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. 2017 May 22;2017(5):CD011669. doi: 10.1002/14651858.CD011669.pub2
Study Treatment Pain outcome Other efficacy outcome
Gilron 2005 Morphine: target 120 mg daily
Morphine + gabapentin: target 60 mg + 2400 mg daily
Gabapentin: target 3200 mg daily
Placebo: lorazepam 1.6 mg daily
n = 57 (cross‐over)
Participants who completed a treatment period with at least moderate pain relief on maximum tolerated dose
Morphine: 35/44 (80%)
Gabapentin: 27/44 (61%)
Placebo (lorazepam): 13/42 (31%)
Question: global pain relief assessed in response to questions from the research nurse on the following scale: pain worse, no relief, slight relief, moderate relief, a lot of relief, or complete relief.
On maximum tolerated dose, mean ± SE:
Mean PI (0‐10 NRS)
[Baseline: 5.72 ± 0.23]
Morphine: 3.70 ± 0.34
Gabapentin: 4.15 ± 0.33
Placebo: 4.49 ± 0.34
McGill Pain Questionnaire PI (10‐cm VAS)
[Baseline: 5.0 ± 0.4]
Morphine: 3.3 ± 0.4
Gabapentin: 3.5 ± 0.4
Placebo: 3.9 ± 0.4
McGill Pain Questionnaire Present PI (0‐3)
[Baseline: 2.40 ± 0.16]
Morphine: 1.57 ± 0.16
Gabapentin: 1.64 ± 0.16
Placebo: 2.07 ± 0.16
SF‐36 Bodily Pain (0‐100)
[Baseline: 52.1 ± 2.7]
Morphine: 64.4 ± 2.9
Gabapentin: 65.6 ± 2.9
Placebo: 56.0 ± 3.0
Gilron 2015 Morphine: target 100 mg daily
Nortriptyline: target 100 mg daily
Morphine + nortriptyline: target 100 mg + 100 mg daily
n = 51 (received treatment) (cross‐over)
Participant‐reported pain relief ≥ 30%:
Morphine: 24/47 (51.3%)
Nortriptyline: 30/45 (65.8%)
Participant‐reported pain relief ≥ 50%:
Morphine: 10/47 (25.6%)
Nortriptyline: 17/45 (36.8%)
PGIC much or very much improved:
Participants with at least moderate relief on maximum tolerated dose
Morphine: 74.4%
Nortriptyline: 70.7%
Reports "Overall effect of treatment on global pain relief scores was not significant (P = 0.17)."
PGIC very much improved:
Not reported
Average daily pain throughout trial ± SE (0‐10 NRS)
Morphine: 3.4 ± 0.4
Nortriptyline: 3.1 ± 0.4
Global pain relief (pain worse, no relief, slight relief, moderate relief, a lot of relief, or complete relief)
Worst pain (0‐10 NRS)
Morphine: 4.4 ± 0.4
Nortriptyline: 4.1 ± 0.4
Nocturnal pain (0‐10 NRS)
Morphine: 2.2 ± 0.4
Nortriptyline: 2.0 ± 0.4
Huse 2001 Morphine: target 70‐300 mg daily
Placebo
n = 12 (cross‐over)
> 25% and ≤ 50% PI reduction
Morphine: 1/12 (8%)
Placebo: 1/12 (8%)
> 50% PI reduction
Morphine: 5/12 (42%)
Placebo: 1/12 (8%)
At end of treatment phase:
Mean PI ± SD (10‐cm VAS)
[Baseline: 4.65 ± 1.06]
Morphine: 3.26 ± 1.59
Placebo: 3.99 ± 1.23
Data also for sensory pain and affective pain components, not required.
Khoromi 2007 Morphine: target dose 90 mg daily
Nortriptyline: target dose 100 mg daily
Morphine + nortriptyline: target dose 90 mg + 100 mg daily
Placebo (benztropine) 0.25‐1 mg daily
n = 55 (cross‐over)
Global pain relief (moderate + a lot + complete relief):
Morphine: 13/32 (41%)
Nortriptyline: 12/31 (39%)
Placebo: 11/28 (39%)
Global pain relief (a lot + complete relief):
Morphine: 8/32 (25%)
Nortriptyline: 10/31 (32%)
Placebo: 5/28 (18%)
Average leg pain (scale 0‐10):
[Baseline 4.9 ± 2.4]
Morphine: 3.4 ± 2.8 (7% reduction)
Nortriptyline: 3.0 ± 2.7 (14% reduction)
Placebo: 3.7 ± 2.7
Wu 2008 Morphine SR: target dose 180 mg daily
Mexiletine: target dose 1200 mg daily
Placebo
n = 60 (cross‐over)
33% decrease in PI:
Morphine: 33/50 (66%)
Mexiletine: 16/42 (38%)
Placebo: 19/43 (44%)
50% decrease in PI:
Morphine: 23/50 (46%)
Mexiletine: 11/42 (26%)
Placebo: 13/43 (30%)
Any pain‐related outcome:
Average reduction in PI from baseline (0‐10):
Morphine: 2.8 (95% CI 2.3 to 3.4)
Mexiletine: 1.5 (95% CI 0.9 to 2.2)
Placebo: 1.4 (95% CI 0.6 to 2.2)
No difference between groups for overall functional activity and pain‐related interference with daily activities.