The Effect of Bupropion in Peripheral Neuropathic Pain A Randomized, Double-Blind, Placebo-Controlled Study.
Melissa Dall Kreutzfeldt, Malin Erika Carmland, Jakob Vormstrup Holbech et al.
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In 30 seconds
This randomized, double-blind, placebo-controlled crossover study assessed bupropion for peripheral neuropathic pain and whether response varied with conditioned pain modulation (CPM) or sensory phenotype. Among 67 patients, treatment periods lasted 6 weeks. Mean daily pain decreased from NRS 6.4 to 5.5 with bupropion; the average effect versus placebo was -0.5 (95% CI -0.8 to -0.1, p = 0.005). Response was not related to CPM efficiency or sensory phenotype. The authors describe the effect as modest and suggest bupropion may be an option when first-line treatments are ineffective or poorly tolerated.
Key findings
- Bupropion’s average effect on daily pain versus placebo was -0.5 (95% CI -0.8 to -0.1, p = 0.005).
- Pain fell from mean NRS 6.4 to 5.5 after bupropion treatment.
- A 30% pain reduction occurred in 10 patients and a 50% reduction in 6; NNT for 50% reduction was 15.
- Treatment response was not associated with CPM efficiency or sensory phenotype; pain-relief scale results were not significant.
Why it matters
The findings suggest a modest analgesic effect of bupropion in peripheral neuropathic pain, without evidence that CPM status or sensory phenotype identifies likely responders. The reported NNT for 50% pain reduction was higher than that reported for first-line treatments, but the result may be relevant when established options provide insufficient benefit or cause intolerable side effects.
What to keep in mind
The study included 67 patients, and the authors state that further, larger studies are needed to determine the optimal dosage.