence to support or refute the suggestion that buprenorphine has any efficacy in any neuropathic pain condition.
Author(s)
Philip J Wiffen, Sheena Derry, R Andrew Moore, Cathy Stannard, Dominic Aldington, Peter Cole, Roger Knaggs
Abstract
Plain language summary
Buprenorphine for neuropathic pain in adults
Neuropathic pain is pain coming from damaged nerves. It is different from pain messages that are carried along healthy nerves from damaged tissue (for example, a fall or cut, or arthritic knee). Neuropathic pain is often treated by different medicines (drugs) to those used for pain from damaged tissue, which we often think of as painkillers. Medicines that are sometimes used to treat depression or epilepsy can be very effective in some people with neuropathic pain. But sometimes opioid painkillers are used to treat neuropathic pain.
Opioid painkillers are drugs like morphine. Morphine is derived from plants, but many opioids are also made by chemical synthesis rather than being extracted from plants. Buprenorphine is one of these synthetic opioids. It is available in numerous countries for use as a painkiller, and can be given by injection, as a tablet placed under the tongue, or as a patch that delivers the drug to the body through the skin.
In June 2015, we performed searches to look for clinical trials where buprenorphine was used to treat neuropathic pain in adults. We found no study that did this, and that met our requirements for the review.
There is no evidence to support or refute the suggestion that buprenorphine works in any neuropathic pain condition. Large, properly conducted new clinical trials would be needed to provide evidence that buprenorphine worked in neuropathic pain conditions.
Author(s)
Philip J Wiffen, Sheena Derry, R Andrew Moore, Cathy Stannard, Dominic Aldington, Peter Cole, Roger Knaggs
Reviewer's Conclusions
Authors' conclusions
Implications for practice
For people with neuropathic pain
There is insufficient evidence to support or refute the suggestion that buprenorphine has any efficacy in any neuropathic pain condition.
For clinicians
There is insufficient evidence to support or refute the suggestion that buprenorphine has any efficacy in any neuropathic pain condition.
For policy makers
There is insufficient evidence to support or refute the suggestion that buprenorphine has any efficacy in any neuropathic pain condition. In the absence of any supporting evidence, it should probably not be recommended, except at the discretion of a pain specialist with particular expertise in opioid use.
For funders
There is insufficient evidence to support or refute the suggestion that buprenorphine has any efficacy in any neuropathic pain condition. In the absence of any supporting evidence, it should probably not be recommended, except at the discretion of a pain specialist with particular expertise in opioid use.
Implications for research
Large, robust randomised trials with patient‐centred outcomes would be required to produce evidence to support or refute efficacy of buprenorphine in neuropathic pain. The necessary design of such trials is well established, but for opioids in neuropathic pain, the outcomes should be those of at least 30% and at least 50% pain intensity reduction over baseline at the end of a trial of 12 weeks' duration in participants continuing on treatment. Withdrawal for any reason should be regarded as treatment failure, and LOCF analysis should not be used. The reason for this is that, in chronic pain, opioids frequently produce withdrawal rates of 50% or more, meaning that LOCF analysis can overstate treatment efficacy.
