Combination medication for the

treatment of neuropathic pain

• Neuropathic pain – due to nerve disease or damage – is often treated by pain medications
which have limited effect and/or dose-related side effects when given alone. Combinations
of more than one drug are often used with the goal of achieving better pain relief or fewer
side effects (if the pain relieving effects of the combined drugs are more additive than the
side effects), or both. Despite evidence that over 45% of individuals suffering from
neuropathic pain take two or more drugs for their pain, we could find only 21 high-quality
studies of various different systemic and topical drug combinations. Given the wide
possible variety of different drug combinations and the small number of studies, results for
neuropathic pain from this review are insufficient to suggest the value of any one specific
drug combination. However, the publication of multiple high-quality studies suggesting the
superiority of some drug combinations, together with evidence that drug combinations are
widely used in clinical practice, underline the importance of conducting more combination
studies with improved methodology.
• Combination therapies are often used in patients with NP who have either failed to have a
response, or only had a partial response to monotherapy. In theory, utilising lower doses of
different classes of drugs may help alleviate or prevent adverse drug effects that are seen with
higher doses of monotherapy. Studies have focused on the use of combination therapies and
have found mixed results. A meta-analysis of two studies did find that a combination of
gabapentin with an opioid were superior to monotherapy (or placebo), but the combination of
the two medications were associated with higher drop-out rates due to adverse effects. A large
study that focused on comparing duloxetine and pregabalin at high doses as monotherapy to
lower doses in combination did not show any difference in efficacy or side effects. Owing to the
limited number of studies, there is not much available evidence that supports specific
combinations of medications for Neuropatic pain

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