BACKGROUND: Neuropathic pain (NP) encompasses many difficult-to-treat disorders. There are few head-to-head, comparative, randomized controlled trials (RCTs) of drugs for NP in different analgesic categories, or of different drugs within a category, despite many placebo-controlled RCTs for individual agents. Well-designed head-to-head comparative trials are an effective way to determine the relative efficacy and safety of a new drug.OBJECTIVE: To perform a systematic review of head-to-head RCTs of oral analgesics in NP.METHODS: A systematic review of RCTs involving NP patients was performed, of which head-to-head comparative trials were selected. Reference lists from published systematic reviews were searched. These studies were rated according to the Jadad scale for quality.RESULTS AND CONCLUSIONS: Twenty-seven such trials were identified. Seventeen were comparisons of different analgesics, and 10 were of different drugs within an analgesic class. Important information was obtained about the relative efficacy and safety of drugs in different categories and within a category. Some significant differences between active treatments were reported. Trial inadequacies were identified. More and improved head-to-head RCTs are needed to inform clinical choices.

中文翻译：

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定性系统评价神经性疼痛中口服止痛药的头对头随机对照试验。

背景：神经性疼痛（NP）涵盖了许多难以治疗的疾病。尽管有很多针对单个药物的安慰剂对照RCT，但很少有针对不同镇痛药类别或同一类别中不同药物的NP头对头随机对照试验（RCT）。设计良好的头对头比较试验是确定新药相对疗效和安全性的有效方法。目的：对NP中口服镇痛药的头对头RCT进行系统评价。对涉及NP患者的RCT进行了综述，并选择了头对头比较试验。搜索已发表的系统评价的参考文献清单。根据Jadad量表对这些研究进行质量评定。结果与结论：共有27项这样的试验。十七种是不同镇痛药的比较，而十种是镇痛药中不同药物的比较。获得了有关不同类别和类别内药物的相对功效和安全性的重要信息。据报道主动治疗之间存在一些显着差异。确定了审判不足之处。需要更多和改进的头对头RCT来指导临床选择。