1
|
Gilron I, DeBow C, Elkerdawy H, Khan JS, Salomons TV, Duggan S, Tu D, Holden RR, Milev R, Buckley DN, Moulin DE. PRECISE trial (Pain RElief Combination Intervention StratEgies): protocol for the clinical trial of a pregabalin-melatonin combination for fibromyalgia. BMJ Open 2024; 14:e087180. [PMID: 38910006 PMCID: PMC11328632 DOI: 10.1136/bmjopen-2024-087180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/25/2024] Open
Abstract
INTRODUCTION Fibromyalgia is associated with chronic widespread pain and disturbed sleep. Multidisciplinary, multimodal management often includes pharmacotherapy; however, current drugs used to treat fibromyalgia provide meaningful benefit to only 30-60% of treated individuals. Combining two or more different drugs is common in clinical practice with the expectation of better efficacy, tolerability or both; however, further research is needed to identify which combinations actually provide added benefit. Thus, we are planning a clinical trial to evaluate melatonin (MLT)-pregabalin (PGB) combination in participants with fibromyalgia. METHODS AND ANALYSIS This will be a single-centre, double-blind, randomised, double-dummy, three-period, crossover trial comparing a MLT-PGB combination to each monotherapy in 54 adult participants satisfying the 2016 American College of Rheumatology criteria for fibromyalgia. Participants will receive maximally tolerated doses of MLT, PGB and MLT-PGB combination for 6 weeks. The primary outcome will be daily pain intensity (0-10); secondary outcomes will include the Fibromyalgia Impact Questionnaire, SF-36 survey, Medical Outcomes Study Sleep Scale, Beck Depression Inventory (BDI-II), adverse events and other measures. Analysis of the primary and secondary outcomes will involve a linear mixed model with sequence, period, treatment, the first-order carryover and baseline pain score as fixed effects and participant as a random effect to test whether there are any treatment differences among three treatments and to estimate the least square mean of the mean daily pain intensity for each treatment, adjusting for carryover as well as period effects (ie, stability of pain levels). ETHICS AND DISSEMINATION This trial has been registered with the International Standard Randomised Controlled Trial Number Registry, ISRCTN #18278231, has been granted ethical approval by the Queen's University Health Sciences Research Ethics Board (Queen's HSREB Protocol #6040998) and is currently under review for a Clinical Trial Application to Health Canada Natural and Non-prescription Health Products Directorate. All participants will provide written informed consent prior to trial participation. Following trial completion, results will be disseminated in one or more biomedical journal publications and presented at one or more scientific meetings. TRIAL REGISTRATION NUMBER This trial has been registered with the International Standard Randomised Controlled Trial Number Registry, ISRCTN18278231.
Collapse
Affiliation(s)
- Ian Gilron
- Kingston Health Sciences Centre, Kingston, Ontario, Canada
- Providence Care Hospital, Kingston, Ontario, Canada
- Department of Biomedical & Molecular Sciences, Queen's University, Kingston, Ontario, Canada
| | - Chris DeBow
- Arcus Analytica, Halifax, Nova Scotia, Canada
| | - Hala Elkerdawy
- Kingston Health Sciences Centre, Kingston, Ontario, Canada
| | - James S Khan
- ANESTHESIOLOGY and Pain Medicine, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Tim V Salomons
- Psychology, Queen's University, Kingston, Ontario, Canada
| | - Scott Duggan
- Kingston Health Sciences Centre, Kingston, Ontario, Canada
- Department of Biomedical & Molecular Sciences, Queen's University, Kingston, Ontario, Canada
| | - Dongsheng Tu
- Canadian Cancer Trials Group, Queens University at Kingston, Kingston, Ontario, Canada
| | - Ronald R Holden
- Department of Psychology, Queen's University, Kingston, Ontario, Canada
