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Nwankwo A, Koyyalagunta D, Huh B, D'Souza RS, Javed S. A comprehensive review of the typical and atypical side effects of gabapentin. Pain Pract 2024. [PMID: 38949515 DOI: 10.1111/papr.13400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Revised: 04/18/2024] [Accepted: 06/19/2024] [Indexed: 07/02/2024]
Abstract
BACKGROUND Gabapentin, a widely prescribed medication for various neuropathic pain conditions, has demonstrated efficacy in managing diverse neurological disorders. While conventional side effects are well-documented, a growing body of evidence suggests the existence of atypical side effects, necessitating comprehensive exploration. This paper aims to systematically review and summarize the literature on the atypical side effects of gabapentin, shedding light on manifestations beyond the conventional spectrum. METHODS A systematic review was conducted, encompassing peer-reviewed articles published up to the knowledge cutoff date in November 2023. Databases, specifically PubMed, were searched for relevant studies, focusing on atypical side effects such as myoclonus, ataxia, pediatric aggression, respiratory depression, pneumonia, pregnancy complications, sleep interference, encephalopathy, peripheral edema, suicidal ideation, dyskinesia, anorgasmia, and myopathy. Inclusion criteria comprised studies with a focus on gabapentin-related atypical side effects, published in recognized journals and involving human subjects. RESULTS The review identified a spectrum of atypical side effects associated with gabapentin use, ranging from neurological manifestations like myoclonus and ataxia to behavioral changes such as pediatric aggression and suicidal ideation. Additionally, respiratory complications, pregnancy-related issues, sleep disturbances, and rare complications like encephalopathy and myopathy were observed. Literature synthesis provided insights into the incidence, clinical presentation, and potential mechanisms underlying these atypical side effects. CONCLUSION This comprehensive review highlights the diverse range of atypical side effects associated with gabapentin use, expanding beyond conventional knowledge. Healthcare practitioners must be cognizant of these manifestations, recognizing their potential impact on patient well-being. As clinical decision-making relies on a thorough understanding of a medication's side effect profile, this review contributes to enhancing awareness and fostering informed practices in the prescription and management of gabapentin. Further research is warranted to elucidate the mechanisms and risk factors associated with these atypical side effects, refining our understanding of gabapentin's safety profile.
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Affiliation(s)
| | | | - Billy Huh
- University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | | | - Saba Javed
- University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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Coker C, Park J, Jacobson RD. Neurologic Approach to Radiculopathy, Back Pain, and Neck Pain. Prim Care 2024; 51:345-358. [PMID: 38692779 DOI: 10.1016/j.pop.2024.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/03/2024]
Abstract
Back pain and neck pain are common in clinical practice, but significant challenges and pitfalls exist in their diagnosis, treatment, and management. From the neurologic standpoint, cervical radiculopathy and lumbosacral radiculopathy are characterized by neck pain or back pain accompanied by sensory and motor symptoms in an arm or leg. The basic neurologic examination is vital, but testing like electromyography and MRI is often needed especially in cases that fail conservative management. Oral medications, injection-based therapies, physical therapy, and surgical evaluation all have a place in the comprehensive neurologic management of back and neck pain and associated radiculopathy.
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Affiliation(s)
- Canaan Coker
- Department of Neurological Sciences, Rush University Medical Center, 1725 W. Harrison Street, Suite 1118, Chicago, IL 60612, USA
| | - Jade Park
- Department of Neurological Sciences, Rush University Medical Center, 1725 W. Harrison Street, Suite 1118, Chicago, IL 60612, USA
| | - Ryan D Jacobson
- Department of Neurological Sciences, Rush University Medical Center, 1725 W. Harrison Street, Suite 1118, Chicago, IL 60612, USA.
