“We need better, larger, clinical trials if oxycodone is to be considered useful in neuropathic pain treatment, and to balance any benefits against known risks with strong opioids.”. “There is, unfortunay, no convincing, unbiased evidence that oxycodone is of value in treating people with neuropathic pain or fibromyalgia,” said Andrew Moore, part of the Cochrane Review team.
Neuropathic pain is pain coming from damaged nerves. Medicines such as paracetamol (acetaminophen) and ibuprofen are not effective in neuropathic pain, while medicines that are sometimes used to treat epilepsy or depression can be very effective in some people with neuropathic pain. It differs from pain messages carried along healthy nerves from damaged tissue (as in a fall, a cut, or an arthritic knee). Fibromyalgia is a widespread pain disorder characterised by a number of other symptoms including poor sleep, fatigue and cognitive impairment. Neuropathic pain is treated by different medicines than pain from damaged tissue. The cause, or causes, are not well understood, but it has features in common with neuropathic pain.
All studies had one or more sources of potential major bias. All studies used a placebo comparator, although in one study, an active placebo (benztropine) was used. Controlled release oxycodone was used in all three studies, with doses titrated up to a maximum of 60 to 120 mg daily; mean doses achieved ranged between 37 and 45 mg daily. The authors could find and review data from only three studies with 254 participants; 204 had painful diabetic neuropathy and 50 had postherpetic neuralgia. A team of Cochrane authors, based in the UK and working with the Cochrane Pain, Palliative and Supportive Care Group, set out to assess the analgesic efficacy and adverse events of oxycodone for chronic neuropathic pain and fibromyalgia.
Weak and strong opioids have been used frequently for treating neuropathic pain. The standards used to assess evidence in chronic pain trials have changed substantially since about 2010; the most important change is the move from using average pain scores, or average change in pain scores, to using the number of patients who have a large decrease in pain (by at least 50%); this level of pain relief has been shown to correlate with improvements in comorbid symptoms, function, and quality of life. Oxycodone is a strong opioid agonist, developed in the early 20th century, and is considered to be comparable to morphine in its effectiveness. Its analgesic potency makes it useful for the management of severe pain, usually acute postoperative, post-traumatic, or cancer pain.
Oxycodone has not been shown to work as a pain medicine in diabetic neuropathy or postherpetic neuralgia. Oxycodone was not convincingly shown to help relieve pain; compared with placebo, fewer people stopped taking oxycodone because they felt it was not effective, but more people experienced adverse effects. No studies examined its use in other types of neuropathic pain, or in fibromyalgia. Both of the findings were based on very low quality evidence because of the small numbers, and because trial methods could have been better.
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The Cochrane Library Cochrane Colloquium Cochrane Methods Cochrane Summaries Cochrane Training Consumer Network Evidence Aid.
A multidisciplinary approach is now advocated, with pharmacological interventions being combined with physical and/or cognitive interventions. Neuropathic pain and fibromyalgia are known to be difficult to treat effectively, with only a minority of individuals experiencing a clinically relevant benefit from any one intervention.
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