Cochrane on Opioids for Neuropathic Pain: Just Say No.

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http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD006146.pub2/abstract

Since the last version of this review, new studies were found providing additional information. Data were reanalyzed but the results did not alter any of our previously published conclusions. Short-term studies provide only equivocal evidence regarding the efficacy of opioids in reducing the intensity of neuropathic pain. Intermediate-term studies demonstrated significant efficacy of opioids over placebo, but these results are likely to be subject to significant bias because of small size, short duration, and potentially inadequate handling of dropouts. Analgesic efficacy of opioids in chronic neuropathic pain is subject to considerable uncertainty. Reported adverse events of opioids were common but not life-threatening. Further randomized controlled trials are needed to establish unbiased estimates of long-term efficacy, safety (including addiction potential), and effects on quality of life.

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interesting conclusions.

I have seen a few studies where combination therapy of opiod with neuropathic pain med (gabapentinoid, ? TCA) was better than either alone. And according to the Dworkin paper that everyone cites, opioids are second-line therapy for neuropathic pain.

I also read somewhere that opioids may down-regulate VGCC in the dorsal horn.

And the FDA did approve of nucynta for dpn (though it does have some NE effect)

Anyone out there prescribe opioids for specifically for neuropathic pain?
 
Good rule of thumb, avoid Opioids for : Neuropathic Pain, CLBP in working-aged adults with well aligned spines, FMS, Abd Pain, HA/Migraine, Pelvic Pain, and Phantom Limb Pain. No markers of disease, no proof of efficacy, abundant proof of harm.
 
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