Antidepressants for neuropathic pain

Tiina Saarto; Philip J Wiffen

doi:10.1002/14651858.CD005454.pub2

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Analysis 1.1

Comparison 1 Global improvement ‐ number of patients with moderate pain relief or better, Outcome 1 Amitriptyline versus placebo.

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Analysis 1.2

Comparison 1 Global improvement ‐ number of patients with moderate pain relief or better, Outcome 2 Desipramine vs placebo.

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Analysis 1.3

Comparison 1 Global improvement ‐ number of patients with moderate pain relief or better, Outcome 3 Imipramine vs placebo.

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Analysis 1.4

Comparison 1 Global improvement ‐ number of patients with moderate pain relief or better, Outcome 4 Other antidepressants vs placebo.

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Analysis 1.5

Comparison 1 Global improvement ‐ number of patients with moderate pain relief or better, Outcome 5 Tricyclics versus anticonvulsants.

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Analysis 1.6

Comparison 1 Global improvement ‐ number of patients with moderate pain relief or better, Outcome 6 Venlafaxine vs placebo.

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Analysis 2.1

Comparison 2 Diabetic neuropathy, Outcome 1 Antidepressant vs placebo. Number of patients with moderate pain relief or better.

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Analysis 2.2

Comparison 2 Diabetic neuropathy, Outcome 2 Changes in pain intensity: Desipramine vs placebo.

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Analysis 2.3

Comparison 2 Diabetic neuropathy, Outcome 3 Changes in pain intensity: Amitriptyline vs placebo.

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Analysis 2.4

Comparison 2 Diabetic neuropathy, Outcome 4 Changes in pain intensity: Fluoxetine vs placebo.

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Analysis 3.1

Comparison 3 Postherpetic neuralgia‐ number of patients with moderate pain relief or better, Outcome 1 Antidepressant vs placebo.

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Analysis 4.1

Comparison 4 Central pain‐ number of patients with moderate pain relief or better, Outcome 1 Antidepressant vs placebo.

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Analysis 5.1

Comparison 5 Atypical facial pain‐ number of patients with moderate pain relief or better, Outcome 1 Antidepressant vs placebo.

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Analysis 7.1

Comparison 7 Topical Doxepin, Outcome 1 Mean change scores ‐ doxepin vs placebo.

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Table 1. Continuous data studies

Study ID	Condition	Medicines used	Continuous data
Cardenas 2002	Spinal cord injury	Amitriptyline versus benztropine (active placebo)	No significant difference between acive and placebo
Gomez Perez 1996	Diabetic Neuropathy	Nortriptyline‐Fluphenazine versus carbamazepine	Mean percent change but no standard deviations (SD)
Graff Radford 2000	Post herpetic neuralgia	Amitiptyline and Fluphenazine	VAS change scores‐ see Metaview
Hampf 1989	Mixed pain but only neuropathic pain analysed for this review	Distigmine and Amitriptyline	VAS change scores but no SDs
Harrison 1997	Chronic Idiopathic Facial Pain	Fluoxetine	No evaluable data
Kalso 1995	Post mastectomy pain	Amitriptyline	Pre and post VAS with Median and range scores.
Max 1987	Diabetic Neuropathy	Amitriptyline versus benztropine (active placebo)	No evaluable data
Max 1992a	Diabetic neuropathy	Desipramine, amitriptyline and fluoxetine	Mean change scores with standard error. See metaview
McCleane 2000a	Neuropathic pain	Topical doxepin, topical capsaicin, and combination of both	Change scores with 95% CI
McCleane 2000b	Neuropathic pain	Topical doxepin	Mean plus SD for change in pain scores. See metaview
Panerai 1990	Central pain	Clomipramine, nortriptyline	No evaluable data
Sharav 1987	Chronic facial pain	Amitriptyline	Change VAS data with range
Sindrup 1990a	Diabetic neuropathy	Paroxetine, imipramine	No evaluable data
Sindrup 1990b	Diabetic neuropathy	Clomipramine, desipramine	No evaluable data
Sindrup 1992a	Diabetic neuropathy	Citalopram	No mean scores or SD
Sindrup 1992b	Diabetic neuropathy	Mianserin	No mean scores or SD
Tasmuth 2002	Neuropathic pain following treatment for breast cancer	Venlafaxine	Medians for pain relief with ranges
Ventafridda 1987	Neuropathic cancer pain	Amitriptyline, trazodone	No evaluable data.
Rowbotham 2004	Diabetic Neuropathy	Venlafaxine	Means but no SD

Table 1. Continuous data studies

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Comparison 1. Global improvement ‐ number of patients with moderate pain relief or better

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Amitriptyline versus placebo Show forest plot	10	588	Risk Ratio (M‐H, Random, 95% CI)	2.23 [1.35, 3.69]

2 Desipramine vs placebo Show forest plot	2	78	Risk Ratio (M‐H, Fixed, 95% CI)	5.75 [2.19, 15.08]

3 Imipramine vs placebo Show forest plot	2	58	Risk Ratio (M‐H, Fixed, 95% CI)	19.0 [3.97, 90.84]

4 Other antidepressants vs placebo Show forest plot	3		Risk Ratio (M‐H, Fixed, 95% CI)	Totals not selected

5 Tricyclics versus anticonvulsants Show forest plot	3		Risk Ratio (M‐H, Fixed, 95% CI)	Totals not selected

6 Venlafaxine vs placebo Show forest plot	3	200	Risk Ratio (M‐H, Fixed, 95% CI)	2.16 [1.50, 3.11]

Comparison 1. Global improvement ‐ number of patients with moderate pain relief or better

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Comparison 2. Diabetic neuropathy

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Antidepressant vs placebo. Number of patients with moderate pain relief or better Show forest plot	5	177	Risk Ratio (M‐H, Fixed, 95% CI)	12.41 [5.27, 29.21]

2 Changes in pain intensity: Desipramine vs placebo Show forest plot	1		Mean Difference (IV, Fixed, 95% CI)	Totals not selected

3 Changes in pain intensity: Amitriptyline vs placebo Show forest plot	1		Mean Difference (IV, Fixed, 95% CI)	Totals not selected

4 Changes in pain intensity: Fluoxetine vs placebo Show forest plot	1		Mean Difference (IV, Fixed, 95% CI)	Totals not selected

Comparison 2. Diabetic neuropathy

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Comparison 3. Postherpetic neuralgia‐ number of patients with moderate pain relief or better

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Antidepressant vs placebo Show forest plot	4	219	Risk Ratio (M‐H, Fixed, 95% CI)	2.33 [1.70, 3.19]

Comparison 3. Postherpetic neuralgia‐ number of patients with moderate pain relief or better

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Comparison 4. Central pain‐ number of patients with moderate pain relief or better

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Antidepressant vs placebo Show forest plot	2	48	Risk Ratio (M‐H, Fixed, 95% CI)	3.5 [1.31, 9.33]

Comparison 4. Central pain‐ number of patients with moderate pain relief or better

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Comparison 5. Atypical facial pain‐ number of patients with moderate pain relief or better

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Antidepressant vs placebo Show forest plot	2	133	Risk Ratio (M‐H, Fixed, 95% CI)	1.67 [1.22, 2.29]

Comparison 5. Atypical facial pain‐ number of patients with moderate pain relief or better

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Comparison 7. Topical Doxepin

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Mean change scores ‐ doxepin vs placebo Show forest plot	1		Mean Difference (IV, Fixed, 95% CI)	Totals not selected

Comparison 7. Topical Doxepin

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