Systematic Review on Nonopioid Pharmacologic Treatments for Chronic Pain: Surveillance Report 1

Abstract

Purpose of ReviewEvaluate the benefits and harms of nonopioid drugs in randomized controlled trials of patients with specific types of chronic pain, considering the effects on pain, function, quality of life, and adverse events. Key Messages• In the short term, improvement in pain and function was small with specific anticonvulsants, moderate with specific antidepressants in diabetic peripheral neuropathy/post-herpetic neuralgia and fibromyalgia, and small with nonsteroidal antiinflammatory drugs (NSAIDs) in osteoarthritis and inflammatory arthritis. • In the intermediate term, evidence was limited, with evidence of benefit for memantine in fibromyalgia and for serotonin norepinephrine reuptake inhibitor (SNRI) antidepressants in low back pain and fibromyalgia. • In the long term, evidence was too limited to draw conclusions. In general, evidence on quality of life was limited and no treatment achieved a large improvement in pain or function.• Small to moderate, dose-dependent increases in withdrawal due to adverse events were found with SNRIs duloxetine and milnacipran, anticonvulsants pregabalin and gabapentin, and NSAIDs. Large increases were seen with oxcarbazepine. NSAIDs have increased risk of serious gastrointestinal, liver dysfunction, and cardiovascular adverse events.