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Branstetter JW, Mantione J, Deangelo A, Branstetter LA. Safety and Efficacy of Gabapentin for Pain in Pediatric Patients: A Systematic Review. Hosp Pediatr 2024; 14:e57-e65. [PMID: 38098443 DOI: 10.1542/hpeds.2023-007376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2024]
Abstract
CONTEXT Gabapentin has shown benefits for a variety of pain etiologies in adult patients, with off-label use as an adjunctive agent in pediatric patients occurring more frequently. OBJECTIVES To summarize the studies which evaluate safety and efficacy of gabapentin for the treatment of pediatric pain. DATA SOURCES A systematic review of the literature was conducted via PubMed query with controlled vocabulary and key terms using indexed medical subject heading. STUDY SELECTION Prospective studies published between January 1, 2000, and July 1, 2023, were selected utilizing a predetermined exclusion criteria independently by 2 authors, with a third independent author available for discrepancies. DATA EXTRACTION Data extraction was performed by 2 authors independently to include study design, patient population and characteristics, drug dosing, and outcomes. Studies were then assessed for their independent risk of bias utilizing the Grading of Recommendations, Assessment, Development, and Evaluations approach to risk of bias. RESULTS A total of 11 studies describing 195 pediatric patients who received gabapentin were included. Of the 11 studies, 9 were randomized controlled trials, 1 was a prospective multicenter study, and 1 was an open-label pilot study. CONCLUSIONS Heterogeneity of pain type and gabapentin dosing regimens within the included studies made conclusions difficult to quantify. Efficacy likely depends significantly on etiology of pain; however, per these studies, gabapentin is likely safe to use for a variety of pediatric patient populations as a multimodal agent.
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Affiliation(s)
| | - Jill Mantione
- Department of Pharmacy, Children's Healthcare of Atlanta, Atlanta, Georgia
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Zhou X, Li Z, Xing B. Efficacy and safety of TRPV1-related preparations in the treatment of inflammatory arthralgia. Medicine (Baltimore) 2023; 102:e36268. [PMID: 38013379 PMCID: PMC10681444 DOI: 10.1097/md.0000000000036268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 11/01/2023] [Indexed: 11/29/2023] Open
Abstract
BACKGROUND Currently, medications for the treatment of inflammatory arthralgia are limited. The role and safety of transient receptor potential vanilloid subtype 1 (TRPV1)-related preparations in reducing inflammatory arthralgia have not yet been fully established. Thus, we aimed to review the efficacy and safety of TRPV1-related preparations for the treatment of inflammatory arthralgia. METHODS We searched PubMed, Web of Science, Cochrane, and Embase databases for relevant studies, and the primary outcome was pain score (VAS, PI, NRS, and WOMAC). RESULTS Six randomized controlled trials involving 481 patients were analyzed. Patients with inflammatory arthralgia who received TRPV1-related preparations had lower pain scores after treatment than those who received placebo or nonsteroidal anti-inflammatory agents (standardized mean difference = -0.525; 95% confidence interval [CI], -0.789 to -0.261; P < .001). There was no significant difference in the incidence of total adverse reactions between the TRPV1-related preparations and control groups (relative risk = 1.225; 95% CI, 0.685 to 2.191; P = .494). CONCLUSION TRPV1-related preparations are clinically safe and effective in the treatment of inflammatory arthralgia and are superior to placebo or nonsteroidal drugs. This may be the preferred treatment for patients with inflammatory arthralgia.
