ABSTRACT
Background: Neuropathic pain is the most common form of chronic pain often associated with impaired quality of life due to its poor management. Tricyclic antidepressants, serotonin and norepinephrine reuptake inhibitors and calcium channel alpha 2 ligand agonist are preferred as first line therapy for neuropathic pain. Lignocaine patches and transdermal patches of capsaicin are used as second line agents. Moderate efficacy opioids like tramadol and strong opioids are recommended as second line and third line therapy for neuropathic pain respectively. Previous meta-analysis and systematic review shows inconsistent data and lacks reliability in getting conclusive results in opioids use in neuropathic pain. So, author conducted a meta-analysis to reanalyse the analgesic efficacy of opioid agonist for the treatment of neuropathic pain.Methods: Author searched Oxford pain relief data base, Google web, Embase, Medline and Cochrane library from February 2001 to November 2017 for articles related to analgesic efficacy of opioid agonist in neuropathic pain based on author抯 selection criteria. Reference list of reviews were retrieved using Prisma Algorithm and analysed using REVIEW MANAGER 5 software.Results: Among 1108 publications searched, only 5 trials met the inclusion criteria. Primary outcome measure was proportion of participants reporting 50% of pain relief or better. In five trials, 305 patients treated with opioids and placebo/standard treatment for neuropathic pain, the number per treatment group ranges from 31 to 170 (median 50�. The overall point estimate of risk difference was 0.17 (95% CI 0.02 to 0.33, P=0.026) translating to number needed to treat (Benefit) of 5.9 (3.0 to 50.0).Conclusions: In this meta-analysis, opioid agonist efficacy trials shown consistent analgesic efficacy and benefit over placebo/standard treatment in reducing neuropathic pain.
ABSTRACT
Background: Epilepsy is a common chronic neurological disorder characterized by paroxysmal cerebral dysrhythmia. Conventional antiepileptic drugs such as Phenytoin, carbamazepine, phenobarbitone and sodium valproate, have been proven to have good therapeutic effects. There are currently more than 10 different adjuvants which are approved for use in epileptics. Topiramate, a second-generation antiepileptic drug, is being used for several types of partial-onset and generalized-onset seizures. Effective treatment of epilepsy depends on medication compliance. The incidence of adverse effects is an important issue when antiepileptic drugs are prescribed to treat epilepsy. This study was done in Department of Neurology to observe the adverse effects of Topiramate in patients with epilepsy in a Tertiary care hospital.Methods: For this study 100 patients receiving topiramate as an adjuvant drug along with regular anti epileptic drugs were enrolled in the study for prescheduled three months. Data of the patients were collected.Results: In this study we observed that paresthesia (31%) was the commonly noted adverse effect followed by cognitive impairment (24%), sleepiness (19%), nausea (13%), anorexia (9%) and weight loss (4%).Conclusions: Topiramate is a potent antiepileptic drug effective against most seizure types and has relatively favourable pharmacokinetic profile. It is appropriate for initial monotherapy as well as for adjuvant therapy in refractory patients. The major problem limiting its use is the frequent occurrence of cognitive adverse effects, especially expressive language dysfunction, which are reversible upon discontinuation of the medication.