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. 2012 May 16;2012(5):CD009486.
doi: 10.1002/14651858.CD009486.pub2.

Clonazepam for neuropathic pain and fibromyalgia in adults

Affiliations

Clonazepam for neuropathic pain and fibromyalgia in adults

Ruth Corrigan et al. Cochrane Database Syst Rev. .

Abstract

Background: Antiepileptic drugs have been used in pain management since the 1960s; some have shown efficacy in treating different neuropathic pain conditions. Clonazepam, a benzodiazepine, is an established antiepileptic drug, but its place in the treatment of neuropathic pain is unclear.

Objectives: To assess the analgesic efficacy and adverse effects of the antiepileptic drug clonazepam in neuropathic pain and fibromyalgia.

Search methods: We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2012, Issue 2). MEDLINE, and EMBASE to 28 February 2012, together with reference lists of retrieved papers and reviews, and ClinicalTrials.gov.

Selection criteria: We planned to include randomised, double-blind studies of eight weeks duration or longer, comparing clonazepam with placebo or another active treatment in chronic neuropathic pain or fibromyalgia.

Data collection and analysis: Two review authors would independently extract data for efficacy and adverse events, and examine issues of study quality.

Main results: We did not identify any studies that satisfied the inclusion criteria.

Authors' conclusions: This review uncovered no evidence of sufficient quality to support the use of clonazepam in chronic neuropathic pain or fibromyalgia.

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Conflict of interest statement

SD and RAM have received research support from charities, government, and industry sources at various times. RAM has consulted for various pharmaceutical companies, and received lecture fees from pharmaceutical companies related to analgesics and other healthcare interventions. PW is a full‐time employee of the UK Cochrane Centre, funded by the UK National Institute of Health Research and has no relevant interests to declare. RC has no interests to declare. No company with any interest in clonazepam had any involvement in the production of this review.

Update of

  • doi: 10.1002/14651858.CD009486

References

References to studies excluded from this review

Gremeau‐Richard 2004 {published data only}
    1. Gremeau‐Richard C, Woda A, Navez ML, Attal N, Bouhassira D, Gagnieu MC, et al. Topical clonazepam in stomatodynia: a randomised placebo‐controlled study. Pain 2004;108:51‐7. - PubMed
Harkins 1991 {published data only}
    1. Harkins S, Linford J, Cohen J, Kramer T, Cueva L. Administration of clonazepam in the treatment of TMD and associated myofascial pain: a double blind pilot study. Journal of Craniomandibular Disorders: Facial and Oral Pain 1991;5:179‐86. - PubMed
Herman 2002 {published data only}
    1. Herman CR, Schiffman EL, Look JO, Rindal DB. The effectiveness of adding pharmacologic treatment with clonazepam or cyclobenzaprine to patient education and self‐care for the treatment of jaw pain upon awakening: a randomized clinical trial. Journal of Orofacial Pain 2002;16:64‐70. - PubMed

