Eficacia y tolerancia de la pregabalina en el tratamiento del dolor neuropático: Estudio multicéntrico

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Abstract

Introducción: Se pretendió evaluar la eficacia y tolerabilidad de la pregabalina, para el tratamiento del dolor neuropático en las Unidades de Dolor hospitalarias. Material y método: Estudio prospectivo, multicéntrico, abierto, que se llevó a cabo en 10 unidades del dolor de hospitales de Cataluña. Se prescribió pregabalina, a criterio del facultativo, de manera consecutiva. Criterios de inclusión: consentimiento, dolor neuropático, mayor de edad y paciente externo. Criterios de exclusión: alteraciones cognitivas, embarazo. Se estipularon 5 visitas: basal, 15 días, 1 mes, 2 y 3 meses de tratamiento. La titulación de las dosis de pregabalina estaba preespecificada. Se registró edad, sexo, tipo de dolor neuropático, EVA (basal, 15 días, 1 mes, 2 meses, 3 meses), escala MOS de sueño (basal y tercer mes), tratamiento farmacológico concomitante y episodios de efectos adversos. Se crearon 3 grupos de estudio: pregabalina + antiinflamatorios no esteroideos (AINE) + antidepresivos tricíclicos (AINE + ATC), pregabalina + AINE + ansiolíticos (AINE + ANS), pregabalina + AINE + opioides (AINE + OPI). Se efectuó prueba paramétrica t de Student y test no paramétrico de Wilcoxon para datos apareados de variables cuantitativas. Resultados: Se reclutaron 578 pacientes de los que 472 (81,66%) completaron el estudio. El 98,8% recibieron politerapia. El alivio del dolor registró una media de -3,6 (± 1,9) (p < 0,0001) puntos. Por tipo de dolor: mixto -3,7 (±1,7) (p < 0,0001); puro -3,4 (± 2,2) (p < 0,0001). Por medicación coadyuvante: grupo AINE + ATC -3,1 (± 1,9) (p = 0,0002); AINE + ANS -3,4 (± 2,0) (p < 0,0001); AINE + OPI -3,7 (± 1,9) (p < 0,0001). Mejora del sueño: media de -1,9 (± 6,4) (p < 0,0001) puntos. Por tipología: mixto -3,1 (± 7,0) (p < 0,0001); puro -1,1 (± 4,2) (p < 0,0001). Por medicación coadyuvante: grupo AINE + OPI -2,1 (± 6,0) (p < 0,0001); AINE + ATC y AINE + ANS ambos -1,0 no estadísticamente significativo, (p = 0,1250 y p = 0,4063 respectivamente). 90 pacientes (15,6%) discontinuaron el estudio debido a efectos adversos. Conclusiones: La pregabalina produjo una reducción rápida y significativa del dolor neuropático, una relevante mejoría del sueño, demostrando un perfil bajo de interacción y buena tolerancia.

Translated abstract

Aim and objective: This study was intended to avaluate the efficacy and tolerability of pregabalin in patients with neuropathic pain and concomitant medication. Material and methods: Investigator-initiated, prospective multicenter study, open-label, uncontrolled conducted in 10 pain units from Catalonia hospitals. Pregabalin was consecutively prescribed at the physicians' discretion to avoid selective bias. Inclusion criteria were: outpatient, age >18 years, admission diagnosis as "neuropathic pain" and informed consent. Exclusion criteria were pregnancy or cognitive disorders. Protocol scheduled five study visits: at baseline, 15 days, 1 month, 2 months, and 3 months of treatment. Titration of pregabalin doses was pre-specified. We recorded: age, sex, type of neuropathic pain (pure or mixed), VAS (baseline, 15 days, 1 month, 2 and 3 months), MOS sleep scale (baseline and third month), concomitant drug treatment and adverse effects episodes. Patients were divided into three groups: pregabalin + NSAID + tricyclic antidepressants (NSAID+TCA), pregabalin + NSAID + anxiolytics (NSAID+ANX), pregabalin + NSAID + opioids (NSAID+OPI). A parametric Student's t test and non-parametric Wilcoxon test for paired data of quantitative variables were performed. Results: 578 patients were recruited and 472 (81.66%) completed the study. 98.8% of patients were treated with politherapy. Pain relief: mean reduction by -3.6 (± 1.9) (p < 0.0001) points. By type of pain: mixed pain -3.7 (± 1.7) (p < 0.0001); pure neuropathic pain -3.4 (± 2.2) (p < 0.0001). By adjuvant medication, the NSAID + TCA group -3.1 (± 1.9) (p = 0.0002); NSAID + ANX -3.4 (± 2.0) (p < 0.0001); NSAID + OPI -3.7 (± 1.9) (p < 0.0001). Sleep improvement: mean reduction by -1.9 (± 6.4) (p < 0.0001) points. By type of pain: mixed pain -3.1 (± 7.0) (p < 0.0001); pure neuropathic pain -1.1 (± 4.2) (p < 0.0001). By adjuvant medication, NSAID+OPI -2.1 (± 6.0) (p < 0.0001); NSAID + TCA and NSAID + ANX groups both -1.0 not statistically significant (p = 0.1250 and p = 0.4063 respectively). 90 patients (15.6%) discontinued the study due to adverse effects. Conclusions: Treatment with pregabalin induces a fast and significant relief of neuropathic pain, improves sleep and shows a low drug interaction profile.

