A Meta-analysis Exploring the Efficacy of Neuropathic Pain Medication for Low Back Pain or Spine-Related Leg Pain: Is Efficacy Dependent on the Presence of Neuropathic Pain?

IF 13 1区 医学 Q1 PHARMACOLOGY & PHARMACY Drugs Pub Date : 2024-10-26 DOI:10.1007/s40265-024-02085-6
Jennifer Ward, Anthony Grinstead, Amy Kemp, Paula Kersten, Annina B Schmid, Colette Ridehalgh
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Abstract

Background and objective: Highly variable pain mechanisms in people with low back pain or spine-related leg pain might contribute to inefficacy of neuropathic pain medication. This meta-analysis aimed to determine how neuropathic pain is identified in clinical trials for people taking neuropathic pain medication for low back pain or spine-related leg pain and whether subgrouping based on the presence of neuropathic pain influences efficacy.

Methods: EMBASE, MEDLINE, Cochrane Central, CINAHL [EBSCO], APA PsycINFO, ClinicalTrials.gov, and the World Health Organization International Clinical Trials Registry were searched from inception to 14 May, 2024. Randomized and crossover trials comparing first-line neuropathic pain medication for people with low back pain or spine-related leg pain to placebo or usual care were included. Two independent authors extracted data. Random-effects meta-analyses of all studies combined, and pre-planned subgroup meta-analyses based on the certainty of neuropathic pain (according to the neuropathic pain Special Interest Group [NeuPSIG] neuropathic pain grading criteria) were completed. Certainty of evidence was judged using the grading of recommendations assessment development and evaluation [GRADE] framework.

Results: Twenty-seven included studies reported on 3619 participants. Overall, 33% of studies were judged unlikely to include people with neuropathic pain, 26% remained unclear. Only 41% identified people with possible, probable, or definite neuropathic pain. For pain, general analyses revealed only small effects at short term (mean difference [MD] - 9.30 [95% confidence interval [CI] - 13.71, - 4.88], I2 = 87%) and medium term (MD - 5.49 [95% CI - 7.24, - 3.74], I2 = 0%). Subgrouping at short term revealed studies including people with definite or probable neuropathic pain showed larger effects on pain (definite; MD - 16.65 [95% CI - 35.95, 2.65], I2 = 84%; probable; MD - 10.45 [95% CI - 14.79, - 6.12], I2 = 20%) than studies including people with possible (MD - 5.50 [95% CI - 20.52, 9.52], I2 = 78%), unlikely (MD - 6.67 [95% CI - 10.58, 2.76], I2 = 0%), or unclear neuropathic pain (MD - 8.93 [95% CI - 20.57, 2.71], I2 = 96%). Similarly, general analyses revealed negligible effects on disability at short term (MD - 3.35 [95% CI - 9.00, 2.29], I2 = 93%) and medium term (MD - 4.06 [95% CI - 5.63, - 2.48], I2 = 0%). Sub-grouping at short term revealed larger effects in studies including people with definite/probable neuropathic pain (MD - 9.25 [95% CI - 12.59, - 5.90], I2 = 2%) compared with those with possible/unclear/unlikely neuropathic pain (MD -1.57 [95% CI - 8.96, 5.82] I2 = 95%). Medium-term outcomes showed a similar trend, but were limited by low numbers of studies. Certainty of evidence was low to very low for all outcomes.

Conclusions: Most studies using neuropathic pain medication for low back pain or spine-related leg pain fail to adequately consider the presence of neuropathic pain. Meta-analyses suggest neuropathic pain medication may be most effective in people with low back pain or spine-related leg pain with a definite/probable neuropathic pain component. However, the low to very low certainty of evidence and poor identification of neuropathic pain in most studies prevent firm recommendations.

