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NEUROLOGY 1998;50:1837-1841
© 1998 American Academy of Neurology

Efficacy of oxycodone in neuronathic pain

A randomized trial in postherpetic neuralgia

C. Peter N. Watson, MD, FRCP(C) and Najib Babul, Pharm D

From the Department of Medicine (Dr. Watson), University of Toronto, and Department of Scientific Affairs (Dr. Babul), Furdue Frederick, Pickering, Ontario, Canada.

Address correspondence and reprint requests to Dr. C. Peter N. Watson, 1 Sir Williams Lane, Toronto, Ontario, Canada M9A 1T8

Objective Although opioid analgesics are used in the management of neuropathic pain syndromes, evidence of their efficacy remains to be established. We evaluated the clinical efficacy and safety of oxycodone in neuropathic pain using postherpetic neuralgia as a model.

Methods Patients with postherpetic neuralgia of at least moderate intensity were randomized to controlled-release oxycodone 10 mg or placebo every 12 hours, each for 4 weeks, using a double-blind, crossover design. The dose was increased weekly up to a possible maximum of 30 mg every 12 hours. Pain intensity and pain relief were assessed daily, and steady (ongoing) pain, brief (paroxysmal) pain, skin pain (allo-dynia), and pain relief were recorded at weekly visits. Clinical effectiveness, disability, and treatment preference were also assessed.

Results Fifty patients were enrolled and 38 completed the study (16 men, 22 women, age 70± 2 11 years, onset of postherpetic neuralgia 31± 2 29 months, duration of pain 18 ± 5 hours per day). The oxycodone dose during the final week was 45 ±5 17 mg per day. Compared with placebo, oxycodone resulted in pain relief (2.9±2 1.2 versus 1.8 ± 1.1, p = 0.0001) and reductions in steady pain (34 ± 26 versus 55 ± 27 mm, p = 0.0001), allodynia (32 ±2 26 versus 50 ±2 30 mm, p = 0.0004), and paroxysmal spontaneous pain (22 ± 24 versus 42 ± 32 mm, p = 0.0001). Global effectiveness, disability, and masked patient preference all showed superior scores with oxycodone relative to placebo (1.8 ±.11 versus 0.7 ± 1.0, p = 0.0001; 0.3 ± 0.8 versus 0.7 ± 1.0, p = 0.041; 67% versus 11%, p = 0.001, respectively).

Conclusions Controlled-release oxycodone is an effective analgesic for the management of steady pain, paroxysmal spontaneous pain, and allodynia, which frequently characterize postherpetic neuralgia.

Supported by a research grant from Purdue Frederick.

Received October 15, 1997. Accepted in final form January 23, 1998.




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