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Affiliation(s)
- Xin Zhou
- Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
| | - Ziping Li
- Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
| | - Bingfeng Xing
- The First Affiliated Hospital/School of Clinical Medicine of Guangdong Pharmaceutical University, Guangzhou, Guangdong, China
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Schmid AB, Tampin B, Baron R, Finnerup NB, Hansson P, Hietaharju A, Konstantinou K, Lin CWC, Markman J, Price C, Smith BH, Slater H. Recommendations for terminology and the identification of neuropathic pain in people with spine-related leg pain. Outcomes from the NeuPSIG working group. Pain 2023; 164:1693-1704. [PMID: 37235637 PMCID: PMC10348639 DOI: 10.1097/j.pain.0000000000002919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Revised: 02/16/2023] [Accepted: 02/24/2023] [Indexed: 05/28/2023]
Abstract
ABSTRACT Pain radiating from the spine into the leg is commonly referred to as "sciatica," "Sciatica" may include various conditions such as radicular pain or painful radiculopathy. It may be associated with significant consequences for the person living with the condition, imposing a reduced quality of life and substantial direct and indirect costs. The main challenges associated with a diagnosis of "sciatica" include those related to the inconsistent use of terminology for the diagnostic labels and the identification of neuropathic pain. These challenges hinder collective clinical and scientific understanding regarding these conditions. In this position paper, we describe the outcome of a working group commissioned by the Neuropathic Pain Special Interest Group (NeuPSIG) of the International Association for the Study of Pain (IASP) which was tasked with the following objectives: (1) to revise the use of terminology for classifying spine-related leg pain and (2) to propose a way forward on the identification of neuropathic pain in the context of spine-related leg pain. The panel recommended discouraging the term "sciatica" for use in clinical practice and research without further specification of what it entails. The term "spine-related leg pain" is proposed as an umbrella term to include the case definitions of somatic referred pain and radicular pain with and without radiculopathy. The panel proposed an adaptation of the neuropathic pain grading system in the context of spine-related leg pain to facilitate the identification of neuropathic pain and initiation of specific management in this patient population.
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Affiliation(s)
- Annina B. Schmid
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom
| | - Brigitte Tampin
- Department of Physiotherapy, Sir Charles Gairdner Hospital, Perth, Australia
- Curtin School of Allied Health, Faculty of Health Sciences, Curtin University, Perth, Australia
- Faculty of Business and Social Sciences, Hochschule Osnabrueck, University of Applied Sciences, Osnabrueck, Germany
| | - Ralf Baron
- Division of Neurological Pain Research and Therapy, Department of Neurology, University Medical Center Schleswig-Holstein, Kiel, Germany
| | - Nanna B. Finnerup
- Danish Pain Research Center, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Department of Neurology, Aarhus University Hospital, Aarhus, Denmark
| | - Per Hansson
- Department of Pain Management & Research, Norwegian National Advisory Unit on Neuropathic Pain, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Aki Hietaharju
- Department of Neurology, Tampere University Hospital, Tampere, Finland
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Kika Konstantinou
- School of Medicine, Keele University, Keele, Staffordshire, United Kingdom
- Haywood Hospital, Midlands Partnership Foundation NHS Trust, Staffordshire, United Kingdom
| | - Chung-Wei Christine Lin
- Institute for Musculoskeletal Health, The University of Sydney and Sydney Local Health District, Sydney, Australia
- Sydney Musculoskeletal Health, the University of Sydney, Sydney Australia
| | - John Markman
- Translational Pain Research Program, Departments of Neurosurgery and Neurology, University of Rochester, Rochester, NY, United States
| | - Christine Price
- Patient Advocate Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom
| | - Blair H. Smith
- Division of Population Health and Genomics, University of Dundee, Dundee, Scotland
| | - Helen Slater
- Curtin School of Allied Health, Faculty of Health Sciences, Curtin University, Perth, Australia
- Division of Population Health and Genomics, University of Dundee, Dundee, Scotland
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Trager RJ, Cupler ZA, Srinivasan R, Casselberry RM, Perez JA, Dusek JA. Association between chiropractic spinal manipulation and gabapentin prescription in adults with radicular low back pain: retrospective cohort study using US data. BMJ Open 2023; 13:e073258. [PMID: 37479505 PMCID: PMC10364168 DOI: 10.1136/bmjopen-2023-073258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 07/09/2023] [Indexed: 07/23/2023] Open
Abstract