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探索神经性疼痛药物对腰痛或脊柱相关腿痛疗效的 Meta 分析:疗效是否取决于神经性疼痛的存在?
背景和目的:腰痛或脊柱相关腿痛患者的疼痛机制千差万别,这可能导致神经性疼痛药物疗效不佳。本荟萃分析旨在确定在针对腰痛或脊柱相关腿痛患者服用神经性疼痛药物的临床试验中如何识别神经性疼痛,以及根据神经性疼痛的存在进行分组是否会影响疗效:方法:检索了 EMBASE、MEDLINE、Cochrane Central、CINAHL [EBSCO]、APA PsycINFO、ClinicalTrials.gov 和世界卫生组织国际临床试验注册中心(World Health Organization International Clinical Trials Registry)从开始到 2024 年 5 月 14 日的数据。纳入的随机和交叉试验比较了治疗腰痛或脊柱相关腿痛患者的一线神经病理性疼痛药物与安慰剂或常规护理。两名独立作者提取了数据。对所有研究进行随机效应荟萃分析,并根据神经病理性疼痛的确定性(根据神经病理性疼痛特殊兴趣小组[NeuPSIG]神经病理性疼痛分级标准)进行预先计划的亚组荟萃分析。证据的确定性采用建议评估开发和评价分级[GRADE]框架进行判断:纳入的 27 项研究报告了 3619 名参与者的情况。总体而言,33%的研究被判定为不可能纳入神经病理性疼痛患者,26%的研究仍不明确。只有 41% 的研究确定了可能、疑似或明确的神经性疼痛患者。对于疼痛,一般分析显示短期(平均差 [MD] - 9.30 [95% 置信区间 [CI] - 13.71, - 4.88],I2 = 87%)和中期(MD - 5.49 [95% CI - 7.24, - 3.74],I2 = 0%)影响较小。短期分组显示,包括明确或可能患有神经病理性疼痛的患者在内的研究对疼痛的影响更大(明确;MD - 16.65 [95% CI - 35.95, 2.65],I2 = 84%;可能;MD - 10.45 [95% CI - 14.79, - 6.12],I2 = 20%)。12],I2 = 20%)高于包括可能(MD - 5.50 [95% CI - 20.52, 9.52],I2 = 78%)、不可能(MD - 6.67 [95% CI - 10.58, 2.76],I2 = 0%)或不明确神经病理性疼痛(MD - 8.93 [95% CI - 20.57, 2.71],I2 = 96%)患者的研究。同样,一般分析显示,短期(MD - 3.35 [95% CI - 9.00, 2.29],I2 = 93%)和中期(MD - 4.06 [95% CI - 5.63, - 2.48],I2 = 0%)对残疾的影响可以忽略不计。短期分组显示,与可能/不明确/不确定的神经痛患者(MD - -1.57 [95% CI - 8.96, 5.82] I2 = 95%)相比,明确/可能的神经痛患者(MD - 9.25 [95% CI - 12.59, - 5.90],I2 = 2%)的研究效果更大。中期结果显示出类似的趋势,但由于研究数量较少而受到限制。所有结果的证据确定性都较低或很低:大多数使用神经性疼痛药物治疗腰痛或脊柱相关腿痛的研究未能充分考虑神经性疼痛的存在。元分析表明,神经病理性疼痛药物可能对具有明确/可能神经病理性疼痛成分的腰痛或脊柱相关腿痛患者最有效。然而,由于证据的确定性较低或很低,且大多数研究对神经病理性疼痛的识别较差,因此无法提出明确的建议。
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来源期刊
Drugs
Drugs 医学-毒理学
CiteScore
22.70
自引率
0.90%
发文量
134
审稿时长
3-8 weeks
期刊介绍: Drugs is a journal that aims to enhance pharmacotherapy by publishing review and original research articles on key aspects of clinical pharmacology and therapeutics. The journal includes: Leading/current opinion articles providing an overview of contentious or emerging issues. Definitive reviews of drugs and drug classes, and their place in disease management. Therapy in Practice articles including recommendations for specific clinical situations. High-quality, well designed, original clinical research. Adis Drug Evaluations reviewing the properties and place in therapy of both newer and established drugs. AdisInsight Reports summarising development at first global approval. Moreover, the journal offers additional digital features such as animated abstracts, video abstracts, instructional videos, and podcasts to increase visibility and educational value. Plain language summaries accompany articles to assist readers with some knowledge of the field in understanding important medical advances.
期刊最新文献
The Challenge of Treating Infections Caused by Metallo-β-Lactamase-Producing Gram-Negative Bacteria: A Narrative Review. A Meta-analysis Exploring the Efficacy of Neuropathic Pain Medication for Low Back Pain or Spine-Related Leg Pain: Is Efficacy Dependent on the Presence of Neuropathic Pain? How Psychedelics Modulate Multiple Memory Mechanisms in Posttraumatic Stress Disorder. Trientine Tetrahydrochloride, From Bench to Bedside: A Narrative Review. Difficult-to-Treat Axial Spondyloarthritis: A New Challenge.
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