Oral nonsteroidal anti‐inflammatory drugs for neuropathic pain Stable (no update expected for reasons given in 'What's new')

Abstract

Background

Although often considered to be lacking adequate evidence, nonsteroidal anti‐inflammatory drugs (NSAIDs) are widely used in the management of neuropathic pain. Previous surveys found 18% to 47% of affected people reported using NSAIDs specifically for their neuropathic pain, although possibly not in the United Kingdom (UK).

Objectives

To assess the analgesic efficacy of oral NSAIDs for chronic neuropathic pain in adults, when compared to placebo or another active intervention, and the adverse events associated with its use in clinical trials.

Search methods

We searched CENTRAL, MEDLINE, and EMBASE from inception to 29 May 2015, together with reference lists of retrieved papers and reviews, and an online trials registry.

Selection criteria

We included randomised, double‐blind studies of two weeks duration or longer, comparing any oral NSAID 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 analysis.

Main results

We included two studies involving 251 participants with chronic low back pain with a neuropathic component or postherpetic neuralgia; 209 of these participants were involved in a study of an experimental NSAID not used in clinical practice, and of the remaining 42, only 16 had neuropathic pain. This represented only third tier evidence, and was of very low quality. There was no indication of any significant pain reduction with NSAIDs. Adverse event rates were low, with insufficient events for any analysis.

Authors' conclusions

There is no evidence to support or refute the use of oral NSAIDs to treat neuropathic pain conditions.

Author(s)

R Andrew Moore, Ching‐Chi Chi, Philip J Wiffen, Sheena Derry, Andrew SC Rice

Abstract

Plain language summary

Oral nonsteroidal anti‐inflammatory drugs (NSAIDs) for neuropathic pain in adults 

Neuropathic pain is pain which comes from damaged nerves, spinal cord, or brain. 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 treated by different medicines to those used for pain from damaged tissue. Medicines that are sometimes used to treat depression or epilepsy can be very effective in some people with neuropathic pain.

Commonly used painkillers such as ibuprofen (a nonsteroidal anti‐inflammatory drug, or NSAID) are not usually considered to be effective in treating neuropathic pain, but in some parts of the world they are used commonly for neuropathic pain conditions.

In May 2015 we searched for clinical trials in which oral NSAIDs were used to treat neuropathic pain in adults. We found only two small studies that included 251 participants who had chronic low back pain with a neuropathic component, or had neuropathic pain after shingles. Of these 251 participants, 209 were in a study of an experimental drug that is not licensed and not available for use.

The trial results show that there was no difference between NSAIDs and placebo in terms of pain or adverse events (very low quality evidence). There is no good evidence to tell us whether or not oral NSAIDs are helpful to treat neuropathic pain conditions.

Author(s)

R Andrew Moore, Ching‐Chi Chi, Philip J Wiffen, Sheena Derry, Andrew SC Rice

Reviewer's Conclusions

Authors' conclusions 

Implications for practice 

For people with neuropathic pain

There is insufficient evidence to support or refute the suggestion that oral NSAIDs have any efficacy in any neuropathic pain condition.

For clinicians

There is insufficient evidence to support or refute the suggestion that oral NSAIDs have any efficacy in any neuropathic pain condition. The absence of any reliable evidence of oral NSAID efficacy is a challenge to their continued widespread use.

For policy makers

There is insufficient evidence to support or refute the suggestion that oral NSAIDs have any efficacy in any neuropathic pain condition, and in the absence of any supporting evidence they should probably not be recommended.

For funders

There is insufficient evidence to support or refute the suggestion that oral NSAIDs have any efficacy in any neuropathic pain condition.

Implications for research 

General

Large, robust randomised trials with patient‐centred outcomes would be required to produce evidence to support or refute efficacy of NSAIDs in neuropathic pain.

Design

There are no implications for design of studies.

Measurement (endpoints)

There are no implications for measurement.

Comparison between active treatments

NSAIDs cannot be compared with other treatments for neuropathic pain with established efficacy.

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