Pregabalin for neuropathic pain based on recent clinical trials. Curr Pain Headache Rep

Department of Anesthesiology & Peri-Operative Medicine, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Mailcode OP-26, Portland, OR 97239, USA.
Current Pain and Headache Reports (Impact Factor: 2.26). 07/2006; 10(3):179-84. DOI: 10.1007/s11916-006-0043-x
Source: PubMed


Pregabalin is a ligand for the alpha-2-delta subunit of voltage-gated calcium channels with anticonvulsant, analgesic, and anxiolytic properties. It has predictable absorption across the gastrointestinal tract, is neither metabolized nor protein-bound, and has minimal drug-drug interactions. It is effective with two or three-times daily dosing in a dose range of 150 to 600 mg daily. Seven published prospective, randomized clinical trials in postherpetic neuralgia (PHN) and painful diabetic peripheral neuropathy (DPN) demonstrate pain relief, decreased sleep interference, and improvements in several secondary outcome measures. The 50% responder rates for PHN and DPN compare favorably with other first-line agents for neuropathic pain. Pregabalin is well tolerated in most patients with infrequent severe adverse effects. Pregabalin is an important addition to the treatment armamentarium for neuropathic pain.

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    • "And careful titration is required due to nonlinear absorption of gabapentin [27]. Comparatively, pregabalin is well tolerated, and has predictable absorption across the gastrointestinal tract and linear pharmacokinetics [28]. "
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    ABSTRACT: Neuropathic pain develops from a lesion or disease affecting the somatosensory system. Translational investigations of neuropathic pain by using different animal models reveal that peripheral sensitization, spinal and cortical plasticity may play critical roles in neuropathic pain. Furthermore, descending facilitatory or excitatory modulation may also act to enhance chronic pain. Current clinical therapy for neuropathic pain includes the use of pharmacological and nonpharmacological (psychological, physical, and surgical treatment) methods. However, there is substantial need to better medicine for treating neuropathic pain. Future translational researchers and clinicians will greatly facilitate the development of novel drugs for treating chronic pain including neuropathic pain.
    Molecular Pain 03/2012; 8(1):15. DOI:10.1186/1744-8069-8-15 · 3.65 Impact Factor
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    • "Pregabalin is used for various neuropathic painful conditions.6,7 However, its role in acute pain of zoster has not been explored. "
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    ABSTRACT: BackgroundHerpes zoster is an intractable painful condition. The pain during first thirty days of onset is known as acute herpetic neuralgia. Multiple treatments using NSAIDS, opioids and tricyclic antidepressants are available but the role of pregabalin in acute Herpetic Neuralgia is not assessed in any of Indian studies.PurposeThis study was aimed to determine efficacy and safety of Pregabalin in reducing pain of acute Herpetic Neuralgia.MethodsIn this placebo-controlled 4 week trial including 45 subjects, 23 patients received Pregabalin in the dosage of 150 mg/day in divided doses and 22 patients received placebo within 72 hours of onset of Herpes zoster.ResultsSubjects receiving Pregabalin had a statistically significant reduction (p<0.0001) in visual analogue scale(VAS) score as compared to placebo, indicating the efficacy of Pregabalin in the treatment of acute pain associated with Herpes zoster. Side effects most commonly noted were somnolence and dizziness.ConclusionThe results of this study indicate that Pregabalin is effective in relieving pain of acute Herpetic Neuralgia.
    Annals of Neurosciences 10/2011; 18(4):148-150. DOI:10.5214/ans.0972.7531.1118405
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    • "duloxetine) should be used with caution in patients who take multiple medications because of the potential for drug-drug interactions with drugs that inhibit or are metabolized by cytochrome P450 [34]. Pregabalin is not metabolized by cytochrome P450 and has no known drug-drug interactions [8]; however, appropriate dose reductions should be made in older patients with renal impairment [34]. "
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    ABSTRACT: Older patients are typically underrepresented in clinical trials of medications for chronic pain. A post hoc analysis of multiple clinical studies of pregabalin in patients with painful diabetic peripheral neuropathy (DPN) or postherpetic neuralgia (PHN) was conducted to evaluate the efficacy and safety of pregabalin in older patients. Data from 11 double-blind, randomized, placebo-controlled clinical studies of pregabalin in patients with DPN or PHN were pooled. Efficacy outcomes included change in Daily Pain Rating Scale score, ≥30% and ≥50% responders, and endpoint pain score ≤3. Safety was based on adverse events (AEs). Primary efficacy was analyzed by analysis of covariance with terms for treatment, age category, protocol, baseline pain, and treatment-by-age category interaction. 2516 patients (white, n = 2344 [93.2%]; men, n = 1347 [53.5%]; PHN, n = 1003 [39.9%]; pregabalin, n = 1595) were included in the analysis. Patients were grouped by age: 18 to 64 years (n = 1236), 65 to 74 years (n = 766), and ≥75 years (n = 514). Baseline mean pain and sleep interference scores were comparable across treatment and age groups. Significant improvements in endpoint mean pain were observed for all pregabalin dosages versus placebo in all age groups (p ≤ 0.0009), except for the lowest dosage (150 mg/day) in the youngest age group. Clinically meaningful pain relief, defined as ≥30% and ≥50% pain response, was observed in all age groups. The most common AEs were dizziness, somnolence, peripheral edema, asthenia, dry mouth, weight gain, and infections. The relative risks for these AEs increased with pregabalin dose, but did not appear related to older age or type of neuropathic pain. Pregabalin (150-600 mg/day) significantly reduced pain in older patients (age ≥65 years) with neuropathic pain and improvements in pain were comparable to those observed in younger patients. Titration of pregabalin to the lowest effective dose should allow for effective pain relief while minimizing AEs in older patients with neuropathic pain. Given the common use of polypharmacy in older patients, the absence of known drug-drug interactions makes pregabalin an important treatment option for older patients with pain of neuropathic origin.
    BMC Family Practice 11/2010; 11(1):85. DOI:10.1186/1471-2296-11-85 · 1.67 Impact Factor
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