Skip to main content
NCBI home page
The BMJ logoLink to The BMJ
. 1995 Oct 21;311(7012):1047–1052. doi: 10.1136/bmj.311.7012.1047

Anticonvulsant drugs for management of pain: a systematic review.

H McQuay 1, D Carroll 1, A R Jadad 1, P Wiffen 1, A Moore 1
PMCID: PMC2551361  PMID: 7580659

Abstract

OBJECTIVE--To determine effectiveness and adverse effects of anticonvulsant drugs in management of pain. DESIGN--Systematic review of randomised controlled trials of anticonvulsants for acute, chronic, or cancer pain identified by using Medline, by hand searching, by searching reference lists, and by contacting investigators. SUBJECTS--Between 1966 and February 1994, 37 reports were found; 20 reports, of four anticonvulsants, were eligible. MAIN OUTCOME MEASURES--Numbers needed to treat were calculated for effectiveness, adverse effects, and drug related withdrawal from study. RESULTS--The only placebo controlled study in acute pain found no analgesic effect of sodium valproate. For treating trigeminal neuralgia, carbamazepine had a combined number needed to treat of 2.6 for effectiveness, 3.4 for adverse effects, and 24 for severe effects (withdrawal from study). For treating diabetic neuropathy, anticonvulsants had a combined number needed to treat of 2.5 for effectiveness, 3.1 for adverse effects, and 20 for severe effects. For migraine prophylaxis, anticonvulsants had a combined number needed to treat of 1.6 for effectiveness, 2.4 for adverse effects, and 39 for severe effects. Phenytoin had no effect on the irritable bowel syndrome, and carbamazepine had little effect on pain after stroke. Clonazepam was effective in one study for temporomandibular joint dysfunction. No study compared one anticonvulsant with another. CONCLUSIONS--Anticonvulsants were effective for trigeminal neuralgia and diabetic neuropathy and for migraine prophylaxis. Minor adverse effects occurred as often as benefit.

