A reduction in neuropathic pain in cancer patients was observed with anticonvulsants or antidepressants in combination pharmacotherapy when compared with treatments without anticonvulsants or antidepressants, according to a meta-analysis of 8 trials and 1,359 patients. Researchers found:

• There was a favorable association with anticonvulsants or antidepressants in combination pharmacotherapy compared with control groups (mean difference, -0.41) with no heterogeneity across trials.

• The mean difference in change estimated in all sensitivity analyses ranged from -0.36 to -0.47, suggesting these effects were consistent across different study design and statistical assumptions.

Citation: Guan J, Tanaka S, Kawakami K. Anticonvulsants or antidepressants in combination pharmacotherapy for treatment of neuropathic pain in cancer patients: A systematic review and meta-analysis. [Published online ahead of print October 21, 2015]. Clin J Pain. doi: 10.1097/AJP.0000000000000310.

Commentary: Treatment of cancer pain is a part of the management of cancer patients in which primary care physicians are very involved. Typically the treatment of cancer pain involves the use of opioid analgesics in increasing doses with a preference for using long-acting opioids for baseline pain relief and short-acting opioids for breakthrough pain. This study shows that even in cancer pain, a type of pain not typically thought of as being neuropathic in origin, the use of both the antiepileptic and tricyclic antidepressant adjuvant pain medications improves pain control compared with not using those adjuvant pain medications. —Neil Skolnik, MD