Guan, J., Tanaka, S., & Kawakami, K. (2015). Anticonvulsants or antidepressants in combination pharmacotherapy for treatment of neuropathic pain in cancer patients: A systematic review and meta-analysis. Clinical Journal of Pain, 32, 719–725. 

DOI Link

Purpose

STUDY PURPOSE: To investigate the efficacy of antidepressants and anticonvulsants in combination therapy for neuropathic pain in patients with cancer

TYPE OF STUDY: Meta-analysis and systematic review

Search Strategy

DATABASES USED: MEDLINE, EMBASE, and Cochrane Collaboration
 
INCLUSION CRITERIA: Randomized controlled trials with at least one week duration, patients having neuropathic pain score of at least 4 on an 11-point scale, comparison group with no use of anticonvulsants or antidepressants
 
EXCLUSION CRITERIA: Unspecified

Literature Evaluated

TOTAL REFERENCES RETRIEVED: 911 after removal of duplicates
 
EVALUATION METHOD AND COMMENTS ON LITERATURE USED: Cochrane collaboration risk of bias tool. Only two studies for antidepressants and four studies for anticonvulsants were included in the meta-analysis.

Sample Characteristics

  • FINAL NUMBER STUDIES INCLUDED = 8
  • TOTAL PATIENTS INCLUDED IN REVIEW: 1,359
  • SAMPLE RANGE ACROSS STUDIES: Unavailable
  • KEY SAMPLE CHARACTERISTICS: Five studies involved chemotherapy-induced neuropathic pain, and one involved postmastectomy pain. One study included only breast cancer. Four studies included varied tumor types.

Phase of Care and Clinical Applications

PHASE OF CARE: Multiple phases of care
 
APPLICATIONS: Palliative care

Results

When both types of interventions were considered, use of these adjuvant medications in combination pharmacotherapy was superior to control regimens (p < 0.010, MD = -0.41). However, in subgroup analysis, anticonvulsants (MD = -0.12, 95% CI [-0.64, 0.39]) did not show a significant effect. Antidepressants showed some efficacy (MD = -0.54, 95% CI [-0.94, -0.12]) based on only two studies. Anticonvulsants showed better efficacy among studies including only chemotherapy-induced neuropathic pain. Withdrawals in experimental groups was two times higher than in control groups. Study duration ranged from 10 days to 6 weeks.

Conclusions

Use of adjuvant antidepressants and anticonvulsants had a significant but small effect on neuropathic pain, and anticonvulsants considered alone showed no overall significant effectiveness. Evidence was too limited to formulate a recommendation for use.

Limitations

  • Limited number of studies were included.
  • Few studies existed for each type of medication.
  • Three studies were of very short duration.
  • Overall analysis included a study with topical application and one that included opioid use in the experimental group—these inclusions could have skewed overall findings.

Nursing Implications

There is limited evidence to demonstrate effectiveness of anticonvulsants or antidepressants as adjuvant medications for neuropathic pain management, and high withdrawal rates in studies within groups receiving these drugs may point to their potential side effects. Nurses need to be aware of and monitor the adverse side effects of these medications.

Legacy ID

5852