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Selph S, Carson S, Fu R, et al. Drug Class Review: Neuropathic Pain: Final Update 1 Report [Internet]. Portland (OR): Oregon Health & Science University; 2011 Jun.

Appendix EStrength of evidence

Table 1Strength of the body of evidence in patients with diabetic neuropathy and postherpetic neuralgia

Domains pertaining to strength of evidenceMagnitude of effectStrength of evidence
Number of Studies; Number of SubjectsRisk of bias (design/quality)ConsistencyDirectnessPrecisionSummary effect size (95% Confidence Interval)High, Moderate, Low, Insufficient
Outcome 1.Gabapentin, pregabalin, lamotrigine vs. amitriptyine/nortriptyline ≥50% pain reduction
ModerateConsistentDirectPreciseRR 1.0 (0.84, 0.18)Moderate
Outcome 2.Venlafaxine vs. carbamazepine in pain reduction on 11-point Likert scale
High1 studyDirectImprecisegreater reduction of approximately 1.5 pointsInsufficient
Outcome 3.5% Lidocaine patch vs. oral pregabalin ≥50% pain reduction
Moderate1 studyDirectImpreciseRR 1.21 (0.88, 1.67)Low
Outcome 4.Gabapentin, pregabalin, and lamotrigine vs. tricyclics in withdrawal due to adverse events
ModerateConsistentDirectPreciseRR 0.61, (0.33, 1.12)Moderate
Outcome 5.Venlafaxine vs. carbamazepine in withdrawal due to adverse events
Moderate1 studyDirectImpreciseRR 2.00 (0.44, 9.14)Low
Outcome 6.5% lidocaine patch vs. pregabalin in withdrawal due to adverse events
Moderate1 studyDirectImpreciseRR 4.39 (2.25, 8.69)Moderate
Outcome 7.Gabapentin and pregabalin vs. tricyclic antidepressants in causing dry mouth
LowConsistentDirectImpreciseRR 0.27 (0.14, 0.56)Moderate
Outcome 8.Gabapentin and pregabalin vs. tricyclics antidepressants in causing ataxia
ModerateConsistentDirectImpreciseRR 3.70 (1.18, 11.65)Low

Table 2Strength of the body of evidence in patients with other types of neuropathic pain

Domains pertaining to strength of evidenceMagnitude of effectStrength of evidence
Number of studies; Number of subjectsRisk of bias (design/quality)ConsistencyDirectnessPrecisionSummary effect sizeHigh, Moderate, Low, Insufficient
Outcome 1Pain reduction
Comparison:Gabapentin 400 or 800 mg plus opioids vs. imipramine 10 mg plus opioids for cancer-related neuropathic pain
1
52 subjects
Moderate/Randomized controlled trial/FairNADirectImpreciseInsufficient data to calculate RR
No difference between treatments on pain score or use of rescue medication

Combination with gabapentin + imipramine + opioids more effective than therapy with either gabapentin + opioids or imipramine + opioids
Low
Comparison:Gabapentin 3600 mg vs. amitriptyline 150 mg for spinal cord injury-related neuropathic pain
1
38 subjects
Moderate/Randomized controlled trial/FairNADirectImpreciseAverage pain intensity score at week 8
Amitriptyline: 3.46±2.09
Gabapentin:
4.85±2.86
P=0.03

Response (30% or more pain reduction)
Overall:
Amitriptyline: 50%, Gabapentin: 42.9%
P=NS
High CESD-SF group (score ≥10): Amitriptyline: 62.5% Gabapentin: 12.5%
P=0.042
Insufficient data to calculate relative risks
Low
Comparison:Amitriptyline vs. carbamazepine in patients with central poststroke pain
1
15 subjects
Moderate/Randomized controlled trial/FairNADirectImprecisePatients reporting improvement in pain: Amitriptyline vs carbamazepine RR=1.87 (95% CI 0.90, 4.32)
Mean pain score at endpoint:
Amitriptyline: 4.2 (SD 1.6)
Carbamazepine: 4.2 (SD 1.7)
P=NS
Low
Outcome 2Withdrawal due to adverse events
Comparison:Gabapentin 400 or 800 mg plus opioids vs. imipramine 10 mg plus opioids for cancer-related neuropathic pain
1
52 subjects
Moderate/Randomized controlled trial/FairNADirectImpreciseNo withdrawals due to adverse events in either groupInsufficient
Comparison:Gabapentin 3600 mg vs, amitriptyline 150 mg for spinal cord injury-related neuropathic pain
1
38 subjects
Moderate/Randomized controlled trial/FairNADirectImpreciseAmitriptyline vs gabapentin: RR=0.88 (95% CI 0.36, 1.57)Low
Comparison:Amitriptyline vs, carbamazepine in patients with central poststroke pain
1
15 subjects
Moderate/Randomized controlled trial/FairNADirectImpreciseAmitriptyline vs carbamazepine: 0/12 vs 3/12
P=0.10
Low
Copyright © 2011 by Oregon Health & Science University.
Cover of Drug Class Review: Neuropathic Pain
Drug Class Review: Neuropathic Pain: Final Update 1 Report [Internet].
Selph S, Carson S, Fu R, et al.
Portland (OR): Oregon Health & Science University; 2011 Jun.

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