Tramadol (Ultram) for neuropathic pain

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Cochrane Database Syst Rev. 2006 Jul 19;3

Tramadol for neuropathic pain.

Hollingshead J, Duhmke R, Cornblath D.

BACKGROUND: Peripheral neuropathic pains often include symptoms such

as burning or shooting sensations, abnormal sensitivity to normally

painless stimuli, or an increased sensitivity to normally painful

stimuli. Neuropathic pain is a common symptom in many diseases of the

peripheral nervous system.

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 (June 2005), MEDLINE

(January 1966 to June 2005), EMBASE (January 1980 to June 2005), and

LILACS (January 1982 to June 2005) 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 authors extracted data and scored

trial quality. We calculated relative risks a

nd numbers needed to treat for effectiveness and adverse effects.

MAIN RESULTS: We identified six eligible trials, four comparing

tramadol with placebo, one comparing tramadol with clomipramine, and

one comparing tramadol with morphine. All four trials comparing

tramadol with placebo showed a significant reduction in neuropathic

pain with tramadol. Three of the trials which compared tramadol to

placebo (total 269 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 3.8 (95% confidence interval 2.8 to

6.3). 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. Three trials provided these data, and

the combined number needed to harm was 8.3 (95% confidence interval

5.6 to 17).

AUTHORS' CONCLUSIONS: Tramadol is an effective treatment for

neuropathic pain.