Comparison of the use of opioids only and pregabalin add-on for the treatment of neuropathic pain in cervical myelopathy patients: a pilot trial.
Adolescent
Adult
Aged
Aged, 80 and over
Analgesics
/ therapeutic use
Analgesics, Opioid
/ therapeutic use
Cervical Vertebrae
/ pathology
Drug Therapy, Combination
Female
Follow-Up Studies
Humans
Male
Middle Aged
Neuralgia
/ drug therapy
Pain Measurement
Pilot Projects
Pregabalin
/ therapeutic use
Prognosis
Spinal Cord Diseases
/ complications
Treatment Outcome
Young Adult
Journal
Scientific reports
ISSN: 2045-2322
Titre abrégé: Sci Rep
Pays: England
ID NLM: 101563288
Informations de publication
Date de publication:
15 05 2020
15 05 2020
Historique:
received:
23
09
2019
accepted:
15
04
2020
entrez:
17
5
2020
pubmed:
18
5
2020
medline:
1
12
2020
Statut:
epublish
Résumé
Among patients with cervical myelopathy who were diagnosed with neuropathic pain (NP) by the LANSS test, the study participants were randomly assigned to one of the two study groups. The participants in one study group received opioids only, while those in the other group received opioids and pregabalin. Thirty-nine patients were analyzed in the study (20 patients in the opioid-only group and 19 in the pregabalin add-on group). The LANSS, neck pain, and arm pain scores in the pregabalin add-on group improved significantly compared with those in the opioid-only group after the first 4 weeks (p = 0.005, 0.001 and 0.035, respectively), but there was no significant difference between the two groups during the next 4 weeks (p = 0.615, 0.377 and 0.716, respectively). There was no significant difference in the neck disability index and EuroQol-5Dimension scores after four weeks and eight weeks of follow-up. Adverse events were reported by four patients (20.0%) in the opioid-only group and five patients (26.3%) in the pregabalin add-on group (p = 0.716). However, over time, the occurrence of side effects and dropouts increased in the pregabalin add-on group. This exploratory pilot study suggests that pregabalin add-on treatment is more efficient than the use of opioids alone at the beginning of NP treatment in cervical myelopathy patients. However, prescribing pregabalin add-on treatment for more than four weeks should be done cautiously.
Identifiants
pubmed: 32415211
doi: 10.1038/s41598-020-65108-8
pii: 10.1038/s41598-020-65108-8
pmc: PMC7229110
doi:
Substances chimiques
Analgesics
0
Analgesics, Opioid
0
Pregabalin
55JG375S6M
Types de publication
Comparative Study
Journal Article
Randomized Controlled Trial
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
8120Références
Backonja, M. M. Defining neuropathic pain. Anesth. Analg. 97, 785–790 (2003).
doi: 10.1213/01.ANE.0000062826.70846.8D
Dworkin, R. H. et al. Advances in neuropathic pain: diagnosis, mechanisms, and treatment recommendations. Arch. Neurol. 60, 1524–1534, https://doi.org/10.1001/archneur.60.11.1524 (2003).
doi: 10.1001/archneur.60.11.1524
pubmed: 14623723
Derry, S. et al. Pregabalin for neuropathic pain in adults. Cochrane Database Syst. Rev. 1, CD007076, https://doi.org/10.1002/14651858.CD007076.pub3 (2019).
doi: 10.1002/14651858.CD007076.pub3
pubmed: 30673120
D’Arcy, Y. et al. Pregabalin for the treatment of neuropathic pain: a narrative review for primary care providers. Curr. Med. Res. Opin. 33, 1353–1359, https://doi.org/10.1080/03007995.2017.1322051 (2017).
doi: 10.1080/03007995.2017.1322051
pubmed: 28426255
Ogawa, S., Arakawa, A., Hayakawa, K. & Yoshiyama, T. Pregabalin for Neuropathic Pain: Why Benefits Could Be Expected for Multiple Pain Conditions. Clin. Drug. Investig. 36, 877–888, https://doi.org/10.1007/s40261-016-0423-x (2016).
doi: 10.1007/s40261-016-0423-x
pubmed: 27448285
Gajraj, N. M. Pregabalin: Its pharmacology and use in pain management. Anesthesia Analgesia 105, 1805–1815, https://doi.org/10.1213/01.ane.0000287643.13410.5e (2007).
doi: 10.1213/01.ane.0000287643.13410.5e
pubmed: 18042886
Wiffen, P. J. et al. Antiepileptic drugs for neuropathic pain and fibromyalgia - an overview of Cochrane reviews. Cochrane Database Syst Rev, CD010567, https://doi.org/10.1002/14651858.CD010567.pub2 (2013).
