496 No evidence for efficacy of NSAIDs for neuropathic pain

December 06, 2016

written by Brian R McAvoy

Clinical question
Compared with placebo, how effective are nonsteroidal anti-inflammatory drugs (NSAIDs) for chronic neuropathic pain in adults?

Bottom line
There was no evidence of significant pain reduction in patients who had chronic low-back pain with a neuropathic component, or neuropathic pain after shingles. Adverse event rates were low, with insufficient events for any analysis. The absence of any reliable evidence of oral NSAID efficacy is a challenge to their continued widespread use.

This review involved only 2 small studies, and the quality of the evidence was poor. Of the 251 participants, 209 were in a study of an experimental drug not used in clinical practice, and of the remaining 42, only 16 had neuropathic pain.

Although often considered to be lacking adequate evidence, NSAIDs are widely used in the management of neuropathic pain. Surveys have found 18–47% of affected people reported using NSAIDs specifically for their neuropathic pain.

Cochrane Systematic Review
Moore RA et al. Oral nonsteroidal anti-inflammatory drugs for neuropathic pain. Cochrane Reviews, 2015, Issue 10. Art. No.: CD010902.DOI: 10.1002/14651858. CD010902.pub2. This review contains 2 studies involving 251 participants.

Pearls are an independent product of the Cochrane primary care group and are meant for educational use and not to guide clinical care.