Additional references

AAN 2011
    1. American Academy of Neurology. Treatment of painful diabetic neuropathy. www.aan.com/globals/axon/assets/8400.pdf (accessed 10 November 2011).
Binder 1987
    1. Binder RL. Three case reports of behavioral disinhibition with clonazepam. General Hospital Psychiatry 1987;9(2):151‐3. - PubMed
Birse 2012
    1. Birse F, Derry S, Moore RA. Phenytoin for neuropathic pain and fibromyalgia in adults. Cochrane Database of Systematic Reviews 2012, Issue 5. - PMC - PubMed
BNF 2011
    1. Joint Formulary Committee. Clonazepam. British National Formulary (online ed) : http://bnf.org/bnf/bnf/current/3577.htm (accessed 9 November 2011). Vol. 62, London: BMJ Group and Pharmaceutical Press, September 2011:Section 4.8.1.
Bouhassira 2008
    1. Bouhassira D, Lantéri‐Minet M, Attal N, Laurent B, Touboul C. Prevalence of chronic pain with neuropathic characteristics in the general population. Pain 2008;236(3):380‐7. [DOI: 10.1016/j.pain.2007.08.013] - DOI - PubMed
Chou 2007
    1. Chou R, Norris SL, Carson S, Chan BKS. Drug class review on drugs for neuropathic pain: final report. Drug Class Reviews. Portland: Oregon Health and Science University, 2007. - PubMed
Dworkin 2008
    1. Dworkin RH, Turk DC, Wyrwich KW, Beaton D, Cleeland CS, Farrar JT, et al. Interpreting the clinical importance of treatment outcomes in chronic pain clinical trials: IMMPACT recommendations. Journal of Pain 2008;9(2):105‐21. [DOI: 10.1016/j.jpain.2007.09.005] - DOI - PubMed
Finnerup 2010
    1. Finnerup NB, Sindrup SH, Jensen TS. The evidence for pharmacological treatment of neuropathic pain. Pain 2010;150:573‐81. [DOI: 10.1016/j.pain.2010.06.019] - DOI - PubMed
Gustorff 2008
    1. Gustorff B, Dorner T, Likar R, Grisold W, Lawrence K, Schwarz F, et al. Prevalence of self‐reported neuropathic pain and impact on quality of life: a prospective representative survey. Acta Anaesthesiologica Scandinavica 2008;52(1):132‐6. - PubMed
Hall 2006
    1. Hall GC, Carroll D, Parry D, McQuay HJ. Epidemiology and treatment of neuropathic pain: the UK primary care perspective. Pain 2006;122(1‐2):156‐62. [DOI: 10.1016/j.pain.2006.01.030] - DOI - PubMed
Jensen 2009
    1. Jensen TS, Madsen CS, Finnerup NB. Pharmacology and treatment of neuropathic pains. Current Opinion in Neurology 2009;22:467‐74. [DOI: 10.1097/WCO.0b013e3283311e13] - DOI - PubMed
Jensen 2011
    1. Jensen TS, Baron R, Haanpää M, Kalso E, Loeser JD, Rice AS, et al. A new definition of neuropathic pain. Pain 2011;152(10):2204‐5. [DOI: 10.1016/j.pain.2011.06.017] - DOI - PubMed
L'Abbé 1987
    1. L'Abbé KA, Detsky AS, O'Rourke K. Meta‐analysis in clinical research. Annals of Internal Medicine 1987;107:224‐33. - PubMed
Martin 2011
    1. Martin WJJM, Forouzanfar T. The efficacy of anticonvulsants on orofacial pain: a systematic review. Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology and Endodontics 2011;111:627‐33. [DOI: 10.1016/j.tripleo.2011.01.033] - DOI - PubMed
McQuay 1995
    1. McQuay H, Carroll D, Jada AR, Wiffen P, Moore A. Anticonvulsant drugs for management of pain: a systematic review. BMJ 1995;311:1047‐52. - PMC - PubMed
McQuay 1998
    1. McQuay H, Moore R. An evidence‐based resource for pain relief. Oxford: Oxford University Press, 1998. [ISBN: 0‐19‐263048‐2]
McQuay 2007
    1. McQuay HJ, Smith LA, Moore RA. Chronic pain. In: Stevens A, Raferty J, Mant J, Simpson S editor(s). Health Care Needs Assessment. Oxford: Radcliffe Publishing Ltd, 2007:519‐600. [ISBN: 978‐1‐84619‐063‐6]
Moore 1998
    1. Moore RA, Gavaghan D, Tramèr MR, Collins SL, McQuay HJ. Size is everything ‐ large amounts of information are needed to overcome random effects in estimating direction and magnitude of treatment effects. Pain 1998;78(3):209‐16. [DOI: 10.1016/S0304-3959(98)00140-7] - DOI - PubMed
Moore 2005
    1. Moore RA, Edwards JE, McQuay HJ. Acute pain: individual patient meta‐analysis shows the impact of different ways of analysing and presenting results. Pain 2005;116(3):322‐31. [DOI: 10.1016/j.pain.2005.05.001] - DOI - PubMed
Moore 2009a
    1. Moore RA, Straube S, Wiffen PJ, Derry S, McQuay HJ. Pregabalin for acute and chronic pain in adults. Cochrane Database of Systematic Reviews 2009, Issue 3. [DOI: 10.1002/14651858.CD007076.pub2] - DOI - PMC - PubMed
Moore 2009b
    1. Moore RA, Moore OA, Derry S, Peloso PM, Gammaitoni AR, Wang H. Responder analysis for pain relief and numbers needed to treat in a meta‐analysis of etoricoxib osteoarthritis trials: bridging a gap between clinical trials and clinical practice. Annals of the Rheumatic Diseases 2009;69(2):374‐9. [DOI: 10.1136/ard.2009.107805] - DOI - PMC - PubMed
