|
March 1997
A systematic review of antidepressants in neuropathic pain.
McQuay HJ, Tramer M, Nye BA, Carroll D, Wiffen PJ, Moore RA. Pain 1996; 68:217-227
[ no abstract available ]
Much of the use of antidepressants for the treatment of neuropathic pain has been the result of anecdotal reports and personal experience rather than of systematic study. McQuay and colleagues from the University of Oxford have performed a systematic review and meta-analysis of the available studies to address current clinical debates:
- Which drug is best?
- Do selective serotonin uptake inhibitors have an advantage over tricyclic antidepressants?
- How should doses be titrated?
- Are benefits due to analgesia or mood improvement?
- Is the character of the pain is predictive of the response?
- Are antidepressants are preferable to anticonvulsants in the management of neuropathic pain?
To do this, they rated all the reports of randomized controlled trials of antidepressants in chronic pain for inclusion and quality (presence and quality of randomization, presence and quality of blinding, and number and reasons for withdrawals). They dichotomized the data for effectiveness and adverse effects, and analyzed it with odds ratio and number needed to treat methods. The latter was initially described by Laupacis in the New England Journal of Medicine in 1988 and evaluated by Cook and Sackett in the British Medical Journal in 1995. It is a way of summarizing the effect of a clinical treatment in terms of the number of patients a clinician needs to treat with a given therapy in order to expect to prevent one adverse event.
This outcome measure is not well described in the McQuay paper; however, their tables describing the studies and their results are a useful compilation. They have not arrived at any definitive answers to the questions outlined above, but have I believe succeeded in focusing those questions for future research, and clarified the sources of information currently available.
Return to the Current Literature Review Front Page
|
