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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.
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.
Neurogastroenterology and Motility
Oral and parenteral anti-neuropathic agents for the management of pain and discomfort in irritable bowel syndrome: A systematic review and meta-analysis
Andrew Lambarth et al.
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