Trial reportAnesthesiology2008
Morphine versus mexiletine for treatment of postamputation pain: a randomized, placebo-controlled, crossover trial.
Trial report in Anesthesiology, 2008. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 35 papers, 10 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
35 citing papers in PubMed, 10 syntheses or guidelines pooled it, 121 citations in OpenAlex.
- Beyond traditional therapies: a network meta-analysis on the treatment efficacy for chronic phantom limb pain.Regional anesthesia and pain medicine · 2025Pooled it
- Pooled it
- Systematic review of management of chronic pain after surgery.The British journal of surgery · 2017Pooled it
- Morphine for chronic neuropathic pain in adults.The Cochrane database of systematic reviews · 2017Pooled it
- Pharmacologic interventions for treating phantom limb pain.The Cochrane database of systematic reviews · 2016Pooled it
- [Opioids in chronic neuropathic pain. A systematic review and meta-analysis of efficacy, tolerability and safety in randomized placebo-controlled studies of at least 4 weeks duration].Schmerz (Berlin, Germany) · 2015Pooled it
- [Opioids in chronic noncancer pain-are opioids superior to nonopioid analgesics? A systematic review and meta-analysis of efficacy, tolerability and safety in randomized head-to-head comparisons of opioids versus nonopioid analgesics of at least four week's duration].Schmerz (Berlin, Germany) · 2015Pooled it
- Opioids for neuropathic pain.The Cochrane database of systematic reviews · 2013Pooled it
- Pharmacotherapy for the prevention of chronic pain after surgery in adults.The Cochrane database of systematic reviews · 2013Pooled it
- A qualitative systematic review of head-to-head randomized controlled trials of oral analgesics in neuropathic pain.Pain research & managementPooled it
- Primary 3-Month Outcomes of a Double-Blind Randomized Prospective Study (The QUEST Study) Assessing Effectiveness and Safety of Novel High-Frequency Electric Nerve Block System for Treatment of Post-Amputation Pain.Journal of pain research · 2024Trial
- Safety and Efficacy of a Topical Sodium Channel Inhibitor (TV-45070) in Patients With Postherpetic Neuralgia (PHN): A Randomized, Controlled, Proof-of-Concept, Crossover Study, With a Subgroup Analysis of the Nav1.7 R1150W Genotype.The Clinical journal of pain · 2017Trial
- Targeting inflammation as a treatment modality for neuropathic pain in spinal cord injury: a randomized clinical trial.Journal of neuroinflammation · 2016Trial
- A comparison of change in the 0-10 numeric rating scale to a pain relief scale and global medication performance scale in a short-term clinical trial of breakthrough pain intensity.Anesthesiology · 2010Trial
- Discordance between preclinical and clinical testing of Na V 1.7-selective inhibitors for pain.Pain · 2025Review
- Phantom limb syndrome: from pathogenesis to treatment. A narrative review.Neurological sciences : official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology · 2024Review
- Post-Amputation Pain: Combined Analyses of Randomized Controlled Trials Evaluating Opioids and Gabapentinoids versus Placebo.Journal of pain research · 2024Article
- Trigeminal Traumatic Neuroma: a Comprehensive Review of the Literature Based On a Rare Case.Current pain and headache reports · 2022Review
- An Algorithm Approach to Phantom Limb Pain.Journal of pain research · 2022Review
- Nerve trauma-caused downregulation of opioid receptors in primary afferent neurons: Molecular mechanisms and potential managements.Experimental neurology · 2021Review
Corrections and comments
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Authors and funding
8 authors at 1 institution in 1 country.
Funding
Abstract
backgroundStump and phantom pains are debilitating sequelae of amputations that are often resistant to treatment. The efficacy of pharmacologic therapies, including opioids and sodium channel blockers, for postamputation pain is uncertain.
methodsThe authors conducted a double-blind, randomized, placebo-controlled, crossover study in adult patients with postamputation pain of 6 months or longer and greater than 3 on a 0-10 numeric pain rating scale. Each of the three treatment periods (morphine, mexiletine, or placebo) included a 1-week drug-free interval followed by 4-week titration, 2-week maintenance, and 2-week drug-taper phases. The primary outcome measure was change in average pain intensity from the drug-free baseline to the last week of maintenance.
resultsSixty amputees were enrolled; data were analyzed from 56 subjects for one drug period, 45 subjects for two drug periods, and 35 subjects who completed all three drug periods. The mean morphine and mexiletine dosages were 112 and 933 mg, respectively. Morphine treatment provided lower pain scores compared with placebo and mexiletine (P = 0.0003). The mean percent pain relief during treatment with placebo, mexiletine, and morphine was 19, 30, and 53%, respectively (P < 0.0001, morphine vs. placebo and mexiletine). The numbers needed to treat to obtain 50% and 33% decreases in pain intensity with morphine were 5.6 and 4.5, respectively. Treatment with morphine was associated with a higher rate of side effects.
conclusionsTherapy with morphine, but not mexiletine, resulted in a decrease in intensity of postamputation pain but was associated with a higher rate of side effects and no improvement in self-reported levels of overall functional activity and pain-related interference in daily activities.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.