Full text

PDF
1047

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Arieff A. J., Wetzel N. Tegretol in the treatment of neuralgias. Dis Nerv Syst. 1967 Dec;28(12):820–823. [PubMed] [Google Scholar]
  2. Campbell F. G., Graham J. G., Zilkha K. J. Clinical trial of carbazepine (tegretol) in trigeminal neuralgia. J Neurol Neurosurg Psychiatry. 1966 Jun;29(3):265–267. doi: 10.1136/jnnp.29.3.265. [DOI] [PMC free article] [PubMed] [Google Scholar]
  3. Chadda V. S., Mathur M. S. Double blind study of the effects of diphenylhydantoin sodium on diabetic neuropathy. J Assoc Physicians India. 1978 May;26(5):403–406. [PubMed] [Google Scholar]
  4. Colditz G. A., Miller J. N., Mosteller F. How study design affects outcomes in comparisons of therapy. I: Medical. Stat Med. 1989 Apr;8(4):441–454. doi: 10.1002/sim.4780080408. [DOI] [PubMed] [Google Scholar]
  5. Cook R. J., Sackett D. L. The number needed to treat: a clinically useful measure of treatment effect. BMJ. 1995 Feb 18;310(6977):452–454. doi: 10.1136/bmj.310.6977.452. [DOI] [PMC free article] [PubMed] [Google Scholar]
  6. Eddy D. M. Clinical decision making: from theory to practice. Three battles to watch in the 1990s. JAMA. 1993 Jul 28;270(4):520–526. [PubMed] [Google Scholar]
  7. Farago F. Trigeminal neuralgia: its treatment with two new carbamazepine analogues. Eur Neurol. 1987;26(2):73–83. doi: 10.1159/000116315. [DOI] [PubMed] [Google Scholar]
  8. Fromm G. H., Terrence C. F., Chattha A. S. Baclofen in the treatment of trigeminal neuralgia: double-blind study and long-term follow-up. Ann Neurol. 1984 Mar;15(3):240–244. doi: 10.1002/ana.410150306. [DOI] [PubMed] [Google Scholar]
  9. Gerson G. R., Jones R. B., Luscombe D. K. Studies on the concomitant use of carbamazepine and clomipramine for the relief of post-herpetic neuralgia. Postgrad Med J. 1977;53 (Suppl 4):104–109. [PubMed] [Google Scholar]
  10. Goncikowska M. Próba leczenia bólu głowy Hortona małymi dawkami pilokarpiny i karbamazepina. Wiad Lek. 1984 Jul 15;37(14):1093–1095. [PubMed] [Google Scholar]
  11. Greenbaum D. S., Ferguson R. K., Kater L. A., Kuiper D. H., Rosen L. W. A controlled therapeutic study of the irritable-bowel syndrome: effect of diphenylhydantoin. N Engl J Med. 1973 Jan 4;288(1):13–16. doi: 10.1056/NEJM197301042880103. [DOI] [PubMed] [Google Scholar]
  12. Harkins S., Linford J., Cohen J., Kramer T., Cueva L. Administration of clonazepam in the treatment of TMD and associated myofascial pain: a double-blind pilot study. J Craniomandib Disord. 1991 Summer;5(3):179–186. [PubMed] [Google Scholar]
  13. Hatta V., Saxena A., Kaul H. L. Phenytoin reduces suxamethonium-induced myalgia. Anaesthesia. 1992 Aug;47(8):664–667. doi: 10.1111/j.1365-2044.1992.tb02386.x. [DOI] [PubMed] [Google Scholar]
  14. Holmes B., Brogden R. N., Heel R. C., Speight T. M., Avery G. S. Flunarizine. A review of its pharmacodynamic and pharmacokinetic properties and therapeutic use. Drugs. 1984 Jan;27(1):6–44. doi: 10.2165/00003495-198427010-00002. [DOI] [PubMed] [Google Scholar]
  15. Keczkes K., Basheer A. M. Do corticosteroids prevent post-herpetic neuralgia? Br J Dermatol. 1980 May;102(5):551–555. doi: 10.1111/j.1365-2133.1980.tb07654.x. [DOI] [PubMed] [Google Scholar]
  16. Kienast H. W., Boshes L. D. Clinical trials of carbamazepine in suppressing pain. Headache. 1968 Apr;8(1):1–5. doi: 10.1111/j.1526-4610.1968.hed0801001.x. [DOI] [PubMed] [Google Scholar]
  17. Killian J. M., Fromm G. H. Carbamazepine in the treatment of neuralgia. Use of side effects. Arch Neurol. 1968 Aug;19(2):129–136. doi: 10.1001/archneur.1968.00480020015001. [DOI] [PubMed] [Google Scholar]
  18. Lechin F., van der Dijs B., Lechin M. E., Amat J., Lechin A. E., Cabrera A., Gómez F., Acosta E., Arocha L., Villa S. Pimozide therapy for trigeminal neuralgia. Arch Neurol. 1989 Sep;46(9):960–963. doi: 10.1001/archneur.1989.00520450030015. [DOI] [PubMed] [Google Scholar]
  19. Leijon G., Boivie J. Central post-stroke pain--a controlled trial of amitriptyline and carbamazepine. Pain. 1989 Jan;36(1):27–36. doi: 10.1016/0304-3959(89)90108-5. [DOI] [PubMed] [Google Scholar]
