Anticonvulsant drugs for management of pain: a systematic review

H McQuay, D Carroll, A R Jadad, P Wiffen, A Moore, H McQuay, D Carroll, A R Jadad, P Wiffen, A Moore

Abstract

Objective: To determine effectiveness and adverse effects of anticonvulsant drugs in management of pain.

Design: Systematic review of randomised controlled trials of anticonvulsants for acute, chronic, or cancer pain identified by using Medline, by hand searching, by searching reference lists, and by contacting investigators.

Subjects: Between 1966 and February 1994, 37 reports were found; 20 reports, of four anticonvulsants, were eligible.

Main outcome measures: Numbers needed to treat were calculated for effectiveness, adverse effects, and drug related withdrawal from study.

Results: The only placebo controlled study in acute pain found no analgesic effect of sodium valproate. For treating trigeminal neuralgia, carbamazepine had a combined number needed to treat of 2.6 for effectiveness, 3.4 for adverse effects, and 24 for severe effects (withdrawal from study). For treating diabetic neuropathy, anticonvulsants had a combined number needed to treat of 2.5 for effectiveness, 3.1 for adverse effects, and 20 for severe effects. For migraine prophylaxis, anticonvulsants had a combined number needed to treat of 1.6 for effectiveness, 2.4 for adverse effects, and 39 for severe effects. Phenytoin had no effect on the irritable bowel syndrome, and carbamazepine had little effect on pain after stroke. Clonazepam was effective in one study for temporomandibular joint dysfunction. No study compared one anticonvulsant with another.

Conclusions: Anticonvulsants were effective for trigeminal neuralgia and diabetic neuropathy and for migraine prophylaxis. Minor adverse effects occurred as often as benefit.

References

    1. Diabetologia. 1969 Aug;5(4):215-8
    1. Headache. 1969 Apr;9(1):54-7
    1. Scand J Dent Res. 1970;78(2):144-8
    1. Acta Neurol Scand. 1970;46(4):385-408
    1. N Engl J Med. 1973 Jan 4;288(1):13-6
    1. J Neurol Sci. 1973 Jan;18(1):47-51
    1. Clin Pharmacol Ther. 1977 Aug;22(2):196-9
    1. Postgrad Med J. 1977;53 Suppl 4:104-9
    1. J Assoc Physicians India. 1978 May;26(5):403-6
    1. Headache. 1979 Sep;19(6):333-4
    1. Br J Dermatol. 1980 May;102(5):551-5
    1. Drugs. 1984 Jan;27(1):6-44
    1. Ann Neurol. 1984 Mar;15(3):240-4
    1. Wiad Lek. 1984 Jul 15;37(14):1093-5
    1. Cephalalgia. 1986 Sep;6(3):181-2
    1. Diabet Med. 1985 Sep;2(5):363-6
    1. Eur Neurol. 1987;26(2):73-83
    1. Ann Rheum Dis. 1987 Sep;46(9):667-9
    1. Ann Fr Anesth Reanim. 1988;7(5):387-92
    1. Pain. 1989 Jan;36(1):27-36
    1. Stat Med. 1989 Apr;8(4):441-54
    1. Arch Neurol. 1989 Sep;46(9):960-3
    1. Headache. 1991 Feb;31(2):71-4
    1. Pain. 1991 Feb;44(2):171-4
    1. Arzneimittelforschung. 1991 Apr;41(4):427-35
    1. Drugs Exp Clin Res. 1991;17(5):271-5
    1. J Craniomandib Disord. 1991 Summer;5(3):179-86
    1. J Pain Symptom Manage. 1992 May;7(4):209-13
    1. Anaesthesia. 1992 Aug;47(8):664-7
    1. JAMA. 1993 Jul 28;270(4):520-6
    1. JAMA. 1994 May 25;271(20):1609-14
    1. Pain. 1994 Feb;56(2):127-38
    1. BMJ. 1995 Feb 18;310(6977):452-4
    1. S Afr Med J. 1970 Jan 24;44(4):75-80
    1. J Neurol Neurosurg Psychiatry. 1966 Jun;29(3):265-7
    1. Dis Nerv Syst. 1967 Dec;28(12):820-3
    1. Headache. 1968 Apr;8(1):1-5
    1. Arch Neurol. 1968 Aug;19(2):129-36

Source: PubMed

Sponsorer och medarbetare

Medicinska tillstånd

Läkemedelsinterventioner

3
Prenumerera