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One of the more controversial areas in the treatment of neuropathic pain is the proper use of narcotics. The neurologists generally do not believe in using opiods unless other treatments are not successful. I review the article "Efficacy and Safety of Opioid Agonist in the Treatment of Neuropathic Pain of Nonmalignant Origin Systematic Review and Meta-Analysis of Randomized Controlled Trials." JAMA Vol 293, No. 24, pp 3043-3052. As with all controversies, both sides can claim some degree of victory.

In the intermediate studies (8 days to 8 weeks), narcotics were shown to decrease neuropathic pain. The improvement was in the same ballpark as the recently approved Cymbalta® and Lyrica®. The quality of life scales for the narcotic trials are relatively inconsistent with some trials showing no improvement on quality of life indicators and others showing benefit on some but not others. Combined with the side effect profiles of narcotics versus Cymbalta®, Lyrica®, or the other AEDs and I think the decision to avoid narcotics is still the correct decision.