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Pain Research and Management
Volume 15, Issue 3, Pages 147-157

A Qualitative Systematic Review of Head-to-Head Randomized Controlled Trials of Oral Analgesics in Neuropathic Pain

C Peter N Watson,1 Ian Gilron,2 and Jana Sawynok3

1University of Toronto, Toronto, Canada
2Queen’s University, Kingston, Ontario, Canada
3Dalhousie University, Halifax, Nova Scotia, Canada

Copyright © 2010 Hindawi Publishing Corporation. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


BACKGROUND: Neuropathic pain (NP) encompasses many difficult-to-treat disorders. There are few head-to-head, comparative, randomized controlled trials (RCTs) of drugs for NP in different analgesic categories, or of different drugs within a category, despite many placebo-controlled RCTs for individual agents. Well-designed head-to-head comparative trials are an effective way to determine the relative efficacy and safety of a new drug.

OBJECTIVE: To perform a systematic review of head-to-head RCTs of oral analgesics in NP.

METHODS: A systematic review of RCTs involving NP patients was performed, of which head-to-head comparative trials were selected. Reference lists from published systematic reviews were searched. These studies were rated according to the Jadad scale for quality.

RESULTS AND CONCLUSIONS: Twenty-seven such trials were identified. Seventeen were comparisons of different analgesics, and 10 were of different drugs within an analgesic class. Important information was obtained about the relative efficacy and safety of drugs in different categories and within a category. Some significant differences between active treatments were reported. Trial inadequacies were identified. More and improved head-to-head RCTs are needed to inform clinical choices.