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Most cited references 46

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Pregabalin for the treatment of postherpetic neuralgia: a randomized, placebo-controlled trial.

Uma Sharma, E Garofalo, R Poole … (2003)

To evaluate the efficacy and safety of pregabalin in the treatment of postherpetic neuralgia (PHN). The authors conducted a multicenter, parallel-group, double-blind, placebo-controlled, 8-week, randomized clinical trial in PHN, defined as pain for 3 or more months following herpes zoster rash healing. Patients (n = 173) were randomized to treatment with pregabalin or placebo. Patients randomized to pregabalin received either 600 mg/day (creatinine clearance > 60 mL/min) or 300 mg/day (creatinine clearance 30 to 60 mL/min). The primary efficacy measure was the mean of the last seven daily pain ratings. Secondary endpoints included additional pain ratings, sleep interference, quality of life, mood, and patient and clinician ratings of global improvement. Pregabalin-treated patients had greater decreases in pain than patients treated with placebo (endpoint mean scores 3.60 vs 5.29, p = 0.0001). Pain was significantly reduced in the pregabalin-treated patients after the first full day of treatment and throughout the study, and significant improvement on the McGill Pain Questionnaire total, sensory, and affective pain scores was also found. The proportions of patients with >or=30% and >or=50% decreases in mean pain scores were greater in the pregabalin than in the placebo group (63% vs 25% and 50% vs 20%, p = 0.001). Sleep also improved in patients treated with pregabalin compared to placebo (p = 0.0001). Both patients and clinicians were more likely to report global improvement with pregabalin than placebo (p = 0.001). Given the maximal dosage studied, pregabalin had acceptable tolerability compared to placebo despite a greater incidence of side effects, which were generally mild to moderate in intensity. Treatment of PHN with pregabalin is safe, efficacious in relieving pain and sleep interference, and associated with greater global improvement than treatment with placebo.

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Pregabalin for acute and chronic pain in adults.

R Andrew Moore, Sebastian Straube, Philip J Wiffen … (2009)

Antiepileptic drugs have been used in pain management since the 1960s. Pregabalin is a recently developed antiepileptic drug also used in management of chronic neuropathic pain conditions. To assess analgesic efficacy and associated adverse events of pregabalin in acute and chronic pain. We searched MEDLINE, EMBASE, and CENTRAL to May 2009 for randomised controlled trials (RCTs). Additional studies were identified from the reference lists of retrieved papers and on-line clinical trial databases. Randomised, double blind trials reporting on the analgesic effect of pregabalin, with subjective pain assessment by the patient as either the primary or a secondary outcome. Two independent review authors extracted data and assessed trial quality. Numbers-needed-to-treat-to-benefit (NNTs) were calculated, where possible, from dichotomous data for effectiveness, adverse events and study withdrawals. There was no clear evidence of beneficial effects of pregabalin in established acute postoperative pain. No studies evaluated pregabalin in chronic nociceptive pain, like arthritis.Pregabalin at doses of 300 mg, 450 mg, and 600 mg daily was effective in patients with postherpetic neuralgia, painful diabetic neuropathy, central neuropathic pain, and fibromyalgia (19 studies, 7003 participants). Pregabalin at 150 mg daily was generally ineffective. Efficacy was demonstrated for dichotomous outcomes equating to moderate or substantial pain relief, alongside lower rates for lack of efficacy discontinuations with increasing dose. The best (lowest) NNT for each condition for at least 50% pain relief over baseline (substantial benefit) for 600 mg pregabalin daily compared with placebo were 3.9 (95% confidence interval 3.1 to 5.1) for postherpetic neuralgia, 5.0 (4.0 to 6.6) for painful diabetic neuropathy, 5.6 (3.5 to 14) for central neuropathic pain, and 11 (7.1 to 21) for fibromyalgia.With 600 mg pregabalin daily somnolence typically occurred in 15% to 25% and dizziness occurred in 27% to 46%. Treatment was discontinued due to adverse events in 18 to 28%. The proportion of participants reporting at least one adverse event was not affected by dose, nor was the number with a serious adverse event, which was not more than with placebo.Higher rates of substantial benefit were found in postherpetic neuralgia and painful diabetic neuropathy than in central neuropathic pain and fibromyalgia. For moderate and substantial benefit on any outcome NNTs for the former were generally six and below for 300 mg and 600 mg daily; for fibromyalgia NNTs were much higher, and generally seven and above. Pregabalin has proven efficacy in neuropathic pain conditions and fibromyalgia. A minority of patients will have substantial benefit with pregabalin, and more will have moderate benefit. Many will have no or trivial benefit, or will discontinue because of adverse events. Individualisation of treatment is needed to maximise pain relief and minimise adverse events. There is no evidence to support the use of pregabalin in acute pain scenarios.

