Abstract
Objective To evaluate the analgesic effectiveness and adverse effects of anticonvulsant drugs for pain management in clinical practice and to identify a clinical research agenda.
Data sources Medline (1966–1999), Embase (1994–1999), SIGLE (1980–1999) and the Cochrane Controlled Trials Register. In addition, 40 medical journals were searched by hand. Additional reports were identified from reference lists of retrieved papers and by contacting investigators.
Study selection Randomised trials reporting the analgesic effects of anticonvulsant drugs, with subjective pain assessment as either the primary or a secondary outcome.
Results Twenty-three trials of six anticonvulsants were considered eligible (1074 patients). Three placebo-controlled studies of carbamazepine in trigeminal neuralgia had a combined number needed to treat (NNT) for effectiveness of 2.5 (95% Cl, 2.0–3.4). A single placebo-controlled trial of gabapentin in post-herpetic neuralgia had an NNT of 3.2 (95% Cl, 2.4–5.0). Clonazepam was effective in one study of temporomandibular joint dysfunction. Carbamazepine had a numbers-needed-to-harm (NNH) for minor harm of 3.7 (95% Cl, 2.4–7.8) and gabapentin 2.5 (95% Cl, 2.0–3.2).
Conclusion There is no evidence that anticonvulsants are effective for acute pain. In chronic pain anticonvulsants are effective, but with the exception of trigeminal neuralgia they should be withheld until other interventions have been tried. Although gabapentin is increasingly being used for neuropathic pain, the evidence suggests that it is not superior to carbamazepine.
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Wiffen P, McQuay H, Carroll D, Jadad A, Moore A. Anticonvulsant drugs for acute and chronic pain (Cochrane Review). The Cochrane Library, Issue 3, 2000. Oxford: Update Software
Address for reprints: Mr P Wiffen, Pain Research Unit, Churchill Hospital, Oxford OX3 7LJ, UK. E-mail: phil.wiffen@pru.ox.ac.uk
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Skoglund, L. Anticonvulsants are effective for acute pain in trigeminal neuralgia. Evid Based Dent 2, 72 (2000). https://doi.org/10.1038/sj.ebd.6400040
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DOI: https://doi.org/10.1038/sj.ebd.6400040