| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
|
|
|
|||||||
|
|||||||||
From the Department of Neurology, Odense and Aarhus University Hospitals, Denmark.
Address correspondence and reprint requests to Dr. Søren H. Sindrup, Department of Neurology, Odense University Hospital, DK-5000 Odense C, Denmark.
Tricyclic antidepressants and anticonvulsants have become the mainstay in the treatment of pain in polyneuropathy. Within the last decade, controlled trials have shown that numerous other drugs relieve such pain. To estimate the efficacy of the different treatments, the authors identified all placebo-controlled trials and calculated numbers needed to treat (NNT) to obtain one patient with more than 50% pain relief. The NNT was 2.6 for tricyclic antidepressants, 6.7 for selective serotonin reuptake inhibitors, 2.5 for anticonvulsant sodium channel blockers, 4.1 for the anticonvulsant calcium channel blocker gabapentin, and 3.4 for the mixed opioid and monoaminergic drug tramadol, as calculated from a sufficiently large number of patients. Favorable point estimates of NNT of 1.9 for the NMDA-antagonist dextromethorphan and 3.4 for L-dopa were determined from a limited number of data. For capsaicin, the NNT calculated from many exposed patients was 5.9, but most of the data are controversial owing to trial methodology. Finally, the NNT for the antiarrhythmic sodium channel blocker mexiletine was 38, but this value may be biased because of a lack of dichotomous data in several positive trials. Tricyclic antidepressants are at the moment still the drugs of first choice, and drugs such as gabapentin, carbamazepine, and tramadol may be tried if contraindications or tolerability problems are encountered with the tricyclics.
This article has been cited by other articles:
|
|
 |
|
  B. A. Chizh Low dose ketamine: a therapeutic and research tool to explore N-methyl-D-aspartate (NMDA) receptor-mediated plasticity in pain pathways J Psychopharmacol, May 1, 2007; 21(3): 259 - 271. [Abstract] [PDF]
|
|
|
|
 |
|
 J. F. Wernicke, Y. L. Pritchett, D. N. D'Souza, A. Waninger, P. Tran, S. Iyengar, and J. Raskin A randomized controlled trial of duloxetine in diabetic peripheral neuropathic pain Neurology, October 24, 2006; 67(8): 1411 - 1420. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. C. Rowbotham Mechanisms of neuropathic pain and their implications for the design of clinical trials Neurology, December 29, 2005; 65(12_suppl_4): S66 - S73. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
G. A. Irving Contemporary assessment and management of neuropathic pain Neurology, June 28, 2005; 64(12_suppl_3): S21 - S27. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
H. Lesser, U. Sharma, L. LaMoreaux, and R. M. Poole Pregabalin relieves symptoms of painful diabetic neuropathy: A randomized controlled trial Neurology, December 14, 2004; 63(11): 2104 - 2110. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 H. Chen, T. J. Lamer, R. H. Rho, K. A. Marshall, B. T. Sitzman, S. M. Ghazi, and R. P. Brewer Contemporary Management of Neuropathic Pain for the Primary Care Physician Mayo Clin. Proc., December 1, 2004; 79(12): 1533 - 1545. [Abstract] [PDF]
|
|
|
|
 |
|
 K. Stiasny-Kolster, W. Magerl, W. H. Oertel, J. C. Moller, and R.-D. Treede Static mechanical hyperalgesia without dynamic tactile allodynia in patients with restless legs syndrome Brain, April 1, 2004; 127(4): 773 - 782. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 D. J. Goldstein, Y. Lu, M. J. Detke, J. Hudson, S. Iyengar, and M. A. Demitrack Effects of Duloxetine on Painful Physical Symptoms Associated With Depression Psychosomatics, February 1, 2004; 45(1): 17 - 28. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 R. H. Dworkin, M. Backonja, M. C. Rowbotham, R. R. Allen, C. R. Argoff, G. J. Bennett, M. C. Bushnell, J. T. Farrar, B. S. Galer, J. A. Haythornthwaite, et al. Advances in Neuropathic Pain: Diagnosis, Mechanisms, and Treatment Recommendations Arch Neurol, November 1, 2003; 60(11): 1524 - 1534. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 E. Rock and A. DeMichele Nutritional Approaches to Late Toxicities of Adjuvant Chemotherapy in Breast Cancer Survivors J. Nutr., November 1, 2003; 133(11): 3785S - 3793. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. H. Sindrup, F. W. Bach, C. Madsen, L. F. Gram, and T. S. Jensen Venlafaxine versus imipramine in painful polyneuropathy: A randomized, controlled trial Neurology, April 22, 2003; 60(8): 1284 - 1289. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. R. Mendell and Z. Sahenk Painful Sensory Neuropathy N. Engl. J. Med., March 27, 2003; 348(13): 1243 - 1255. [Full Text] [PDF]
|
|
|
|
|
|
D. W. Zochodne and M. B. Max An old acquaintance: Opioids in neuropathic pain Neurology, March 25, 2003; 60(6): 894 - 895. [Full Text] [PDF]
|
|
|
|
|
|
M. R. Semenchuk, S. Sherman, and B. Davis Double-blind, randomized trial of bupropion SR for the treatment of neuropathic pain Neurology, November 13, 2001; 57(9): 1583 - 1588. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
W. M. Landau, S. H. Sindrup, and T. S. Jensen Pharmacologic treatment of pain in polyneuropathy Neurology, April 24, 2001; 56(8): 1121 - 1121. [Full Text] [PDF]
|
|
| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
