Guan, J., Tanaka, S., & Kawakami, K. (2015). Anticonvulsants or antidepressants in combination pharmacotherapy for treatment of neuropathic pain in cancer patients: A systematic review and meta-analysis. Clinical Journal of Pain, 32, 719–725.
STUDY PURPOSE: To investigate the efficacy of antidepressants and anticonvulsants in combination therapy for neuropathic pain in patients with cancer
TYPE OF STUDY: Meta-analysis and systematic review
PHASE OF CARE: Multiple phases of care
APPLICATIONS: Palliative care
When both types of interventions were considered, use of these adjuvant medications in combination pharmacotherapy was superior to control regimens (p < 0.010, MD = -0.41). However, in subgroup analysis, anticonvulsants (MD = -0.12, 95% CI [-0.64, 0.39]) did not show a significant effect. Antidepressants showed some efficacy (MD = -0.54, 95% CI [-0.94, -0.12]) based on only two studies. Anticonvulsants showed better efficacy among studies including only chemotherapy-induced neuropathic pain. Withdrawals in experimental groups was two times higher than in control groups. Study duration ranged from 10 days to 6 weeks.
Use of adjuvant antidepressants and anticonvulsants had a significant but small effect on neuropathic pain, and anticonvulsants considered alone showed no overall significant effectiveness. Evidence was too limited to formulate a recommendation for use.
There is limited evidence to demonstrate effectiveness of anticonvulsants or antidepressants as adjuvant medications for neuropathic pain management, and high withdrawal rates in studies within groups receiving these drugs may point to their potential side effects. Nurses need to be aware of and monitor the adverse side effects of these medications.