OBJECTIVES Radicular low back pain (rLBP) is often treated off-label with gabapentin or by chiropractors using chiropractic spinal manipulative therapy (CSMT). To date, no studies have examined the association between these interventions. We hypothesised that adults under 50 years of age receiving CSMT for newly diagnosed rLBP would have reduced odds of receiving a gabapentin prescription over 1 year-follow-up. DESIGN Retrospective cohort study. SETTING US network including linked medical records, medical claims and pharmacy claims of >122 million patients attending large healthcare organisations (TriNetX), queried 15 June 2023, yielding data from 2017 to 2023. PARTICIPANTS Adults aged 18-49 were included at their first occurrence of rLBP diagnosis. Exclusions were severe pathology, other spinal conditions, on-label gabapentin indications and gabapentin contraindications. Propensity score matching controlled for variables associated with gabapentin use and receipt of prescription medication over the preceding year. INTERVENTIONS Patients were divided into CSMT or usual medical care cohorts based on the care received on the index date of rLBP diagnosis. PRIMARY AND SECONDARY OUTCOME MEASURES OR for gabapentin prescription. RESULTS After propensity matching, there were 1635 patients per cohort (mean age 36.3±8.6 years, 60% women). Gabapentin prescription over 1-year follow-up was significantly lower in the CSMT cohort compared with the usual medical care cohort, with an OR (95% CI) of 0.53 (0.40 to 0.71; p<0.0001). Sensitivity analyses revealed early divergence in cumulative incidence of prescription; and no significant between-cohort difference in a negative control outcome (gastrointestinal medication) suggesting adequate control for pharmacological care preference. CONCLUSIONS Our findings suggest that US adults receiving CSMT for newly diagnosed rLBP have significantly reduced odds of receiving a gabapentin prescription over 1-year follow-up compared with those receiving usual medical care. Results may not be generalisable and should be replicated in other healthcare settings and corroborated by a prospective study to reduce confounding.
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Affiliation(s)
- Robert J Trager
- Connor Whole Health, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
- College of Chiropractic, Logan University, Chesterfield, Missouri, USA
| | - Zachary A Cupler
- Physical Medicine & Rehabilitative Services, Butler VA Health Care System, Butler, Pennsylvania, USA
- Institute for Clinical Research Education, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Roshini Srinivasan
- Connor Whole Health, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Regina M Casselberry
- Clinical Research Center, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Jaime A Perez
- Clinical Research Center, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Jeffery A Dusek
- Connor Whole Health, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
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Bas JL, Bas P, Bonilla F, Mariscal G, Pérez S, Bovea-Marco M, Rubio-Belmar PA, Bas T. Efficacy of perioperative gabapentin use in patients with idiopathic scoliosis undergoing fusion surgery: a systematic review and meta-analysis. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2023; 32:2521-2532. [PMID: 37209210 DOI: 10.1007/s00586-023-07764-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 04/03/2023] [Accepted: 05/03/2023] [Indexed: 05/22/2023]
Abstract
PURPOSE This study aimed to assess whether the perioperative use of gabapentin was associated with decreased opioid use. METHODS A meta-analysis was performed using PubMed, Embase, Scopus, and Cochrane Library. The randomized clinical trials included were focused on patients with adolescent idiopathic scoliosis who underwent posterior fusion surgery and were treated with gabapentin versus placebo medicine. The primary outcomes were opioid consumption at 24, 48, 72, and 96 h; time to introduction of oral medication, length of hospital stay, and period of urinary catheterization were also recorded. Data were combined using the Review Manager 5.4 software. RESULTS Four randomized clinical trials with a pool of 196 adolescent patients (mean age: 14.8 ± 2.0 years) were included. At 24 and 48 h after surgery, opioid consumption was significantly lower in the gabapentin group: (standardized mean difference [SMD]: -0.50; 95% confidence interval [CI] - 0.79 to - 0.22) and (SMD: - 0.59; 95% CI - 0.88 to - 0.30), respectively. At 72 and 96 h, there were no significant differences between studies: (SMD: - 0.19; 95% CI - 0.52 to 0.13) and (SMD: 0.12; 95% CI - 0.25 to 0.50), respectively. Regarding the administration type, there were significant differences in favor of the 15 mg/kg subgroup with 600 mg at 48 h (SMD: - 0.69; 95% CI - 1.08 to - 0.30). There were no significant differences concerning the time to introduction of oral medication (MD: - 0.08; 95% CI - 0.39 to 0.23), hospitalization time (MD: - 0.12; 95% CI - 0.40 to 0.16), or period of urinary catheterization (SMD: - 0.27; 95% CI - 0.58 to 0.05). CONCLUSIONS Gabapentin decreased opioid consumption during the first 48 h. Doses of 15 mg/kg showed superiority in reducing opioid consumption in the first 48 h. LEVEL OF EVIDENCE I Diagnostic: individual cross-sectional studies with consistently applied reference standard and blinding.