  20. Martin C., Martin A., Rud C., Valli M. Etude comparative du valproate de sodium et du kétoprofène dans le traitement de la douleur postopératoire. Ann Fr Anesth Reanim. 1988;7(5):387–392. doi: 10.1016/s0750-7658(88)80055-8. [DOI] [PubMed] [Google Scholar]
  21. Mathew N. T., Ali S. Valproate in the treatment of persistent chronic daily headache. An open label study. Headache. 1991 Feb;31(2):71–74. doi: 10.1111/j.1526-4610.1991.hed3102071.x. [DOI] [PubMed] [Google Scholar]
  22. Naidu M. U., Ramesh Kumar T., Anuradha R. T., Rao U. R. Evaluation of phenytoin in rheumatoid arthritis--an open study. Drugs Exp Clin Res. 1991;17(5):271–275. [PubMed] [Google Scholar]
  23. Nicol C. F. A four year double-blind study of tegretol in facial pain. Headache. 1969 Apr;9(1):54–57. doi: 10.1111/j.1526-4610.1969.hed0901054.x. [DOI] [PubMed] [Google Scholar]
  24. Rappaport Z. H., Devor M. Trigeminal neuralgia: the role of self-sustaining discharge in the trigeminal ganglion. Pain. 1994 Feb;56(2):127–138. doi: 10.1016/0304-3959(94)90086-8. [DOI] [PubMed] [Google Scholar]
  25. Rasmussen P., Riishede J. Facial pain treated with carbamazepin (Tegretol). Acta Neurol Scand. 1970;46(4):385–408. doi: 10.1111/j.1600-0404.1970.tb05803.x. [DOI] [PubMed] [Google Scholar]
  26. Richards I. M., Fraser S. M., Hunter J. A., Capell H. A. Comparison of phenytoin and gold as second line drugs in rheumatoid arthritis. Ann Rheum Dis. 1987 Sep;46(9):667–669. doi: 10.1136/ard.46.9.667. [DOI] [PMC free article] [PubMed] [Google Scholar]
  27. Rompel H., Bauermeister P. W. Aetiology of migraine and prevention with carbamazepine (Tegretol): results of a double-blind, cross-over study. S Afr Med J. 1970 Jan 24;44(4):75–80. [PubMed] [Google Scholar]
  28. Rull J. A., Quibrera R., González-Millán H., Lozano Castañeda O. Symptomatic treatment of peripheral diabetic neuropathy with carbamazepine (Tegretol): double blind crossover trial. Diabetologia. 1969 Aug;5(4):215–218. doi: 10.1007/BF01212087. [DOI] [PubMed] [Google Scholar]
  29. Saudek C. D., Werns S., Reidenberg M. M. Phenytoin in the treatment of diabetic symmetrical polyneuropathy. Clin Pharmacol Ther. 1977 Aug;22(2):196–199. doi: 10.1002/cpt1977222196. [DOI] [PubMed] [Google Scholar]
  30. Schaffler K., Wauschkuhn C. H., Gierend M. Analgesic potency of a new anticonvulsant drug versus acetylsalicylic acid via laser somatosensory evoked potentials. Randomized placebo-controlled double-blind (5-way) crossover study. Arzneimittelforschung. 1991 Apr;41(4):427–435. [PubMed] [Google Scholar]
  31. Sharav Y., Benoliel R., Schnarch A., Greenberg L. Idiopathic trigeminal pain associated with gustatory stimuli. Pain. 1991 Feb;44(2):171–174. doi: 10.1016/0304-3959(91)90133-I. [DOI] [PubMed] [Google Scholar]
  32. Shibasaki H., Tabira T., Inoue N., Goto I., Kuroiwa Y. Carbamazepine for painful crises in Fabry's disease. J Neurol Sci. 1973 Jan;18(1):47–51. doi: 10.1016/0022-510x(73)90019-1. [DOI] [PubMed] [Google Scholar]
  33. Stensrud P., Sjaastad O. Clonazepam (rivotril) in migraine prophylaxis. Headache. 1979 Sep;19(6):333–334. doi: 10.1111/j.1526-4610.1979.hed1906333.x. [DOI] [PubMed] [Google Scholar]
  34. Turner J. A., Deyo R. A., Loeser J. D., Von Korff M., Fordyce W. E. The importance of placebo effects in pain treatment and research. JAMA. 1994 May 25;271(20):1609–1614. [PubMed] [Google Scholar]
  35. Vilming S. T., Lyberg T., Lataste X. Tizanidine in the management of trigeminal neuralgia. Cephalalgia. 1986 Sep;6(3):181–182. doi: 10.1046/j.1468-2982.1986.0603181.x. [DOI] [PubMed] [Google Scholar]
  36. Westerholm N. Treatment of facial pain with G 32 883 (Tegretol Geigy). Scand J Dent Res. 1970;78(2):144–148. doi: 10.1111/j.1600-0722.1970.tb02063.x. [DOI] [PubMed] [Google Scholar]
  37. Yajnik S., Singh G. P., Singh G., Kumar M. Phenytoin as a coanalgesic in cancer pain. J Pain Symptom Manage. 1992 May;7(4):209–213. doi: 10.1016/0885-3924(92)90077-u. [DOI] [PubMed] [Google Scholar]
  38. Young R. J., Clarke B. F. Pain relief in diabetic neuropathy: the effectiveness of imipramine and related drugs. Diabet Med. 1985 Sep;2(5):363–366. doi: 10.1111/j.1464-5491.1985.tb00652.x. [DOI] [PubMed] [Google Scholar]

Articles from BMJ : British Medical Journal are provided here courtesy of BMJ Publishing Group

RESOURCES