- Department of Psychiatry, Providence Care Hospital, Kingston, Ontario, Canada
| | - Roumen Milev
- Department of Psychology, Queen's University, Kingston, Ontario, Canada
- Department of Psychiatry, Providence Care Hospital, Kingston, Ontario, Canada
| | | | - Dwight E Moulin
- Clinical Neurological Sciences and Oncology, Western University, London, Ontario, Canada
| |
Collapse
|
2
|
Fornaro M, Caiazza C, De Simone G, Rossano F, de Bartolomeis A. Insomnia and related mental health conditions: Essential neurobiological underpinnings towards reduced polypharmacy utilization rates. Sleep Med 2024; 113:198-214. [PMID: 38043331 DOI: 10.1016/j.sleep.2023.11.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Revised: 11/05/2023] [Accepted: 11/21/2023] [Indexed: 12/05/2023]
Abstract
Insomnia represents a significant public health burden, with a 10% prevalence in the general population. Reduced sleep affects social and working functioning, productivity, and patient's quality of life, leading to a total of $100 billion per year in direct and indirect healthcare costs. Primary insomnia is unrelated to any other mental or medical illness; secondary insomnia co-occurs with other underlying medical, iatrogenic, or mental conditions. Epidemiological studies found a 40-50% comorbidity prevalence between insomnia and psychiatric disorders, suggesting a high relevance of mental health in insomniacs. Sleep disturbances also worsen the outcomes of several psychiatric disorders, leading to more severe psychopathology and incomplete remission, plausibly contributing to treatment-resistant conditions. Insomnia and psychiatric disorder coexistence can lead to polypharmacy, namely, the concurrent use of two or more medications in the same patient, regardless of their purpose or rationale. Polypharmacy increases the risk of using unnecessary drugs, the likelihood of drug interactions and adverse events, and reduces the patient's compliance due to regimen complexity. The workup of insomnia must consider the patient's sleep habits and inquire about any medical and mental concurrent conditions that must be handled to allow insomnia to be remitted adequately. Monotherapy or limited polypharmacy should be preferred, especially in case of multiple comorbidities, promoting multipurpose molecules with sedative properties and with bedtime administration. Also, non-pharmacological interventions for insomnia, such as sleep hygiene, relaxation training and Cognitive Behavioral Therapy may be useful in secondary insomnia to confront behaviors and thoughts contributing to insomnia and help optimizing the pharmacotherapy. However, insomnia therapy should always be patient-tailored, considering drug indications, contraindications, and pharmacokinetics, besides insomnia phenotype, clinical picture, patient preferences, and side effect profile.
Collapse
Affiliation(s)
- Michele Fornaro
- Clinical Section of Psychiatry and Psychology, Department of Neuroscience, Reproductive Sciences, and Odontostomatology, University School of Medicine Federico II, Naples, Italy
| | - Claudio Caiazza
- Clinical Section of Psychiatry and Psychology, Department of Neuroscience, Reproductive Sciences, and Odontostomatology, University School of Medicine Federico II, Naples, Italy.
| | - Giuseppe De Simone
- Clinical Section of Psychiatry and Psychology, Department of Neuroscience, Reproductive Sciences, and Odontostomatology, University School of Medicine Federico II, Naples, Italy; Laboratory of Molecular and Translational Psychiatry, University School of Medicine of Naples Federico II, Naples, Italy
| | - Flavia Rossano
- Clinical Section of Psychiatry and Psychology, Department of Neuroscience, Reproductive Sciences, and Odontostomatology, University School of Medicine Federico II, Naples, Italy
| | - Andrea de Bartolomeis