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Efficacy of pregabalin in neuropathic pain evaluated in a 12-week, randomised, double-blind, multicentre, placebo-controlled trial of flexible- and fixed-dose regimens.

Rainer Freynhagen, Krzysztof Strojek, Teresa Griesing … (2005)

Pregabalin binds with high affinity to the alpha2-delta subunit protein of voltage-gated calcium channels and, thereby, reduces release of excitatory neurotransmitters. This 12-week randomised, double-blind, multicentre, placebo-controlled, parallel-group study evaluated the efficacy and safety of pregabalin in patients with chronic postherpetic neuralgia (PHN) or painful diabetic peripheral neuropathy (DPN). Patients were randomised to placebo (n=65) or to one of two pregabalin regimens: a flexible schedule of 150, 300, 450, and 600 mg/day with weekly dose escalation based on patients' individual responses and tolerability (n=141) or a fixed schedule of 300 mg/day for 1 week followed by 600 mg/day for 11 weeks (n=132). Both flexible- and fixed-dose pregabalin significantly reduced endpoint mean pain score (primary outcome) versus placebo (P=0.002, P<0.001) and were significantly superior to placebo in improving pain-related sleep interference (P<0.001). The most common adverse events (AEs) for pregabalin-treated patients were dizziness, peripheral oedema, weight gain (not affecting diabetes control), and somnolence. These results are consistent with previous studies' demonstrating pregabalin's efficacy, tolerability, and safety for treatment of chronic neuropathic pain associated with DPN or PHN. Pregabalin dosing aimed at optimal balance of efficacy and tolerability provides significant pain relief and may reduce risks for AEs and therapy discontinuation.

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Author and article information

Contributors

V. De Sanctis-Briggs: Role: ND

J. Guitart-Vela: Role: ND

M. Vargas: Role: ND

F. Rodelas: Role: ND

J. Fuentes: Role: ND

M. D. Pérez: Role: ND

J. Cuenca: Role: ND

M. Casals: Role: ND

A. Tomás: Role: ND

V. Mayoral: Role: ND

Journal

Journal ID (publisher-id): dolor

Title: Revista de la Sociedad Española del Dolor

Abbreviated Title: Rev. Soc. Esp. Dolor

Publisher: Inspira Network Group, S.L (Madrid, Madrid, Spain )

ISSN (Print): 1134-8046

Publication date (Print and electronic): October 2011

Volume: 18

Issue: 5

Pages: 267-275

Affiliations

[03] Sant Boi de Llobregat orgnameHospital de Sant Boi orgdiv1Servicio de Anestesiología, Reanimación y Tratamiento del Dolor

[10] Barcelona orgnameHospital de Bellvitge orgdiv1Servicio de Anestesiología, Reanimación y Tratamiento del Dolor

[02] Barcelona orgnameHospital Plató orgdiv1Servicio de Anestesiología, Reanimación y Tratamiento del Dolor

[08] Igualada orgnameConsorci Sanitari d'Igualada orgdiv1Servicio de Anestesiología, Reanimación y Tratamiento del Dolor

[05] Valls orgnamePius Hospital de Valls orgdiv1Servicio de Anestesiología, Reanimación y Tratamiento del Dolor

[06] Barcelona orgnameMC Mutual orgdiv1Servicio de Anestesiología, Reanimación y Tratamiento del Dolor

[01] Barcelona orgnameHospital Universitari del Sagrat Cor orgdiv1Servicio de Anestesiología, Reanimación y Tratamiento del Dolor

[09] Berga orgnameHospital Sant Bernabé de Berga orgdiv1Servicio de Anestesiología, Reanimación y Tratamiento del Dolor

[04] Sitges orgnameHospital Residència Sant Camil orgdiv1Servicio de Anestesiología, Reanimación y Tratamiento del Dolor

[07] Tarragona orgnameHospital Sant Joan de Reus orgdiv1Servicio de Anestesiología, Reanimación y Tratamiento del Dolor

Article

Publisher ID: S1134-80462011000500002

SO-VID: e0fe6b8e-c947-49a3-8d0b-6dda0b85e01d

License:

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

History

Date accepted : 01 March 2011

Date received : 29 December 2010

Page count

Figures: 0, Tables: 0, Equations: 0, References: 28, Pages: 9

Product

SciELO Spain

Keywords: Dolor neuropático,Pregabalina,Analgesia,Farmacoterapia,Neuropathic pain,Pregabalin,Analgesics,Drug therapy

Data availability:

Keywords: Dolor neuropático, Pregabalina, Analgesia, Farmacoterapia, Neuropathic pain, Pregabalin, Analgesics, Drug therapy

Eficacia y tolerancia de la pregabalina en el tratamiento del dolor neuropático: Estudio multicéntrico Translated title: Efficacy and safety of pregabalin in neuropathic pain: Multicenter study

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