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Evidence summaries

Carbamazepine for Acute and Chronic Pain

Carbamazepine might possibly be effective for chronic neuropathic pain, such as trigeminal neuralgia and diabetic neuropathy, but the evidence is insufficient. Level of evidence: "D"

The quality of evidence is downgraded by inconsistency (heterogeneity in patients and treatments), indirectness (only short-term outcomes reported, no common primary endpoint, old studies) and imprecise results (small studies).

A Cochrane review [Abstract] 1 included 10 studies with a total of 480 subjects. Five studies were published in the 1960's and only one study in the last 10 years. The patients had either trigeminal neuralgia, diabetic neuropathy, or post stroke pain. No trial was longer than 4 weeks.A wide range of carbamazepine doses, from 100 mg to 2400 mg daily, were used. No study provided first or second tier evidence for an efficacy outcome. Using post hoc analysis for carbamazepine vs. placebo, for trigeminal neuralgia the RR was 6.02 (95%CI 2.82 to 12.85; 2 trials, n=98) and for diabethic neuropathy RR was 8.50 (95%CI 2.15 to 33.62; one study, n=60). There were too few data in studies comparing carbamazepine with active comparators to draw any conclusions.In 4 studies 65% (113/173) of participants experienced at least one adverse event with carbamazepine, and 27% (47/173) with placebo. In 8 studies 3% (8/268) of participants withdrew due to adverse events with carbamazepine, and none (0/255) with placebo. The NNH for any adverse event was 4. Serious adverse events were not reported consistently; rashes were associated with carbamazepine.

    References

    • Wiffen PJ, Derry S, Moore RA et al. Carbamazepine for chronic neuropathic pain and fibromyalgia in adults. Cochrane Database Syst Rev 2014;4():CD005451. [PubMed]

Primary/Secondary Keywords