- Clinical Section of Psychiatry and Psychology, Department of Neuroscience, Reproductive Sciences, and Odontostomatology, University School of Medicine Federico II, Naples, Italy; Laboratory of Molecular and Translational Psychiatry, University School of Medicine of Naples Federico II, Naples, Italy
| |
Collapse
|
3
|
Shi T, Chen Z, Li W, Wang Z, Liu W. Prevalence of sleep disturbance in patients with cervical radiculopathy and an analysis of risk factors: a cross-sectional study. 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; 32:1624-1635. [PMID: 36935452 DOI: 10.1007/s00586-023-07655-y] [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: 11/19/2022] [Revised: 02/01/2023] [Accepted: 03/12/2023] [Indexed: 03/21/2023]
Abstract
OBJECTIVE Previous research has shown that many patients with musculoskeletal diseases suffer from sleep disturbances. However, the sleep quality of patients with cervical radiculopathy (CR) has yet to be fully investigated. This study aims to investigate the prevalence and status of sleep disturbances in patients with CR and identify the mechanisms and risk factors associated with this condition. METHODS We conducted a cross-sectional study of patients diagnosed with CR. The Pittsburgh Sleep Quality Index (PSQI) and Insomnia Severity Index (ISI) were used to evaluate the sleep quality of patients and determine whether patients experience sleep disturbances. In addition, we analyzed the clinical and radiological risk factors of sleep disturbance and determined the key risk factors related to sleep disturbance by multivariable analysis. RESULTS According to specific inclusion and exclusion criteria, 186 patients with CR were finally included, with a mean age of 59.1 ± 14.3 years, of which 113 (60.8%) were female. Sleep disturbance was defined as a PSQI score ≥ 6 and was identified in 56.5% of patients (105/186). By performing multivariate analysis, we determined that sleep disturbance was closely related to the female gender, a higher Beck Depression Inventory (BDI) score, a reduction in cervical mobility, an increase in C2-C7 sagittal vertical axis (C2-C7 SVA), and severe asymmetry of the paravertebral muscle at C5 and C6 levels. CONCLUSION In this study, we identified the high prevalence and potential high-risk factors of sleep disturbance in patients with CR. Clinicians should closely evaluate and monitor such patients and consider appropriate treatment strategies. LEVEL OF EVIDENCE IV.
Collapse
Affiliation(s)
- Tengbin Shi
- Department of Orthopedics, Fujian Medical University Union Hospital, 29 Xinquan Road, Gulou, Fuzhou, 086-350001, Fujian, People's Republic of China
| | - Zhi Chen
- Department of Orthopedics, Fujian Medical University Union Hospital, 29 Xinquan Road, Gulou, Fuzhou, 086-350001, Fujian, People's Republic of China
| | - Wenwen Li
- School of Health, Fujian Medical University, Fuzhou, 350108, Fujian, People's Republic of China
| | - Zhenyu Wang
- Department of Orthopedics, Fujian Medical University Union Hospital, 29 Xinquan Road, Gulou, Fuzhou, 086-350001, Fujian, People's Republic of China
| | - Wenge Liu
- Department of Orthopedics, Fujian Medical University Union Hospital, 29 Xinquan Road, Gulou, Fuzhou, 086-350001, Fujian, People's Republic of China.
- School of Health, Fujian Medical University, Fuzhou, 350108, Fujian, People's Republic of China.
| |
Collapse
|
4
|
Pain and Analgesic related insomnia. Pain Manag Nurs 2022; 24:254-264. [DOI: 10.1016/j.pmn.2022.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Revised: 10/11/2022] [Accepted: 11/15/2022] [Indexed: 12/23/2022]
|
5
|
Strzelczyk A, Schubert-Bast S. Psychobehavioural and Cognitive Adverse Events of Anti-Seizure Medications for the Treatment of Developmental and Epileptic Encephalopathies. CNS Drugs 2022; 36:1079-1111. [PMID: 36194365 PMCID: PMC9531646 DOI: 10.1007/s40263-022-00955-9] [Citation(s) in RCA: 44] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/07/2022] [Indexed: 02/06/2023]
Abstract
