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Journal of Pain and Symptom Management - The Evidence for Pharmacologic Treatment of Neuropathic Cancer Pain: Beneficial and Adverse Effects
Abstract
Context
The
prevalence of neuropathic pain in patients with cancer pain has been
estimated to be around 40%. Neuropathic pain may be caused by a tumor
invasion and is considered as mixed nociceptive-neuropathic pain or
caused by an anticancer treatment and considered as purely neuropathic
pain. The use of adjuvant analgesics in patients with cancer is usually
extrapolated from their efficacy in nononcological neuropathic pain
syndromes.
Objectives
In
this systematic review, we sought to evaluate the evidence for the
beneficial and adverse effects of pharmacologic treatment of neuropathic
cancer pain.
Methods
A
systematic review of the literature in PubMed and EMBASE was performed.
Primary outcome measures were absolute risk benefit (ARB), defined as
the number of patients with a defined degree of pain relief divided by
the total number of patients in the treatment group, and absolute risk
harm (ARH), defined as the fraction of patients who dropped out as a
result of adverse effects.
Results
We
identified 30 articles that fulfilled our inclusion criteria. Overall,
ARB of antidepressants, anticonvulsants, other adjuvant analgesics, or
opioids greatly outweighed ARH. There were no significant differences in
ARB or ARH between the four groups of medication or between patients
with mixed vs. purely neuropathic pain. Because of the low
methodological quality of the studies, we could not draw conclusions
about the true treatment effect size of the four groups of medications.
Conclusion
Once
a diagnosis of neuropathic pain has been established in patients with
cancer, antidepressants, anticonvulsants, or other adjuvant analgesics
should be considered in addition to or instead of opioids.
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