Abstract Details

Title Comparative Efficacy and Safety of Different Pharmacological Treatments for Postherpetic Neuralgia Pain: A Systematic Review and Network Meta-analysis

Topic Pain

Presentation(s) P5 - Poster Session 5 (8:00 AM-9:00 AM)

Poster/Presentation
Number 7-006

Objective To evaluate the efficacy and safety of various pharmacological interventions for managing Postherpetic Neuralgia (PHN) pain through a comprehensive network meta-analysis (NMA) and systematic review.

Background PHN, a common complication of herpes zoster, affects 5% to 30% of patients, causing severe pain that impacts physical function, psychological well-being, and quality of life. The effectiveness of available treatments varies, complicating management strategies. This NMA aims to provide the most comprehensive evidence for PHN management.

Design/Methods Databases were systematically searched up to April 2024 for RCTs comparing pharmacological interventions for PHN. Pain reduction was the primary outcome, assessed by SMD with a 95% CI. Safety outcomes were evaluated using RR with a 95% CI, employing random-effects models and inverse variance statistics.

Results

Twenty-three RCTs with 6514 patients and 17 pharmacological interventions (6 classes including placebo) were analyzed.

Efficacy:

Week 1: Local anesthetics (Lidocaine) showed the highest efficacy (SMD -2.27, 95%CI -3.00: -1.53), followed by opioids (Hydromorphone) (SMD -1.28, 95%CI -1.96: -0.61) and anticonvulsants (Pregabalin, Gabapentin) (SMD -0.80 to -0.38).

Week 2: Lidocaine remained most effective (SMD -2.95, 95%CI -3.66: -2.24), followed by anticonvulsants (SMD -1.01 to -0.56).
Week 4: Lidocaine (SMD -1.54, 95%CI -2.18: -0.90) and Hydromorphone (SMD -1.30, 95%CI -2.10: -0.49) were most effective. Anticonvulsants (SMD -1.11 to -0.65).
Week 8: our analysis of Anticonvulsants, opioids, antidepressants, and placebo showed that Anticonvulsants (notably Pregabalin (high-dose))(SMD -1.15, 95%CI -1.58: -0.73) and Hydromorphone (SMD -1.14, 95%CI -1.71: -0.57) have the highest efficacy.

Safety:
All interventions showed non-statistically significant differences in safety compared to placebo, including discontinuation rates and common side effects.

Conclusions Local anesthetics are most effective for pain reduction, followed by opioids and anticonvulsants. Antidepressants and COX-2 inhibitors were not significantly effective compared to placebo. Pregabalin, especially at moderate to high doses, was the most effective among anticonvulsants. All interventions had similar safety profiles.

Authors/Disclosures
Sai Varun Bethina, MBBS PRESENTER	Dr. Bethina has nothing to disclose.
Amir N. Attia (Kasr Al Ainy School of Medicine, Cairo University)	Mr. Attia has nothing to disclose.
kareem w. raafat, MBBch	Mr. raafat has nothing to disclose.
Mohamed R. Ezz, MD	Dr. Ezz has nothing to disclose.
Amira A. Aboali, MD (Faculty of Medicine)	Dr. Aboali has nothing to disclose.
Ahmed M. Amin, Jr., MD	Dr. Amin has nothing to disclose.
Ahmed I. Elsekhary, Student	Dr. Elsekhary has nothing to disclose.
Ehab N. Sabry, Sr., PT	Dr. Sabry has nothing to disclose.
Mostafa A. A. Bakr, Jr., MBBS	Dr. Bakr has nothing to disclose.
Ram K. Saha, MD (Virginia Commonwealth University)	Dr. Saha has nothing to disclose.
Ahmed M. Shaheen	Dr. Shaheen has a non-compensated relationship as a A Research Position Candidate Under Trial Task with Solvemed Company that is relevant to AAN interests or activities.

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