The developmental and epileptic encephalopathies encompass a group of rare syndromes characterised by severe drug-resistant epilepsy with onset in childhood and significant neurodevelopmental comorbidities. The latter include intellectual disability, developmental delay, behavioural problems including attention-deficit hyperactivity disorder and autism spectrum disorder, psychiatric problems including anxiety and depression, speech impairment and sleep problems. Classical examples of developmental and epileptic encephalopathies include Dravet syndrome, Lennox-Gastaut syndrome and tuberous sclerosis complex. The mainstay of treatment is with multiple anti-seizure medications (ASMs); however, the ASMs themselves can be associated with psychobehavioural adverse events, and effects (negative or positive) on cognition and sleep. We have performed a targeted literature review of ASMs commonly used in the treatment of developmental and epileptic encephalopathies to discuss the latest evidence on their effects on behaviour, mood, cognition, sedation and sleep. The ASMs include valproate (VPA), clobazam, topiramate (TPM), cannabidiol (CBD), fenfluramine (FFA), levetiracetam (LEV), brivaracetam (BRV), zonisamide (ZNS), perampanel (PER), ethosuximide, stiripentol, lamotrigine (LTG), rufinamide, vigabatrin, lacosamide (LCM) and everolimus. Bromide, felbamate and other sodium channel ASMs are discussed briefly. Overall, the current evidence suggest that LEV, PER and to a lesser extent BRV are associated with psychobehavioural adverse events including aggressiveness and irritability; TPM and to a lesser extent ZNS are associated with language impairment and cognitive dulling/memory problems. Patients with a history of behavioural and psychiatric comorbidities may be more at risk of developing psychobehavioural adverse events. Topiramate and ZNS may be associated with negative effects in some aspects of cognition; CBD, FFA, LEV, BRV and LTG may have some positive effects, while the remaining ASMs do not appear to have a detrimental effect. All the ASMs are associated with sedation to a certain extent, which is pronounced during uptitration. Cannabidiol, PER and pregabalin may be associated with improvements in sleep, LTG is associated with insomnia, while VPA, TPM, LEV, ZNS and LCM do not appear to have detrimental effects. There was variability in the extent of evidence for each ASM: for many first-generation and some second-generation ASMs, there is scant documented evidence; however, their extensive use suggests favourable tolerability and safety (e.g. VPA); second-generation and some third-generation ASMs tend to have the most robust evidence documented over several years of use (TPM, LEV, PER, ZNS, BRV), while evidence is still being generated for newer ASMs such as CBD and FFA. Finally, we discuss how a variety of factors can affect mood, behaviour and cognition, and untangling the associations between the effects of the underlying syndrome and those of the ASMs can be challenging. In particular, there is enormous heterogeneity in cognitive, behavioural and developmental impairments that is complex and can change naturally over time; there is a lack of standardised instruments for evaluating these outcomes in developmental and epileptic encephalopathies, with a reliance on subjective evaluations by proxy (caregivers); and treatment regimes are complex involving multiple ASMs as well as other drugs.
Collapse
Affiliation(s)
- Adam Strzelczyk
- Epilepsy Center Frankfurt Rhine-Main, Center of Neurology and Neurosurgery, Goethe-University and University Hospital Frankfurt, Schleusenweg 2-16, 60528, Frankfurt am Main, Germany. .,LOEWE Center for Personalized and Translational Epilepsy Research (CePTER), Goethe-University Frankfurt, Frankfurt am Main, Germany.
| | - Susanne Schubert-Bast