Moore 2009c
    1. Moore RA, Straube S, Wiffen PJ, Derry S, McQuay HJ. Pregabalin for acute and chronic pain in adults. Cochrane Database of Systematic Reviews 2009, Issue 3. [DOI: 10.1002/14651858.CD007076] - DOI - PMC - PubMed
Moore 2010
    1. Moore RA, Eccleston C, Derry S, Wiffen P, Bell RF, Straube S, et al. ACTINPAIN Writing Group of the IASP Special Interest Group on Systematic Reviews in Pain Relief, Cochrane Pain, Palliative and Supportive Care Systematic Review Group Editors. "Evidence" in chronic pain‐‐establishing best practice in the reporting of systematic reviews. Pain 2010;150(3):386‐9. [DOI: 10.1016/j.pain.2010.05.011] - DOI - PubMed
Moore 2011
    1. Moore RA, Wiffen PJ, Derry S, McQuay HJ. Gabapentin for chronic neuropathic pain and fibromyalgia in adults. Cochrane Database of Systematic Reviews 2011, Issue 3. [DOI: 10.1002/14651858.CD007938.pub2] - DOI - PMC - PubMed
NICE 2010
    1. National Institute for Health and Clinical Excellence. Neuropathic pain: the pharmacological management of neuropathic pain in adults in non‐specialist settings. http://www.nice.org.uk/nicemedia/live/12948/47949/47949.pdf 2010. - PubMed
Patton 2007
    1. Patton LL, Siegel MA, Benoliel R, Laat A. Management of burning mouth syndrome: systematic review and management recommendations. Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology and Endodontics 2007;103 Suppl(S39):e1‐13. [DOI: 10.1016/j.tripleo.2006.11.009] - DOI - PubMed
RevMan 2011 [Computer program]
    1. The Nordic Cochrane Centre, The Cochrane Collaboration. Review Manager (RevMan). Version 5.1. Copenhagen: The Nordic Cochrane Centre, The Cochrane Collaboration, 2011.
Reyes del Paso 2012
    1. Reyes Del Paso GA, Pulgar A, Duschek S, Garrido S. Cognitive impairment in fibromyalgia syndrome: the impact of cardiovascular regulation, pain, emotional disorders and medication. European Journal of Pain 2012;16(3):421‐9. [DOI: 10.1002/j.1532-2149.2011.00032.x] - DOI - PubMed
Rothschild 2000
    1. Rothschild AJ, Shindul‐Rothschild, Viguera A, Murray M, Brewster S. Comparison of the frequency of behavioral disinhibition on alprazolam, clonazepam, or no benzodiazepine in hospitalized psychiatric patients. Journal of Clinical Psychopharmacology 2000;20(1):7‐11. - PubMed
Saarto 2007
    1. Saarto T, Wiffen PJ. Antidepressants for neuropathic pain. Cochrane Database of Systematic Reviews 2007, Issue 4. [DOI: 10.1002/14651858.CD005454.pub2] - DOI - PMC - PubMed
Straube 2008
    1. Straube S, Derry S, McQuay HJ, Moore RA. Enriched enrollment: definition and effects of enrichment and dose in trials of pregabalin and gabapentin in neuropathic pain. A systematic review. British Journal Clinical Pharmacology 2008;66(2):266‐75. [DOI: 10.1111/j.1365-2125.2008.03200.x] - DOI - PMC - PubMed
Sultan 2008
    1. Sultan A, Gaskell H, Derry S, Moore RA. Duloxetine for painful diabetic neuropathy and fibromyalgia pain: systematic review of randomised trials. BMC Neurology 2008;8:29. [DOI: 10.1186/1471-2377-8-29] - DOI - PMC - PubMed
Tremont‐Lukats 2000
    1. Tremont‐Lukats IW, Megeff C, Backonja M. Anticonvulsants for neuropathic pain syndromes. Drugs 2000;60:1029‐52. - PubMed
Wiffen 2011a
    1. Wiffen PJ, Derry S, Moore RA, McQuay HJ. Carbamazepine for acute and chronic pain in adults. Cochrane Database of Systematic Reviews 2011, Issue 1. [DOI: 10.1002/14651858.CD005451.pub2] - DOI - PMC - PubMed
Wiffen 2011b
    1. Wiffen PJ, Derry S, Moore RA. Lamotrigine for acute and chronic pain. Cochrane Database of Systematic Reviews 2011, Issue 2. [DOI: 10.1002/14651858.CD006044.pub3] - DOI - PMC - PubMed
Wolfe 1990
    1. Wolfe F, Smythe HA, Yunus MB, Bennett RM, Bombardier C, Goldenberg DL, et al. The American College of Rheumatology 1990 Criteria for the Classification of Fibromyalgia. Report of the Multicenter Criteria Committee. Arthritis and Rheumatism 1990;33:160‐72. - PubMed
Wolfe 2010
    1. Wolfe F, Clauw DJ, Fitzcharles MA, Goldenberg DL, Katz RS, Mease P, et al. The American College of Rheumatology preliminary diagnostic criteria for fibromyalgia and measurement of symptom severity. Arthritis Care and Research 2010;62(5):600‐10. [DOI: 10.1002/acr.20140] - DOI - PubMed

References to other published versions of this review

Wiffen 2010
    1. Wiffen PJ, Collins S, McQuay HJ, Carroll D, Jadad A, Moore RA. WITHDRAWN. Anticonvulsant drugs for acute and chronic pain. Cochrane Database of Systematic Reviews 2010, Issue 1. [DOI: 10.1002/14651858.CD001133.pub3] - DOI - PMC - PubMed

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