Intervention Review

Tramadol for neuropathic pain

  1. Rudolf Martin Duehmke1,*,
  2. James Hollingshead2,
  3. David R Cornblath3

Editorial Group: Cochrane Neuromuscular Disease Group

Published Online: 19 JUL 2006

Assessed as up-to-date: 16 NOV 2008

DOI: 10.1002/14651858.CD003726.pub3


How to Cite

Duehmke RM, Hollingshead J, Cornblath DR. Tramadol for neuropathic pain. Cochrane Database of Systematic Reviews 2006, Issue 3. Art. No.: CD003726. DOI: 10.1002/14651858.CD003726.pub3.

Author Information

  1. 1

    Papworth Hospital, Cardiac Unit, Cambridge, UK

  2. 2

    Queen Elizabeth II Hospital, General Surgery, Welwyn Garden City, Hertfordshire, UK

  3. 3

    Johns Hopkins Hospital, Department of Neurology, Baltimore, Maryland, USA

*Rudolf Martin Duehmke, Cardiac Unit, Papworth Hospital, Papworth Everard, Cambridge, CB3 8RE, UK. duhmke@hotmail.com.

Publication History

  1. Publication Status: New search for studies and content updated (no change to conclusions)
  2. Published Online: 19 JUL 2006

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Abstract

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Background

Peripheral neuropathic pains often include symptoms such as burning or shooting sensations, abnormal sensitivity to normally painless stimuli, or an increased sensitivity to normally painful stimuli. Neuropathic pain is a common symptom in many diseases of the peripheral nervous system.

Objectives

We aimed to review systematically the evidence from randomised controlled trials for the efficacy of tramadol in treating neuropathic pain.

Search methods

We updated the searches of the Cochrane Neuromuscular Disease Group Trials Register (17 November 2008), MEDLINE (January 1966 to November 17 2008), EMBASE (January 1980 to November 17 2008), and LILACS (January 1982 to November 17 2008) for randomised and quasi-randomised controlled trials. We also searched bibliographies of published trials.

Selection criteria

We included randomised and quasi-randomised controlled trials comparing tramadol with placebo, other pain relieving treatment, or no treatment in people of both sexes and all ages with neuropathic pain of all degrees of severity.

Data collection and analysis

Two authors extracted data and scored trial quality. We calculated relative risks and numbers needed to treat for effectiveness and adverse effects.

Main results

We identified seven eligible trials, five comparing tramadol with placebo, one comparing tramadol with clomipramine, and one comparing tramadol with morphine. All five trials comparing tramadol with placebo showed a significant reduction in neuropathic pain with tramadol. Three of the trials which compared tramadol to placebo (total 303 participants) were combined in a meta-analysis. The number needed to treat with tramadol compared to placebo to reach at least 50% pain relief was 3.8 (95% confidence interval 2.8 to 6.3). There were insufficient data to draw conclusions about the effectiveness of tramadol compared to either clomipramine or morphine.

Only one trial considered subcategories of neuropathic pain. It found a significant therapeutic effect of tramadol on paraesthesiae, allodynia, and touch evoked pain.

Numbers needed to harm were calculated for side effects resulting in withdrawal from the placebo controlled trials. Three trials provided these data, and the combined number needed to harm was 8.3 (95% confidence interval 5.6 to 17).

Authors' conclusions

Tramadol is an effective treatment for neuropathic pain.

 

Plain language summary

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Tramadol for neuropathic pain

Neuropathic pain is frequently caused by damage to the peripheral nerves. Symptoms may include burning or shooting sensations, and abnormal sensitivity to normally non-painful stimuli. Neuropathic pain is difficult to treat. Anticonvulsants and antidepressants are frequently used but their use is limited by side effects. Tramadol is a unique pain killing drug with mild opiate properties.

In the update of this review undertaken in November 2008, five randomised controlled trials involving a total of 374 participants met the inclusion criteria for this review and compared tramadol to placebo. Evidence from these trials showed that 100 to 400 mg of tramadol is an effective symptomatic treatment for peripheral neuropathic pain. One trial involving less than 40 participants compared tramadol to morphine, and one involving 21 participants compared tramadol to clomipramine. It was not possible to draw conclusions from these two trials as to which of these drugs is more effective.