- Epilepsy Center Frankfurt Rhine-Main, Center of Neurology and Neurosurgery, Goethe-University and University Hospital Frankfurt, Schleusenweg 2-16, 60528, Frankfurt am Main, Germany.,LOEWE Center for Personalized and Translational Epilepsy Research (CePTER), Goethe-University Frankfurt, Frankfurt am Main, Germany.,Department of Neuropediatrics, Goethe-University and University Hospital Frankfurt, Frankfurt am Main, Germany
| |
Collapse
|
6
|
Gilron I, Tu D, Holden RR, Moulin DE, Duggan S, Milev R. Melatonin for neuropathic pain: Protocol for a double-blind, randomized, controlled trial (Preprint). JMIR Res Protoc 2022; 11:e40025. [PMID: 36170003 PMCID: PMC9557986 DOI: 10.2196/40025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 07/30/2022] [Accepted: 08/14/2022] [Indexed: 11/13/2022] Open
Affiliation(s)
- Ian Gilron
- Department of Anesthesiology & Perioperative Medicine, Queen's University, Kingston, ON, Canada
| | - Dongsheng Tu
- Department of Psychology, Queen's University, Kingston, ON, Canada
| | - Ronald R Holden
- Department of Psychology, Queen's University, Kingston, ON, Canada
| | | | - Scott Duggan
- Department of Anesthesiology & Perioperative Medicine, Queen's University, Kingston, ON, Canada
| | - Roumen Milev
- Department of Psychology, Queen's University, Kingston, ON, Canada
| |
Collapse
|
7
|
Abe H, Sumitani M, Matsui H, Inoue R, Konishi M, Fushimi K, Uchida K, Yasunaga H. Gabapentinoid Use Is Associated With Reduced Occurrence of Hyperactive Delirium in Older Cancer Patients Undergoing Chemotherapy: A Nationwide Retrospective Cohort Study in Japan. Anesth Analg 2022; 135:362-369. [PMID: 35560025 DOI: 10.1213/ane.0000000000006093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND It is unclear whether gabapentinoids affect the development of delirium. We aimed to determine the association between gabapentinoid use and hyperactive delirium in older cancer patients undergoing chemotherapy. METHODS We conducted propensity score-matched analyses using data from a nationwide inpatient database in Japan. We included cancer patients with pain ≥70 years of age undergoing chemotherapy between April 2016 and March 2018. Patients receiving gabapentinoids were matched with control patients using propensity scores. The primary outcome was occurrence of hyperactive delirium during hospitalization, and the secondary outcomes were length of hospital stay, in-hospital fractures, and in-hospital mortality. Hyperactive delirium was identified by antipsychotic use or discharge diagnoses from the International Classification of Diseases, 10th Revision. RESULTS Among 143,132 identified patients (59% men; mean age, 76.3 years), 14,174 (9.9%) received gabapentinoids and 128,958 (90.1%) did not (control group). After one-to-one propensity score matching, 14,173 patients were included in each group. The occurrence of hyperactive delirium was significantly lower (5.2% vs 8.5%; difference in percent, -3.2% [95% confidence interval, -3.8 to -2.6]; odds ratio, 0.60 [0.54-0.66]; P < .001), the median length of hospital stay was significantly shorter (6 days [interquartile range, 3-15] vs 9 days [4-17]; subdistribution hazard ratio, 1.22 [1.19-1.25]; P < .001), and the occurrence of in-hospital mortality was significantly lower in the gabapentinoid group than in the control group (1.3% vs 1.8%; difference in percent, -0.6% [-0.9 to -0.3]; odds ratio, 0.69 [0.57-0.83]; P < .001). Gabapentinoid use was not significantly associated with the occurrence of in-hospital fractures (0.2% vs 0.2%; difference in percent, 0.0% [-0.1 to 0.1]; odds ratio, 1.07 [0.65-1.76]; P = .799). The results of sensitivity analyses using stabilized inverse probability of treatment weighting were consistent with the results of the propensity score-matched analyses. CONCLUSIONS Our findings suggest that gabapentinoid use is associated with reduced hyperactive delirium in older cancer patients undergoing chemotherapy, with no evidence of an increase in the fracture rate, length of hospital stay, or in-hospital death.
