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.

Authors' conclusions: 

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

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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 strategy: 

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.

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