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.

Authors' conclusions: 

There was insufficient evidence to support or refute the suggestion that buprenorphine has any efficacy in any neuropathic pain condition.

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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 strategy: 

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.

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