Collapse
Affiliation(s)
- Hiroaki Abe
- From theDepartment of Pain and Palliative Medicine, The University of Tokyo Hospital, Tokyo, Japan
| | - Masahiko Sumitani
- From theDepartment of Pain and Palliative Medicine, The University of Tokyo Hospital, Tokyo, Japan
| | - Hiroki Matsui
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
| | - Reo Inoue
- Department of Anesthesiology and Pain Relief Center, The University of Tokyo Hospital, Tokyo, Japan
| | - Mitsuru Konishi
- From theDepartment of Pain and Palliative Medicine, The University of Tokyo Hospital, Tokyo, Japan
| | - Kiyohide Fushimi
- Department of Health Policy and Informatics, Tokyo Medical and Dental University, Tokyo, Japan
| | - Kanji Uchida
- Department of Anesthesiology and Pain Relief Center, The University of Tokyo Hospital, Tokyo, Japan
| | - Hideo Yasunaga
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
| |
Collapse
|
8
|
Papanna B, Lazzari C, Kulkarni K, Perumal S, Nusair A. Pregabalin abuse and dependence during insomnia and protocol for short-term withdrawal management with diazepam: examples from case reports. Sleep Sci 2022; 14:193-197. [PMID: 35082992 PMCID: PMC8764940 DOI: 10.5935/1984-0063.20200129] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Accepted: 03/19/2021] [Indexed: 12/01/2022] Open
Abstract
Introduction: Pregabalin (PGN) is an anxiolytic, analgesic, antiepileptic, and hypnotic medication. There are concerns about its abuse in the community for managing chronic insomnia and other risks when assumed in overdose or combination with other abuse substances. PGN is classified as a controlled medication. While its discontinuation is accompanied by rebound insomnia and other neurological symptoms, cross-tapering PGN with short-term diazepam (DZ) during inpatient admissions has shown promising results in dealing with PGN withdrawal symptoms accompanied by rebound insomnia. Material and Methods: We report three cases that began abusing their prescribed PGN. During hospital admission, our teams used a protocol for cross-tapering PGN with DZ to reduce withdrawal symptoms. Other sedative medications are suspended while alcohol is not allowed if patients are on leave from the hospital. Standardized scales for assessment were clinical global impression scale-severity (CGI-S), generalized anxiety disorder scale (GAD-7), and insomnia severity index (ISI). Results: The cross-tapering PGN with DZ showed similar clinical outcomes with reduced withdrawal symptoms and rebound insomnia during two weeks of cross-tapering. Eventually, DZ, too, is stopped in the hospital to avoid another dependence syndrome. Conclusion: As emerging in the current study, PGN has strong addictive effects in people who have insomnia and is mostly abused for its hypnotic or sleep-inducing properties when other medications have failed. As applied in the current study, DZ can manage PGN withdrawal symptoms with rebound insomnia while cross-tapering. DZ is then discontinued.
Collapse
Affiliation(s)
- Basavaraja Papanna
- Essex Partnership University NHS Foundation Trust, Psychiatry - Colchester - Essex - United Kingdom
| | - Carlo Lazzari
- South-West Yorkshire NHS Trust, Psychiatric Intensive Care Unit - Wakefield - South Yorkshire - United Kingdom
| | - Kapil Kulkarni
- Essex Partnership University NHS Foundation Trust, Psychiatry - Colchester - Essex - United Kingdom
| | - Sivasankar Perumal
- Essex Partnership University NHS Foundation Trust, Psychiatry - Colchester - Essex - United Kingdom
| | - Abdul Nusair
- South-West Yorkshire NHS Trust, Psychiatric Intensive Care Unit - Wakefield - South Yorkshire - United Kingdom
| |
Collapse
|
9
|
Hong JSW, Atkinson LZ, Al-Juffali N, Awad A, Geddes JR, Tunbridge EM, Harrison PJ, Cipriani A. Gabapentin and pregabalin in bipolar disorder, anxiety states, and insomnia: Systematic review, meta-analysis, and rationale. Mol Psychiatry 2022; 27:1339-1349. [PMID: 34819636 PMCID: PMC9095464 DOI: 10.1038/s41380-021-01386-6] [Citation(s) in RCA: 35] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Revised: 09/29/2021] [Accepted: 10/27/2021] [Indexed: 12/29/2022]
Abstract
The gabapentinoids, gabapentin, and pregabalin, target the α2δ subunits of voltage-gated calcium channels. Initially licensed for pain and seizures, they have become widely prescribed drugs. Many of these uses are off-label for psychiatric indications, and there is increasing concern about their safety, so it is particularly important to have good evidence to justify this usage. We conducted a systematic review and meta-analysis of the evidence for three of their common psychiatric uses: bipolar disorder, anxiety, and insomnia. Fifty-five double-blind randomised controlled trials (RCTs) and 15 open-label studies were identified. For bipolar disorder, four double-blind RCTs investigating gabapentin, and no double-blind RCTs investigating pregabalin, were identified. A quantitative synthesis could not be performed due to heterogeneity in the study population, design and outcome measures. Across the anxiety spectrum, a consistent but not universal effect in favour of gabapentinoids compared to placebo was seen (standardised mean difference [SMD] ranging between -2.25 and -0.25). Notably, pregabalin (SMD -0.55, 95% CI -0.92 to -0.18) and gabapentin (SMD -0.92, 95% CI -1.32 to -0.52) were more effective than placebo in reducing preoperative anxiety. In insomnia, results were inconclusive. We conclude that there is moderate evidence of the efficacy of gabapentinoids in anxiety states, but minimal evidence in bipolar disorder and insomnia and they should be used for these disorders only with strong justification. This recommendation applies despite the attractive pharmacological and genetic rationale for targeting voltage-gated calcium channels.