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Affiliation(s)
- Jose Luis Bas
- Spine Unit, Department of Orthopedic Surgery and Traumatology, La Fe University and Polytechnic Hospital, Valencia, Spain
| | - Paloma Bas
- Spine Unit, Department of Orthopedic Surgery and Traumatology, La Fe University and Polytechnic Hospital, Valencia, Spain
| | - Fernando Bonilla
- Spine Unit, Department of Orthopedic Surgery and Traumatology, La Fe University and Polytechnic Hospital, Valencia, Spain
| | - Gonzalo Mariscal
- Spine Unit, Department of Orthopedic Surgery and Traumatology, La Fe University and Polytechnic Hospital, Valencia, Spain.
| | - Silvia Pérez
- Spine Unit, Department of Orthopedic Surgery and Traumatology, La Fe University and Polytechnic Hospital, Valencia, Spain
| | - Miquel Bovea-Marco
- Spine Unit, Department of Orthopedic Surgery and Traumatology, La Fe University and Polytechnic Hospital, Valencia, Spain
| | - Pedro Antonio Rubio-Belmar
- Spine Unit, Department of Orthopedic Surgery and Traumatology, La Fe University and Polytechnic Hospital, Valencia, Spain
| | - Teresa Bas
- Spine Unit, Department of Orthopedic Surgery and Traumatology, La Fe University and Polytechnic Hospital, Valencia, Spain
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Bernatoniene J, Sciupokas A, Kopustinskiene DM, Petrikonis K. Novel Drug Targets and Emerging Pharmacotherapies in Neuropathic Pain. Pharmaceutics 2023; 15:1799. [PMID: 37513986 PMCID: PMC10384314 DOI: 10.3390/pharmaceutics15071799] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 06/19/2023] [Accepted: 06/20/2023] [Indexed: 07/30/2023] Open
Abstract
Neuropathic pain is a debilitating condition characterized by abnormal signaling within the nervous system, resulting in persistent and often intense sensations of pain. It can arise from various causes, including traumatic nerve injury, neuropathy, and certain diseases. We present an overview of current and emerging pharmacotherapies for neuropathic pain, focusing on novel drug targets and potential therapeutic agents. Current pharmacotherapies, including tricyclic antidepressants, gabapentinoids, and serotonin norepinephrine re-uptake inhibitors, are discussed, as are emerging treatments, such as ambroxol, cannabidiol, and N-acetyl-L-cysteine. Additionally, the article highlights the need for further research in this field to identify new targets and develop more effective and targeted therapies for neuropathic pain management.
