To assess the evidence from rigorous clinical trials, systematic reviews, and meta-analyses of complementary and alternative therapies for treating neuropathic and neuralgic pain.
Systematic searches were carried out in the databases Medline, Embase, Amed, Scopus, the Cochrane Database of Systematic Reviews, Natural Standard, and the Natural Medicines Comprehensive Database. Each database was searched from its respective inception until March 2006. To be included, trials were required to state that they were randomized. Systematic reviews and meta-analyses were included if based on the results of randomized trials. No language restrictions were imposed.
Five relevant systematic reviews and meta-analyses and 15 additional trials met the inclusion criteria and were reviewed. Data on the following complementary and alternative medicine treatments were identified: acupuncture, electrostimulation, herbal medicine, magnets, dietary supplements, imagery, and spiritual healing.
On the basis of our findings, the evidence is not fully convincing for most complementary and alternative medicine modalities in relieving neuropathic or neuralgic pain. However, for topically applied capsaicin there is evidence of effectiveness beyond placebo. The evidence can be classified as encouraging and warrants further study for cannabis extract, magnets, carnitine, and electrostimulation.
Complementary Medicine, Peninsula Medical School, Universities of Exeter and Plymouth, Exeter, UK
Conflict of Interest: none. Funding: none external.
Reprints: Max H. Pittler, MD, PhD, Complementary Medicine, Peninsula Medical School, Universities of Exeter and Plymouth, 25 Victoria Park Road, Exeter, EX2 4NT, UK (e-mail: M.H.Pittler@exeter.ac.uk).
Received for publication March 1, 2007; revised February 19, 2008; accepted March 19, 2008