Treatment with tramadol may cause side effects, including constipation, nausea, sedation and a dry mouth, all of which resolve after stopping treatment. In the trials reviewed here, one person out of eight treated with tramadol left the trial because of side effects. Tramadol is also associated with a small risk of seizures (fits) and its use is contraindicated in people with a history of epilepsy.

 

摘要

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

背景

Tramadol用於神經病變痛的治療

周邊神經病變疼痛,常包括燒灼感、刺痛感、對非痛覺刺激異常敏感、或對疼痛刺激的過度敏感。神經病變痛是許多周邊神經系統疾病中一種常見的症狀。

目標

本研究的目的在從隨機對照試驗的結果中,回顧tramadol在治療神經性疼痛的療效。

搜尋策略

搜查內容包括考科藍神經肌肉疾病組試驗紀錄(2005年6月) ,MEDLINE(1966年1月至2005年6月) , EMBASE (1980年1月至2005年6月) ,以及LILACS(1982年1月至2005年6月)中的隨機和準隨機對照試驗。我們也搜查出版過的文獻中的試驗報告。

選擇標準

收集的資料包括隨機和準隨機對照試驗,比較Tramdol與安慰劑、或Tramadol與其他止痛治療相比的療效,以及比較沒有任何治療之下的結果。對象包括了各年齡層以及各種嚴重程度的神經性疼痛的男女患者。

資料收集與分析

兩位審查員獨立擷取試驗的數據資料,以及評估試驗的品質。並計算導致藥物療效和副作用的相對風險及需治數。

主要結論

我們確認了6項符合資格的試驗, 其中4項試驗比較了Tramadol與安慰劑的效果。一項試驗比較了Tramadol與clomipramine。另外一項試驗比較了Tramadol與嗎啡的效果。所有四項比較Tramadol與安慰劑的試驗都發現,Tramadol顯著降低了神經性疼痛的程度。其中三項試驗(共269位病人)納入綜合分析後的結果發現,Tramadol與安慰劑相比,至少達到百分之五十疼痛減輕療效的益一需治數是3.8 人(95 %信賴區間: 2.8 至6.3)。而比較Tramdaol與clomipramine或嗎啡的結果,並沒有足夠的數據得出結論。只有一項試驗把神經病變痛的類型也考慮進去,發現Tramadol對感覺異常,異感痛及觸覺引起的觸感痛,有顯著的治療效果。由三項安慰劑對照試驗提供的數據,計算出因副作用導致停藥的損一需治數為8.3人(95 %信賴區間:5.6至17)。

作者結論

Tramadol對於神經病變疼痛是一項有效的治療方式。

翻譯人

本摘要由新光醫院鍾禎智翻譯。

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

周邊神經的傷害常造成神經病變痛。症狀可能包括燒灼感、刺痛感、或對非疼痛刺激的異常敏感。神經病變痛相當難以治療。常用藥物包括抗癲癇藥物和抗抑鬱藥。但因副作用大,它們的使用效果有限。Tramadol是一種獨特的止痛藥,帶有一些鴉片類藥物的特性。 4項包含了338位患者的隨機對照試驗被納入本項研究。其比較了Tramadol與安慰劑的效果。 從這些試驗的證據發現, 100至400毫克的Tramadol是一種有效治療周邊神經病變痛的方法。另外還有一項40位患者的試驗比較了Tramadol和嗎啡,一項涉及21名患者的試驗比較了Tramadol與clomipramine。這兩項試驗對於哪一種藥物比較有效並沒有得出結論。 Tramadol可能導致的副作用包括便秘,噁心,鎮靜效果和口乾。停藥後這些症狀便可得到緩解。在本篇回顧中,接受Tramadol治療的病人,每八人就有一人因副作用而退出治療。 Tramadol也會稍微增加癲癇的風險。在有癲癇症病史的病人,Tramadol的使用被視為一禁忌症。