Skip navigation
Acute Pain | Chronic Pain | General

Carbamazepine for neuropathic pain

 

Clinical bottom line

Carbamazepine appears to have good efficacy and low NNT of about 2 from a few smaller, older, short duration trials. It has not been tested in better quality, large, longer duration trials. There could be no useful adverse event data from the limited trial data available.


Reference

Wiffen et al. Carbamazepine for acute and chronic pain in adults. Cochrane Database of Systematic Reviews 2005 November

Study

Results

Trigeminal neuralgia

Combining the short-term results for any measure of benefit from the studies with ANY dichotomous pain relief outcomes produced, in 208 participants, a relative benefit for carbamazepine titrated up to 1000 mg daily compared to placebo of 5.9 (3.6 to 9.6), and a NNT of 1.5 (1.3 to 1.8). Restricting the analysis to randomised and double blind studies (Killian 1968; Nicol 1969) produced, in 98 participants, a relative benefit for carbamazepine compared to placebo of 6.0 (2.8 to 13), and a NNT of 1.7 (1.3 to 2.2).

Painful diabetic neuropathy

The small number of small trials with complicated designs gave no useful evidence for efficacy of carbamazepine in painful diabetic neuropathy.

Postherpetic neuralgia

There was insufficient data to determine whether carbamazepine at doses used was of any help.

Overall estimate of efficacy

A series of examinations of the five trials (298 patients) for level of outcome and trial quality all showed similar results, with an NNT in short term trials. The NNT was 1.7 (1.5 to 2.0), with event rates of 70% with carbemazepine and 12% with placebo.

Comment

Carbamazepine appears to have good efficacy from a few smaller, older, short duration trials.