Siddall, P. J. et al. Pregabalin in central neuropathic pain associated with spinal cord injury: a placebo-controlled trial. Neurology 67, 1792–1800, https://doi.org/10.1212/01.wnl.0000244422.45278.ff (2006).
doi: 10.1212/01.wnl.0000244422.45278.ff
pubmed: 17130411
Freynhagen, R., Strojek, K., Griesing, T., Whalen, E. & Balkenohl, M. Efficacy of pregabalin in neuropathic pain evaluated in a 12-week, randomised, double-blind, multicentre, placebo-controlled trial of flexible- and fixed-dose regimens. Pain 115, 254–263, https://doi.org/10.1016/j.pain.2005.02.032 (2005).
doi: 10.1016/j.pain.2005.02.032
pubmed: 15911152
Rosenstock, J., Tuchman, M., LaMoreaux, L. & Sharma, U. Pregabalin for the treatment of painful diabetic peripheral neuropathy: a double-blind, placebo-controlled trial. Pain 110, 628–638, https://doi.org/10.1016/j.pain.2004.05.001 (2004).
doi: 10.1016/j.pain.2004.05.001
pubmed: 15288403
Sabatowski, R. et al. Pregabalin reduces pain and improves sleep and mood disturbances in patients with post-herpetic neuralgia: results of a randomised, placebo-controlled clinical trial. Pain 109, 26–35, https://doi.org/10.1016/j.pain.2004.01.001 (2004).
doi: 10.1016/j.pain.2004.01.001
pubmed: 15082123
Iacobucci, G. UK government to reclassify pregabalin and gabapentin after rise in deaths. BMJ 358, j4441, https://doi.org/10.1136/bmj.j4441 (2017).
doi: 10.1136/bmj.j4441
pubmed: 28947423
Nahar, L. K., Andrews, R., Murphy, K. G. & Paterson, S. Misuse of gabapentin and pregabalin may be underestimated. BMJ 359, j5312, https://doi.org/10.1136/bmj.j5312 (2017).
doi: 10.1136/bmj.j5312
pubmed: 29162631
Guy, S. D. et al. The CanPain SCI Clinical Practice Guidelines for Rehabilitation Management of Neuropathic Pain after Spinal Cord: Recommendations for treatment. Spinal Cord. 54(Suppl 1), S14–23, https://doi.org/10.1038/sc.2016.90 (2016).
doi: 10.1038/sc.2016.90
pubmed: 27444715
Iyer, A., Azad, T. D. & Tharin, S. Cervical Spondylotic Myelopathy. Clin. Spine Surg. 29, 408–414, https://doi.org/10.1097/BSD.0000000000000397 (2016).
doi: 10.1097/BSD.0000000000000397
pubmed: 27352369
Kalsi-Ryan, S., Karadimas, S. K. & Fehlings, M. G. Cervical spondylotic myelopathy: the clinical phenomenon and the current pathobiology of an increasingly prevalent and devastating disorder. Neuroscientist 19, 409–421, https://doi.org/10.1177/1073858412467377 (2013).
doi: 10.1177/1073858412467377
pubmed: 23204243
Harrop, J. S., Hanna, A., Silva, M. T. & Sharan, A. Neurological manifestations of cervical spondylosis: an overview of signs, symptoms, and pathophysiology. Neurosurgery 60, S14–20, https://doi.org/10.1227/01.NEU.0000215380.71097.EC (2007).
doi: 10.1227/01.NEU.0000215380.71097.EC
pubmed: 17204875
Jones, R. C. 3rd & Backonja, M. M. Review of neuropathic pain screening and assessment tools. Curr. Pain. Headache Rep. 17, 363, https://doi.org/10.1007/s11916-013-0363-6 (2013).
doi: 10.1007/s11916-013-0363-6
pubmed: 23996692
EuroQol, G. EuroQol–a new facility for the measurement of health-related quality of life. Health Policy 16, 199–208 (1990).
doi: 10.1016/0168-8510(90)90421-9
Hatch, M. N., Cushing, T. R., Carlson, G. D. & Chang, E. Y. Neuropathic pain and SCI: Identification and treatment strategies in the 21st century. J. Neurol. Sci. 384, 75–83, https://doi.org/10.1016/j.jns.2017.11.018 (2018).
doi: 10.1016/j.jns.2017.11.018
pubmed: 29249383
Zilliox, L. A. Neuropathic Pain. Continuum 23, 512–532, https://doi.org/10.1212/CON.0000000000000462 (2017).
doi: 10.1212/CON.0000000000000462
pubmed: 28375916
Gierthmuhlen, J. & Baron, R. Neuropathic Pain. Semin. Neurol. 36, 462–468, https://doi.org/10.1055/s-0036-1584950 (2016).
doi: 10.1055/s-0036-1584950
pubmed: 27704502
Gilron, I., Baron, R. & Jensen, T. Neuropathic pain: principles of diagnosis and treatment. Mayo Clin. Proc. 90, 532–545, https://doi.org/10.1016/j.mayocp.2015.01.018 (2015).
doi: 10.1016/j.mayocp.2015.01.018
pubmed: 25841257
Kerstman, E., Ahn, S., Battu, S., Tariq, S. & Grabois, M. Neuropathic pain. Handb. Clin. Neurol. 110, 175–187, https://doi.org/10.1016/B978-0-444-52901-5.00015-0 (2013).
doi: 10.1016/B978-0-444-52901-5.00015-0
pubmed: 23312640
Moore, R. A., Derry, S., Aldington, D., Cole, P. & Wiffen, P. J. Amitriptyline for neuropathic pain in adults. Cochrane Database Syst Rev, CD008242, https://doi.org/10.1002/14651858.CD008242.pub3 (2015).
