In irritable bowel syndrome patients, anti-neuropathic analgesics may alleviate pain and warrant further, high-quality evaluation of parenteral administration and agents having reduced gastrointestinal motility effects.

A systematic review and meta-analysis of available evidence were carried out to determine the role of anti-neuropathic medicines to manage pain in people with irritable bowel syndrome.

A systematic search of scientific repositories was done for trials examining conventional oral, and/or parenteral, pharmaceutical anti-neuropathic therapies in people having irritable bowel syndrome. Overall, 13 studies with 629 participants were incorporated. The key participant characteristics, outcomes associated with pain (major endpoint), and selected secondary endpoints were summarized.

Amitriptyline, duloxetine, pregabalin, and gabapentin were evaluated by 6, 3, 3 and 1 study respectively. A significant methodological and statistical heterogeneity was noted. Thus, a narrative synthesis and limited meta-analysis were carried out. Amitriptyline was the most extensively studied, though only in diarrhea-predominant people.

In the individual trials, gabapentin, amitriptyline, and pregabalin were noted to be valuable for the pain endpoints. Though duloxetine studies tended to describe improvements in pain, all were uncontrolled trials having elevated risk of biasness. A meta-analysis of three studies (278 participants) offered a pooled relative-risk of 0.50 for not improving with anti-neuropathic agents when compared to the control group. No eligible studies exploring the role of parenteral anti-neuropathics were detected.

Anti-neuropathic medicines seem to be beneficial for pain control in irritable bowel syndrome. Currently, there is a paucity of evaluation of amitriptyline's effectiveness in non-diarrhea-predominant subtypes. Therefore, it needs to be cautiously used in people having irritable bowel syndrome with constipation.