Lamotrigine for chronic neuropathic pain and fibromyalgia in adults
Editorial Group: Cochrane Pain, Palliative and Supportive Care Group
Published Online: 3 DEC 2013
Assessed as up-to-date: 26 NOV 2013
Copyright © 2013 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
How to Cite
Wiffen PJ, Derry S, Moore RA. Lamotrigine for chronic neuropathic pain and fibromyalgia in adults. Cochrane Database of Systematic Reviews 2013, Issue 12. Art. No.: CD006044. DOI: 10.1002/14651858.CD006044.pub4.
- Publication Status: New search for studies and content updated (no change to conclusions)
- Published Online: 3 DEC 2013
This is an update of the original Cochrane review entitled Lamotrigine for acute and chronic pain published in Issue 2, 2007, and updated in Issue 2, 2011. Some antiepileptic medicines have a place in the treatment of neuropathic pain (pain due to nerve damage). This updated review adds no new additional studies looking at evidence for lamotrigine as an effective treatment for chronic neuropathic pain or fibromyalgia. The update uses higher standards of evidence than previously.
To assess the analgesic efficacy of lamotrigine in the treatment of chronic neuropathic pain and fibromyalgia, and to evaluate adverse effects reported in the studies.
We identified randomised controlled trials (RCTs) of lamotrigine for chronic neuropathic pain and fibromyalgia (including cancer pain) from MEDLINE, EMBASE and the Cochrane Central Register of Controlled Trials (CENTRAL). We ran searches for the original review in 2006, in 2011 for the first update, and subsequent searches in August 2013 for this update. We sought additional studies from the reference lists of the retrieved papers. The original review and first update included acute pain, but no acute pain studies were identified.
RCTs investigating the use of lamotrigine (any dose, by any route, and for any study duration) for the treatment of chronic neuropathic pain or fibromyalgia. Assessment of pain intensity or pain relief, or both, using validated scales. Participants were adults aged 18 and over. We included only full journal publication articles.
Data collection and analysis
Two review authors independently extracted efficacy and adverse event data, and examined issues of study quality. We performed analysis using three tiers of evidence. The first tier used data where studies reported the outcome of at least 50% pain reduction from baseline, lasted at least eight weeks, had a parallel group design, included 200 or more participants in the comparison, and reported an intention-to-treat analysis. First-tier studies did not use last observation carried forward (LOCF) or other imputational methods for dropouts. The second tier used data that failed to meet this standard and second-tier results were therefore subject to potential bias.
Twelve included studies in 11 publications (1511 participants), all with chronic neuropathic pain: central post-stroke pain (1), chemotherapy-induced neuropathic pain (1), diabetic neuropathy (4), HIV-related neuropathy (2), mixed neuropathic pain (2), spinal cord injury-related pain (1), and trigeminal neuralgia (1). We did not identify any additional studies. Participants were aged between 26 and 77 years. Study duration was two weeks in one study and at least six weeks in the remainder; eight were of eight-week duration or longer.
No study provided first-tier evidence for an efficacy outcome. There was no convincing evidence that lamotrigine is effective in treating neuropathic pain and fibromyalgia at doses of 200 mg to 400 mg daily. Almost 10% of participants taking lamotrigine reported a skin rash.
Large, high-quality, long-duration studies reporting clinically useful levels of pain relief for individual participants provided no convincing evidence that lamotrigine is effective in treating neuropathic pain and fibromyalgia at doses of about 200 to 400 mg daily. Given the availability of more effective treatments including antiepileptics and antidepressant medicines, lamotrigine does not have a significant place in therapy based on the available evidence. The adverse effect profile of lamotrigine is also of concern.
Plain language summary
Lamotrigine (an antiepileptic drug) for chronic neuropathic pain or fibromyalgia
Neuropathic pain is pain coming from damaged nerves. It is different from pain messages carried along healthy nerves from damaged tissue (a fall, or cut, or arthritic knee). Neuropathic pain is treated by different medicines than pain from damaged tissue. Medicines like paracetamol or ibuprofen are not effective in neuropathic pain, while medicines that are sometimes used to treat depression or epilepsy can be very effective in some people with neuropathic pain. Our understanding of fibromyalgia (a condition of persistent, widespread pain and tenderness, sleep problems, and fatigue) is lacking, but fibromyalgia can respond to the same medicines as neuropathic pain.
Lamotrigine is a medicine used to treat epilepsy, and so might be a useful medicine for neuropathic pain or fibromyalgia.
On 26 November 2013 we performed searches to look for clinical trials where lamotrigine was used to treat neuropathic pain or fibromyalgia. We found 12 studies of reasonable quality that tested lamotrigine against placebo for a number of weeks. Almost half of the 1511 people in the studies had painful limbs because of damaged nerves caused by diabetes, and seven different painful neuropathic conditions were examined. No studies looked at fibromyalgia.
Lamotrigine did not help the pain, and was no different from placebo except in causing more side effects. Adverse events were more frequent with lamotrigine than placebo, with rash in 1 person in 27.
Lamotrigin (lijek protiv epilepsije) za kroničnu neuropatsku bol i fibromijalgiju odraslih
Neuropatska bol nastaje zbog oštećenih živaca. Razlikuje se od boli koja se širi zdravim živcima i posljedica je oštećenja tkiva (primjerice, zbog pada, porezotine ili artritisa koljena). Neuropatska bol se liječi lijekovima koji se razlikuju od lijekova protiv boli koja nastaje zbog oštećenja tkiva. Lijekovi kao što su paracetamol ili ibuprofen obično nisu učinkoviti za ublažavanje neuropatske boli, dok nekad lijekovi koji se koriste za liječenje depresije ili epilepsije mogu biti vrlo učinkoviti kod nekih osoba koje pate od neuropatske boli. Fibromijalgija je poremećaj koji uzrokuje trajnu bol i osjetljivost diljem tijela, probleme sa spavanjem i umor. O toj se bolesti još uvijek ne zna dovoljno, ali ponekad dobro odgovara na iste lijekove koji se koriste i za neuropatsku bol.
Lamotrigin je lijek koji se koristi za liječenje epilepsije, pa bi mogao biti koristan za liječenje neuropatske boli ili fibromijalgije.
Tijekom izrade ovog Cochrane sustavnog pregleda 26. studenoga 2013. godine je pretražena literatura kako bi se pronašle kliničke studije u kojima je ispitan lamotrigin za liječenje neuropatske boli ili fibromijalgije. Pronađeno je 12 studija odgovarajuće kvalitete u kojima je istraženo davanje lamotrigina u usporedbi s placebom kroz više tjedana. Gotovo polovica od 1511 ispitanika koji su sudjelovali u tim studijama imalo je bolove u udovima zbog oštećenih živaca uslijed dijabetesa, a ukupno je istraženo 7 različitih bolnih neuropatskih stanja. Nije pronađena niti jedna studija u kojoj je lamotrigin ispitan na ispitanicima koji boluju od fibromijalgije.
Lamotrigin nije pomogao ispitanicima u ublažavanju boli i nije se razlikovao od placeba, osim što je uzrokovao više nuspojava. Štetni učinci su zabilježeni češće u osoba koje su primale lamotrigin nego onih koje su primale placebo, a osip je zabilježen u 1 osobe od 27.
Prevela: Livia Puljak
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