文拉法辛神经性疼痛的成年人。

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加拉格尔HC,加拉格尔RM,巴特勒M,车DJ,亨曼MC

文拉法辛神经性疼痛的成年人。

科克伦数据库系统启2015年8月23日;(8):CD011091。cd011091.pub2 doi: 10.1002/14651858.。

PubMed ID
26298465 (在PubMed
]
文摘

背景:神经性疼痛,造成神经损伤,增加在世界范围内的流行。这可能反映出改进的诊断,或者它可能是由于糖尿病危害神经病变的发病率增加,增加的肥胖程度有关。其他类型的神经性疼痛包括post-herpetic神经痛、三叉神经痛、神经痛引起的化疗。抗抑郁药物有时用于治疗神经性疼痛;然而,他们的镇痛疗效尚不清楚。先前Cochrane综述,包括神经性疼痛的所有抗抑郁药物正在被新的评论的个人药物研究慢性神经性疼痛在第一个实例。文拉法辛是一个相当良好的抗抑郁药,是5 -羟色胺再摄取抑制剂和疲软的去甲肾上腺素再摄取抑制剂。虽然不是许可用于治疗慢性或神经性疼痛在大多数国家,有时用于此指示。目的:评估的镇痛疗效及相关的不良反应的临床使用,文拉法辛与成人慢性神经性疼痛。搜索方法:我们搜索Cochrane中央注册的对照试验(中央)通过Cochrane图书馆,并通过奥维德MEDLINE和EMBASE 14 2014年8月。 We reviewed the bibliographies of any randomised trials identified and review articles, contacted authors of one excluded study and searched www.clinicaltrials.gov to identify additional published or unpublished data. We also searched the meta-Register of controlled trials (mRCT) (www.controlled-trials.com/mrct) and the WHO International Clinical Trials Registry Platform (ICTRP) (apps.who.int/trialsearch/) for ongoing trials but did not find any relevant trials. SELECTION CRITERIA: We included randomised, double-blind studies of at least two weeks' duration comparing venlafaxine with either placebo or another active treatment in chronic neuropathic pain in adults. All participants were aged 18 years or over and all included studies had at least 10 participants per treatment arm. We only included studies with full journal publication. DATA COLLECTION AND ANALYSIS: Three review authors independently extracted data using a standard form and assessed study quality. We intend to analyse data in three tiers of evidence as described by Hearn 2014, but did not find any first-tier evidence (ie evidence meeting current best standards, with minimal risk of bias) or second-tier evidence, that was considered at some risk of bias but with adequate participant numbers (at least 200 in the comparison). Third-tier evidence is that arising from studies with small numbers of participants; studies of short duration, studies that are likely to be of limited clinical utility due to other limitations, including selection bias and attrition bias; or a combination of these. MAIN RESULTS: We found six randomised, double-blind trials of at least two weeks' duration eligible for inclusion. These trials included 460 participants with neuropathic pain, with most participants having painful diabetic neuropathy. Four studies were of cross-over design and two were parallel trials. Only one trial was both parallel design and placebo-controlled. Mean age of participants ranged from 48 to 59 years. In three studies (Forssell 2004, Jia 2006 and Tasmuth 2002), only mean data were reported. Comparators included placebo, imipramine, and carbamazepine and duration of treatment ranged from two to eight weeks. The risk of bias was considerable overall in the review, especially due to the small size of most studies and due to attrition bias. Four of the six studies reported some positive benefit for venlafaxine. In the largest study by Rowbotham, 2004, 56% of participants receiving venlafaxine 150 to 225 mg achieved at least a 50% reduction in pain intensity versus 34% of participants in the placebo group and the number needed to treat for an additional beneficial outcome was 4.5. However, this study was subject to significant selection bias. Known adverse effects of venlafaxine, including somnolence, dizziness, and mild gastrointestinal problems, were reported in all studies but were not particularly problematic and, overall, adverse effects were equally prominent in placebo or other active comparator groups. AUTHORS' CONCLUSIONS: We found little compelling evidence to support the use of venlafaxine in neuropathic pain. While there was some third-tier evidence of benefit, this arose from studies that had methodological limitations and considerable risk of bias. Placebo effects were notably strong in several studies. Given that effective drug treatments for neuropathic pain are in current use, there is no evidence to revise prescribing guidelines to promote the use of venlafaxine in neuropathic pain. Although venlafaxine was generally reasonably well tolerated, there was some evidence that it can precipitate fatigue, somnolence, nausea, and dizziness in a minority of people.

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