Wednesday, June 22, 2005

This week's JAMA: opioids for neuropathic pain

This week's JAMA (JAMA's website, I'll add, has had very spotty service this week) has a metaanalysis on the use of opioids for neuropathic pain.  It concludes:

Short-term trials yielded mixed results with respect to the analgesic efficacy of opioids. Intermediate-term trials demonstrated consistent opioid analgesic efficacy in reducing spontaneous neuropathic pain that was statistically significant when their results were pooled.

Doses used were, not surprisingly, widely divergent, but were overall low to moderate doses of long acting opioids (appx. <80mg/day of long acting oxycode, <80mg/day of methadone, up to 300mg/day of long acting morphine).  Reported side effects were as expected.  When I was in medical school--not too long ago--we were still being taught that opioids were ineffective for neuropathic pain, which by now seems quite ridiculous.  Clearly they are a second line choice behind TCAs/anticonvulsants and nonopioid analgesics,  but hopefully this article will end any remaining controversy over whether they have a role at all.

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