Derry, S., Wiffen, P. J., Aldington, D. & Moore, R. A. Nortriptyline for neuropathic pain in adults. Cochrane Database Syst Rev 1, CD011209, https://doi.org/10.1002/14651858.CD011209.pub2 (2015).
Gallagher, H. C., Gallagher, R. M., Butler, M., Buggy, D. J. & Henman, M. C. Venlafaxine for neuropathic pain in adults. Cochrane Database Syst Rev, CD011091, https://doi.org/10.1002/14651858.CD011091.pub2 (2015).
Rowbotham, M. C., Goli, V., Kunz, N. R. & Lei, D. Venlafaxine extended release in the treatment of painful diabetic neuropathy: a double-blind, placebo-controlled study. Pain 110, 697–706, https://doi.org/10.1016/j.pain.2004.05.010 (2004).
doi: 10.1016/j.pain.2004.05.010
pubmed: 15288411
Duehmke, R. M. et al. Tramadol for neuropathic pain in adults. Cochrane Database Syst. Rev. 6, CD003726, https://doi.org/10.1002/14651858.CD003726.pub4 (2017).
doi: 10.1002/14651858.CD003726.pub4
pubmed: 28616956
Gaskell, H., Derry, S., Stannard, C. & Moore, R. A. Oxycodone for neuropathic pain in adults. Cochrane Database Syst. Rev. 7, CD010692, https://doi.org/10.1002/14651858.CD010692.pub3 (2016).
doi: 10.1002/14651858.CD010692.pub3
pubmed: 27465317
Owen, R. J., Zebala, L. P., Peters, C. & McAnany, S. PROMIS Physical Function Correlation With NDI and mJOA in the Surgical Cervical Myelopathy Patient Population. Spine 43, 550–555, https://doi.org/10.1097/BRS.0000000000002373 (2018).
doi: 10.1097/BRS.0000000000002373
pubmed: 28787313
Xiao, R. et al. Quality of life outcomes following cervical decompression for coexisting Parkinson’s disease and cervical spondylotic myelopathy. Spine J. 16, 1358–1366, https://doi.org/10.1016/j.spinee.2016.07.530 (2016).
doi: 10.1016/j.spinee.2016.07.530
pubmed: 27496286
Herzig, S. J., Rothberg, M. B., Cheung, M., Ngo, L. H. & Marcantonio, E. R. Opioid utilization and opioid-related adverse events in nonsurgical patients in US hospitals. J. Hosp. Med. 9, 73–81, https://doi.org/10.1002/jhm.2102 (2014).
doi: 10.1002/jhm.2102
pubmed: 24227700
Moore, R. A., Straube, S., Wiffen, P. J., Derry, S. & McQuay, H. J. Pregabalin for acute and chronic pain in adults. Cochrane Database Syst Rev, CD007076, https://doi.org/10.1002/14651858.CD007076.pub2 (2009).
Kanbayashi, Y., Onishi, K. & Hosokawa, T. Factors predicting adverse events associated with pregabalin administered for neuropathic pain relief. Pain. Res. Manag. 19, e164–167 (2014).
doi: 10.1155/2014/280549
Mercadante, S. et al. Tools for identifying cancer pain of predominantly neuropathic origin and opioid responsiveness in cancer patients. J. Pain. 10, 594–600, https://doi.org/10.1016/j.jpain.2008.12.002 (2009).
doi: 10.1016/j.jpain.2008.12.002
pubmed: 19231297
Mishra, S. et al. Management of neuropathic cancer pain following WHO analgesic ladder: a prospective study. Am. J. Hosp. Palliat. Care 25, 447–451, https://doi.org/10.1177/1049909108322288 (2008).
doi: 10.1177/1049909108322288
pubmed: 19106278
Eisenberg, E., McNicol, E. D. & Carr, D. B. Efficacy and safety of opioid agonists in the treatment of neuropathic pain of nonmalignant origin: systematic review and meta-analysis of randomized controlled trials. JAMA 293, 3043–3052, https://doi.org/10.1001/jama.293.24.3043 (2005).
doi: 10.1001/jama.293.24.3043
pubmed: 15972567