which makes it difficult to collect large homogenous study cohorts. ... ferent dosages of one opioid were com- pared without a ... nol) because these drugs are not available in Germany. .... dichotomous outcomes, we calculated risk ratios (RR).
Schwerpunkt English version of „Opioide bei chronischem neuropathischem Schmerz. Systematische Übersicht und Metaanalyse der Wirksamkeit, Verträglichkeit und Sicherheit in randomisierten, placebokontrollierten Studien über mindestens 4 Wochen” DOI 10.1007/s00482-014-1455-x © Deutsche Schmerzgesellschaft e.V. Published by Springer-Verlag Berlin Heidelberg - all rights reserved 2014
C. Sommer1 · P. Welsch2 · P. Klose3 · R. Schaefert4 · F. Petzke5 · W. Häuser6, 7 1 Neurologische Klinik, Universitätsklinikum Würzburg, Würzburg 2 Stichting Rugzorg Nederland, Ede 3 Abteilung für Naturheilkunde und Integrative Medizin, Kliniken Essen-Mitte, Essen 4 Klinik für Allgemeine Innere Medizin und Psychosomatik, Universitätsklinikum Heidelberg, Heidelberg 5 Schmerz-Tagesklinik und Ambulanz, Universitätsmedizin Göttingen, Göttingen 6 Klinik und Poliklinik für Psychosomatische Medizin und Psychotherapie,
Technische Universität München, München 7 Innere Medizin I, Klinikum Saarbrücken gGmbH, Saarbrücken
Opioids in chronic neuropathic pain A systematic review and meta-analysis of efficacy, tolerability and safety in randomized placebo-controlled studies of at least 4 weeks duration
Supplementary material online This article contains supplementary evidence reports and tables. These are available at: dx.doi.org/10.1007/s00482-014-1455-x.
Introduction Chronic neuropathic pain (CNP) may result from a large variety of insults to the peripheral or central somatosensory nervous system, including trauma, inflammation, ischemia, or metabolic and neoplastic disorders. Common examples of peripheral neuropathic pain include diabetic and postsurgical neuropathy. Central neuropathic pain includes poststroke pain, pain in multiple sclerosis and pain after spinal cord injury. The main clinical characteristics of neuropathic pain are a burning, aching or shooting quality and abnormal sensitivity of the painful site to normally innocuous stimuli [14]. Estimates of the prevalence of chronic pain with neuropathic characteristics range from 6.9 to 10% in the general population [24]. However, specific conditions with neuropathic pain can be rare—such as postherpetic neuralgia with a prevalence of 0.09% and
trigeminal neuralgia with 0.07% [24]— which makes it difficult to collect large homogenous study cohorts. Drug therapy of CNP is under debate [7, 10]. There is a lack of definitive evidence regarding the efficacy of opioids in reducing neuropathic pain [14]. A recent systematic Cochrane review on opioids in neuropathic pain searched the literature up until October 2012. This review included short-term studies (