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Affiliation(s)
- Jurga Bernatoniene
- Department of Drug Technology and Social Pharmacy, Faculty of Pharmacy, Medical Academy, Lithuanian University of Health Sciences, Sukileliu pr. 13, LT-50161 Kaunas, Lithuania
- Institute of Pharmaceutical Technologies, Faculty of Pharmacy, Medical Academy, Lithuanian University of Health Sciences, Sukileliu pr. 13, LT-50161 Kaunas, Lithuania
| | - Arunas Sciupokas
- Pain Clinic, Lithuanian University of Health Sciences Hospital Kauno Klinikos, Eivenių Str. 2, LT-50009 Kaunas, Lithuania
- Department of Neurology, Lithuanian University of Health Sciences, Eivenių Str. 2, LT-50009 Kaunas, Lithuania
| | - Dalia Marija Kopustinskiene
- Institute of Pharmaceutical Technologies, Faculty of Pharmacy, Medical Academy, Lithuanian University of Health Sciences, Sukileliu pr. 13, LT-50161 Kaunas, Lithuania
| | - Kestutis Petrikonis
- Department of Neurology, Lithuanian University of Health Sciences, Eivenių Str. 2, LT-50009 Kaunas, Lithuania
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Nemecek Z, Sturm C, Rauen AC, Reisig F, Streitberger K, Harnik MA. Ultrasound-controlled cryoneurolysis for peripheral mononeuropathies: a retrospective cohort study. Pain Manag 2023; 13:363-372. [PMID: 37424263 DOI: 10.2217/pmt-2023-0053] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/11/2023] Open
Abstract
Aim: Cryoneurolysis is a potential therapy for peripheral mononeuropathies, but randomized studies of its effects on the duration of pain reduction are lacking. Methods: This retrospective cohort study evaluated the analgesic effects of cryoneurolysis on patients with refractory peripheral mononeuropathy. We included 24 patients who underwent ultrasound-guided cryoneurolysis between June 2018 and July 2022. The daily maximum pain level was recorded using a numerical rating scale before and 1, 3 and 6 months after the procedure. Results: At 1 month, 54.2% of patients reported pain reduction of at least 30%. This percentage was significantly lower at 3 and 6 months (13.8 and 9.1%, respectively). Conclusion: Our results suggest that repeated cryoneurolysis may be a viable treatment for refractory mononeuropathy. Further investigations are needed.
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Affiliation(s)
- Zdenek Nemecek
- Department of Anesthesiology & Pain Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Constanze Sturm
- Department of Osteoporosis, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Anna C Rauen
- Department of Anesthesiology & Pain Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Florian Reisig
- Department of Anesthesiology & Pain Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Konrad Streitberger
- Department of Anesthesiology & Pain Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Michael A Harnik
- Department of Anesthesiology & Pain Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
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Bielewicz J, Kamieniak M, Szymoniuk M, Litak J, Czyżewski W, Kamieniak P. Diagnosis and Management of Neuropathic Pain in Spine Diseases. J Clin Med 2023; 12:jcm12041380. [PMID: 36835916 PMCID: PMC9961043 DOI: 10.3390/jcm12041380] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 01/31/2023] [Accepted: 02/07/2023] [Indexed: 02/12/2023] Open
Abstract
Neuropathic pain is generally defined as a non-physiological pain experience caused by damage to the nervous system. It can occur spontaneously, as a reaction to a given stimulus, or independently of its action, leading to unusual pain sensations usually referred to as firing, burning or throbbing. In the course of spine disorders, pain symptoms commonly occur. According to available epidemiological studies, a neuropathic component of pain is often present in patients with spinal diseases, with a frequency ranging from 36% to 55% of patients. Distinguishing between chronic nociceptive pain and neuropathic pain very often remains a challenge. Consequently, neuropathic pain is often underdiagnosed in patients with spinal diseases. In reference to current guidelines for the treatment of neuropathic pain, gabapentin, serotonin and norepinephrine reuptake inhibitors and tricyclic antidepressants constitute first-line therapeutic agents. However, long-term pharmacologic treatment often leads to developing tolerance and resistance to used medications. Therefore, in recent years, a plethora of therapeutic methods for neuropathic pain have been developed and investigated to improve clinical outcomes. In this review, we briefly summarized current knowledge about the pathophysiology and diagnosis of neuropathic pain. Moreover, we described the most effective treatment approaches for neuropathic pain and discussed their relevance in the treatment of spinal pain.
