Tramadol for Neuropathic Pain

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Research from Cochrane Database Syst Rev. 2004;2:CD003726.

Tramadol for neuropathic pain.

Duhmke R, Cornblath D, Hollingshead J.

15 Hospital Way, Hither Green, London, UK, SE13 6UF.

BACKGROUND: Neuropathic pain syndrome consists of a group of symptoms,

including burning or shooting sensations, abnormal sensitivity to

normally painless stimuli, or a greatly raised sensitivity to painful

stimuli. A wide range of disorders can cause neuropathic pain, nerve

damage being the only common factor.

OBJECTIVES: We aimed to review systematically the evidence from

randomised controlled trials for the efficacy of tramadol in treating

neuropathic pain. SEARCH STRATEGY: We searched the Cochrane

Neuromuscular Disease Group trials register (July 2002), MEDLINE

(January 1966 to July 2002), EMBASE (January 1980 to July 2002), and

LILACS (January 1982 to July 2002) for randomised and quasi-randomised

controlled trials. We also searched bibliographies of published trials.

SELECTION CRITERIA: We included randomised and quasi-randomised

controlled trials comparing tramadol with placebo, other pain relieving

treatment, or no treatment in people of both sexes and all ages with

neuropathic pain of all degrees of severity.

DATA COLLECTION AND ANALYSIS: Two reviewers extracted data and scored

trial quality. We calculated relative risks and numbers needed to treat

for effectiveness and adverse effects.

MAIN RESULTS: We identified five eligible trials, three comparing

tramadol with placebo, one comparing tramadol with clomipramine, and one

comparing tramadol with morphine. All three trials comparing tramadol

with placebo showed a significant reduction in neuropathic pain with

tramadol. Two of the trials that compared tramadol to placebo (total 161

participants) were combined in a meta-analysis. The number needed to

treat with tramadol compared to placebo to reach at least 50% pain

relief was 3.5 (95% confidence interval 2.4 to 5.9). There were

insufficient data to draw conclusions about the effectiveness of

tramadol compared to either clomipramine or morphine.Only one trial

considered subcategories of neuropathic pain. It found a significant

therapeutic effect of tramadol on paraesthesiae, allodynia, and

touch-evoked pain. Numbers needed to harm were calculated for side

effects resulting in withdrawal from the placebo-controlled trials. Two

trials provided these data, and the combined number needed to harm was

7.7 (95% confidence interval 4.6 to 20).

REVIEWERS CONCLUSIONS: Tramadol is an effective treatment for

neuropathic pain.