Comparative efficacy of amitriptyline, duloxetine and pregabalin for treating fibromyalgia in adults: an overview with network meta-analysis

Alberti, Fernanda Fávero; Becker, Matheus William; Blatt, Carine Raquel; Ziegelmann, Patrícia Klarmann; Pizzol, Tatiane da Silva Dal; Pilger, Diogo André

doi:10.1007/s10067-022-06129-8

Cited by 26 publications

(10 citation statements)

References 48 publications

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“…Again, as an example, our recent RCT on TENS in FM showed that 44% of individuals had a clinically meaningful reduction in pain with TENS [ 2 , 26 ]. This percentage of responders to treatment is again similar to that observed for pharmaceutical agents for pain [ 79 ]. Thus, uncertainty about the clinical efficacy of TENS is primarily due to limitations of existing literature, as Johnson and colleagues [ 64 ] highlighted in terms of the sample sizes from RCTs included in meta-analysis and the risk for bias and heterogeneity of the systematic reviews with the pooled analysis.…”

Section: Factors That Directly Affect Tens Efficacysupporting

confidence: 82%

Using TENS for Pain Control: Update on the State of the Evidence

et al. 2022

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Transcutaneous electrical nerve stimulation (TENS) is a non-pharmacological intervention used in the treatment of acute and chronic pain conditions. The first clinical studies on TENS were published over 50 years ago, when effective parameters of stimulation were unclear and clinical trial design was in its infancy. Over the last two decades, a better understanding of the mechanisms underlying TENS efficacy has led to the development of an adequate dose and has improved outcome measure utilization. The continued uncertainty about the clinical efficacy of TENS to alleviate pain, despite years of research, is related to the quality of the clinical trials included in systematic reviews. This summary of the evidence includes only trials with pain as the primary outcome. The outcomes will be rated as positive (+), negative (−), undecided (U), or equivalent to other effective interventions (=). In comparison with our 2014 review, there appears to be improvement in adverse events and parameter reporting. Importantly, stimulation intensity has been documented as critical to therapeutic success. Examinations of the outcomes beyond resting pain, analgesic tolerance, and identification of TENS responders remain less studied areas of research. This literature review supports the conclusion that TENS may have efficacy for a variety of acute and chronic pain conditions, although the magnitude of the effect remains uncertain due to the low quality of existing literature. In order to provide information to individuals with pain and to clinicians treating those with pain, we suggest that resources for research should target larger, high-quality clinical trials including an adequate TENS dose and adequate timing of the outcome and should monitor risks of bias. Systematic reviews and meta-analyses should focus only on areas with sufficiently strong clinical trials that will result in adequate sample size.

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Section: Factors That Directly Affect Tens Efficacysupporting

confidence: 82%

Using TENS for Pain Control: Update on the State of the Evidence

et al. 2022

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“…There are several guidelines recommending the use of Pregabalin, Gabapentin, Duloxetine, and Amitriptyline as rst line drugs in the management of neuropathic pain. 33,34,35 However, the use of gabapentinoids is being challenged as it lacks favourable robust evidence for e cacy against pain syndromes other than bromyalgia, post herpetic neuralgia and diabetic neuropathy, and many clinicians have also highlighted the potential for misuse and developing dependence. 36,37,38 The use of BTX-A, Ketamine, Ningmitai and THC for the management of various chronic pain conditions is popular and well established [39][40][41][42][43] and our study shows the effective use of these as analgesics when compared to placebo.…”

Section: Discussionmentioning

confidence: 99%

A Systematic review and Network Meta-analysis of pharmaceutical interventions used to manage chronic pain

Shetty,

Delanerolle,

Cavalini

et al. 2023

Preprint

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Background: It is estimated 1·5 billion of the global population suffer from chronic pain with prevalence increasing with demographics including age. It is suggested long-term exposure to chronic could cause further health challenges reducing people’s quality of life. Therefore, it is imperative to use effective treatment options. We explored the current pharmaceutical treatments available for chronic pain management to better understand drug efficacy and pain reduction. Methods: A systematic methodology was developed and published in PROSPERO (CRD42021235384). Keywords of opioids, acute pain, pain management, chronic pain, opiods, NSAIDs, and analgesics were used across PubMed, Science direct, ProQuest, Web of science, Ovid Psych INFO, PROSPERO, EBSCOhost, MEDLINE, ClinicalTrials.gov and EMBASE. All randomised controlled clinical trials (RCTs), epidemiology and mixed-methods studies published in English between the 1st of January 1990 and 30th of April 2022 were included. A total of 119 studies were included. The data was synthesised using a tri-partied statistical methodology of a meta-analysis (24), pairwise meta-analysis (24) and network meta-analysis (34). Mean, median, standard deviation and confidence intervals for various pain assessments were used as the main outcomes for pre-treatment pain scores at baseline, post-treatment pain scores and pain score changes of each group. Findings: Our meta-analysis revealed the significant reduction in chronic pain scores of patients taking NSAID versus non-steroidal opioid drugs was comparative to patients given placebo under a random effects model. Pooled evidence also indicated significant drug efficiency with Botulinum Toxin Type-A (BTX-A) and Ketamine. Conclusion: Chronic pain is a public health problem that requires far more effective pharmaceutical interventions with minimal better side-effect profiles which will aid to develop better clinical guidelines. The importance of understanding ubiquity of pain by clinicians, policy makers, researchers and academic scholars is vital to prevent social determinant which aggravates issue.

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“…There are a few head-to-head studies on fibromyalgia agents. A meta-analysis of various fibromyalgia treatments indirectly compared pregabalin, amitriptyline, and duloxetine at various dosages and reported that amitriptyline 25 mg had superior results, followed next by pregabalin 450 mg [ 44 ].…”

Section: Reviewmentioning

confidence: 99%

Is Fibromyalgia a Fashionable Diagnosis or a Medical Mystery?

Varrassi,

Rekatsina,

Perrot

et al. 2023

Cureus

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Despite its prevalence, there is no clear-cut diagnostic path or treatment paradigm for fibromyalgia; this can lead to a multiplicity of symptoms and comorbid conditions that complicate care. "Overlapping symptoms" describe conditions that can occur concomitantly with fibromyalgia and include migraine, irritable bowel syndrome, obesity, and pelvic pain syndromes. A variety of pharmacologic and nonpharmacologic treatments are available for fibromyalgia, but treatment is best personalized for an individual and recognizes potential comorbidities. Opioids are not the recommended front-line treatment, cannabinoids hold promise but with limitations and nonpharmacologic options, such as aerobic or resistance exercise and cognitive behavior therapy, can play a very important but often underestimated role. Amitriptyline appears to be safe and effective in treating six of the main fibromyalgia domains: pain, disturbed sleep, fatigue, affective symptoms, functional limitations, and impaired cognition ("fibro fog"). Very low-dose naltrexone (2.5-4.5 mg) may offer analgesic and anti-inflammatory benefits to fibromyalgia patients, but further studies are needed. Fibromyalgia can be a devastating and debilitating condition for patients, and clinicians are challenged with its diagnosis and treatment as well. Further research as well as compassionate approaches to offering personalized care to those with fibromyalgia are required.

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Comparative efficacy of amitriptyline, duloxetine and pregabalin for treating fibromyalgia in adults: an overview with network meta-analysis

Cited by 26 publications

References 48 publications

Using TENS for Pain Control: Update on the State of the Evidence

Using TENS for Pain Control: Update on the State of the Evidence

A Systematic review and Network Meta-analysis of pharmaceutical interventions used to manage chronic pain

Is Fibromyalgia a Fashionable Diagnosis or a Medical Mystery?

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