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Affiliation(s)
- Joanna Bielewicz
- Department of Neurology, Medical University of Lublin, Jaczewskiego 8, 20-954 Lublin, Poland
| | - Maciej Kamieniak
- Department of Neurosurgery and Pediatric Neurosurgery, Medical University of Lublin, Jaczewskiego 8, 20-954 Lublin, Poland
| | - Michał Szymoniuk
- Department of Neurosurgery and Pediatric Neurosurgery, Medical University of Lublin, Jaczewskiego 8, 20-954 Lublin, Poland
- Correspondence:
| | - Jakub Litak
- Department of Neurosurgery and Pediatric Neurosurgery, Medical University of Lublin, Jaczewskiego 8, 20-954 Lublin, Poland
- Department of Clinical Immunology, Medical University of Lublin, Chodźki 4A, 20-093 Lublin, Poland
| | - Wojciech Czyżewski
- Department of Neurosurgery and Pediatric Neurosurgery, Medical University of Lublin, Jaczewskiego 8, 20-954 Lublin, Poland
- Department of Didactics and Medical Simulation, Medical University of Lublin, Chodźki 4, 20-093 Lublin, Poland
| | - Piotr Kamieniak
- Department of Neurosurgery and Pediatric Neurosurgery, Medical University of Lublin, Jaczewskiego 8, 20-954 Lublin, Poland
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11
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Zhao X, Ge S. The efficacy and safety of gabapentin vs. carbamazepine in patients with primary trigeminal neuralgia: A systematic review and meta-analysis. Front Neurol 2023; 14:1045640. [PMID: 37200780 PMCID: PMC10185754 DOI: 10.3389/fneur.2023.1045640] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Accepted: 02/27/2023] [Indexed: 05/20/2023] Open
Abstract
Background Drug therapy is the most commonly used treatment for primary trigeminal neuralgia (PTN), in which carbamazepine is the first-line drug. Recently, the anti-epileptic drug gabapentin has also been widely used in patients with PTN, but whether it can be used as a substitute for carbamazepine still needs to be verified. Our study aimed to assess the safety and efficacy of gabapentin vs. carbamazepine as a treatment for PTN. Methods We searched seven electronic databases for studies published as of 31 July 2022. All randomized controlled trials (RCTs) of gabapentin vs. carbamazepine on patients with PTN that met the inclusion criteria were included. Meta-analysis was conducted using Revman 5.4 and Stata 14.0, in which forest plots, funnel plots, and sensitivity analysis were performed. Mean difference (MD) and odds ratio (OR) with 95% confidence intervals (CIs) were used for the measurement indicators of continuous and categorical variables, respectively. Results A total of 18 RCTs with 1,604 patients were eventually identified. The meta-analysis showed that compared with the carbamazepine group, the gabapentin group significantly improved the effective rate (OR = 2.02, 95% CI 1.56 to 2.62, P < 0.001), reduced the adverse event rate (OR = 0.28, 95% CI 0.21 to 0.37, P < 0.001), and improved the visual analog scale (VAS) score (MD = -0.46, 95% CI -0.86 to -0.06, P = 0.03). Although the funnel plot showed evidence of publication bias, the sensitivity analysis revealed the stability of the results. Conclusion The current evidence showed that gabapentin may be superior to carbamazepine in relation to efficacy and safety in patients with PTN. It is crucial that more RCTs are conducted to confirm the conclusion in the future.
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Affiliation(s)
- Xin Zhao
- Department of Pharmacy, Beilun People's Hospital, Ningbo, China
| | - Shuyu Ge
- Department of Pharmacy, Tongde Hospital of Zhejiang Province, Hangzhou, China
- *Correspondence: Shuyu Ge
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