Page 53 - CPG - Clinical Practice Guidelines - Management of Cancer Pain

Management of Cancer Pain (Second Edition)
However, a meta-analysis on patients with tumour-related cancer pain
demonstrated that adding gabapentin or pregabalin to stable opioid
analgesia did not improve pain intensity. The quality of evidence was
low. 64, level I
The Cochrane systematic review above reported that 63% of those
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compared with 49% on placebo (RR=1.3, 95% CI 1.2 to 1.4; NNH=7.5
95% CI 6.1 to 9.6). The most common AEs reported were somnolence
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A meta-analysis on patients with neuropathic pain including cancer-
related neuropathic pain gave an NNT to achieve 50% pain relief of
3.6 (95% CI 3.0 to 4.4) for amitriptyline and 6.4 (95% CI 5.2 to 8.4) for
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In a Cochrane systematic review, two clinical trials assessed the
effectiveness of amitriptyline in cancer-related neuropathic pain. Only
one trial showed that amitriptyline 50 - 100 mg decreased mean pain
intensity, had a morphine-sparing effect and improved functional
capacity. The quality of the evidence was very low. 65, level I

In another systematic review, an RCT on patients with chemotherapy-
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effective than placebo in pain relief (MD=0.73, 95% 0.26 to 1.20). The
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Another RCT in a systematic review on patients with tumour-related
cancer pain demonstrated that adding amitriptyline to stable opioid
analgesia did not improve pain relief. The quality of evidence was
low. 64, level I

A Cochrane systematic review reported that 55% of patients on
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on placebo (RR=1.5, 95% CI 1.3 to 1.8; NNH=5.2, 95% CI 3.6 to
9.1). The most commonly reported AEs were somnolence, dizziness,
dryness of mouth, nausea and constipation. 64, level I

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cancer pain may be treated with antidepressants and/or anticonvulsants. 9
Despite the lack of high-quality evidence, WHO guidelines also suggests

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