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Tramadol for neuropathic painDuehmke RM, Hollingshead J, Cornblath DR
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SummaryTramadol for neuropathic painNeuropathic pain is frequently caused by damage to the peripheral nerves. Symptoms may include burning or shooting sensations, and abnormal sensitivity to normally non-painful stimuli. Neuropathic pain is difficult to treat. Anticonvulsants and antidepressants are frequently used but their use is limited by side effects. Tramadol is a unique pain killing drug with mild opiate properties. In the update of this review undertaken in November 2008, five randomised controlled trials involving a total of 374 participants met the inclusion criteria for this review and compared tramadol to placebo. Evidence from these trials showed that 100 to 400 mg of tramadol is an effective symptomatic treatment for peripheral neuropathic pain. One trial involving less than 40 participants compared tramadol to morphine, and one involving 21 participants compared tramadol to clomipramine. It was not possible to draw conclusions from these two trials as to which of these drugs is more effective. Treatment with tramadol may cause side effects, including constipation, nausea, sedation and a dry mouth, all of which resolve after stopping treatment. In the trials reviewed here, one person out of eight treated with tramadol left the trial because of side effects. Tramadol is also associated with a small risk of seizures (fits) and its use is contraindicated in people with a history of epilepsy.
This is a Cochrane review abstract and plain language summary, prepared and maintained by The Cochrane Collaboration, currently published in The Cochrane Database of Systematic Reviews 2010 Issue 1, Copyright © 2010 The Cochrane Collaboration. Published by John Wiley and Sons, Ltd.. The full text of the review is available in The Cochrane Library (ISSN 1464-780X).
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April 19. 2004 AbstractBackgroundPeripheral neuropathic pains often include symptoms such as burning or shooting sensations, abnormal sensitivity to normally painless stimuli, or an increased sensitivity to normally painful stimuli. Neuropathic pain is a common symptom in many diseases of the peripheral nervous system. ObjectivesWe aimed to review systematically the evidence from randomised controlled trials for the efficacy of tramadol in treating neuropathic pain. Search strategyWe updated the searches of the Cochrane Neuromuscular Disease Group Trials Register (17 November 2008), MEDLINE (January 1966 to November 17 2008), EMBASE (January 1980 to November 17 2008), and LILACS (January 1982 to November 17 2008) for randomised and quasi-randomised controlled trials. We also searched bibliographies of published trials. Selection criteriaWe included randomised and quasi-randomised controlled trials comparing tramadol with placebo, other pain relieving treatment, or no treatment in people of both sexes and all ages with neuropathic pain of all degrees of severity. Data collection and analysisTwo authors extracted data and scored trial quality. We calculated relative risks and numbers needed to treat for effectiveness and adverse effects. Main resultsWe identified seven eligible trials, five comparing tramadol with placebo, one comparing tramadol with clomipramine, and one comparing tramadol with morphine. All five trials comparing tramadol with placebo showed a significant reduction in neuropathic pain with tramadol. Three of the trials which compared tramadol to placebo (total 303 participants) were combined in a meta-analysis. The number needed to treat with tramadol compared to placebo to reach at least 50% pain relief was 3.8 (95% confidence interval 2.8 to 6.3). There were insufficient data to draw conclusions about the effectiveness of tramadol compared to either clomipramine or morphine. Only one trial considered subcategories of neuropathic pain. It found a significant therapeutic effect of tramadol on paraesthesiae, allodynia, and touch evoked pain. Numbers needed to harm were calculated for side effects resulting in withdrawal from the placebo controlled trials. Three trials provided these data, and the combined number needed to harm was 8.3 (95% confidence interval 5.6 to 17). Authors' conclusionsTramadol is an effective treatment for neuropathic pain. |