Collapse
Affiliation(s)
- James S. W. Hong
- grid.416938.10000 0004 0641 5119Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, OX3 7JX UK
| | - Lauren Z. Atkinson
- grid.416938.10000 0004 0641 5119Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, OX3 7JX UK ,grid.497865.10000 0004 0427 1035Oxford Centre for Human Brain Activity, University of Oxford, Oxford, UK ,grid.416938.10000 0004 0641 5119Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, UK
| | - Noura Al-Juffali
- grid.416938.10000 0004 0641 5119Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, OX3 7JX UK ,grid.416938.10000 0004 0641 5119Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, UK
| | - Amine Awad
- grid.416938.10000 0004 0641 5119Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, OX3 7JX UK ,grid.32224.350000 0004 0386 9924Department of Neurology, Massachusetts General Hospital, Boston, MA 02114 USA
| | - John R. Geddes
- grid.416938.10000 0004 0641 5119Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, OX3 7JX UK ,grid.416938.10000 0004 0641 5119Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, UK
| | - Elizabeth M. Tunbridge
- grid.416938.10000 0004 0641 5119Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, OX3 7JX UK ,grid.416938.10000 0004 0641 5119Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, UK
| | - Paul J. Harrison
- grid.416938.10000 0004 0641 5119Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, OX3 7JX UK ,grid.416938.10000 0004 0641 5119Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, UK
| | - Andrea Cipriani
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, OX3 7JX, UK. .,Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, UK.
| |
Collapse
|
10
|
Raymond JS, Rehn S, Hoyos CM, Bowen MT. The influence of oxytocin-based interventions on sleep-wake and sleep-related behaviour and neurobiology: A systematic review of preclinical and clinical studies. Neurosci Biobehav Rev 2021; 131:1005-1026. [PMID: 34673110 DOI: 10.1016/j.neubiorev.2021.10.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Revised: 10/13/2021] [Accepted: 10/14/2021] [Indexed: 12/26/2022]
Abstract
The oxytocin (OXT) system has garnered considerable interest due to its influence on diverse behaviours. However, scant research has considered the influence of oxytocin on sleep-wake and sleep-related behaviour and neurobiology. Consequently, the objective of this systematic review was to assess the extant preclinical and clinical evidence for the influence of oxytocin-based interventions on sleep-wake outcomes. The primary search was conducted on 22/7/2020 using six electronic databases; 30 studies (19 preclinical, 11 clinical) were included based on inclusion criteria. Studies were evaluated for risk of bias using the SYRCLE tool and the Cochrane risk of bias tools for preclinical and clinical studies, respectively. Results indicated manipulation of the OXT system can influence sleep-wake outcomes. Preclinical evidence suggests a wake-promoting influence of OXT system activation whereas the clinical evidence suggests little or no sleep-promoting influence of OXT. OXT dose was identified as a likely modulatory factor of OXT-induced effects on sleep-wake behaviour. Future studies are necessary to validate and strengthen these tentative conclusions about the influence of OXT on sleep-wake behaviour.
Collapse
Affiliation(s)
- Joel S Raymond
- The University of Sydney, Faculty of Science, School of Psychology, Camperdown, NSW, Australia; The University of Sydney, Brain and Mind Centre, Camperdown, NSW, Australia
| | - Simone Rehn
- The University of Sydney, Faculty of Science, School of Psychology, Camperdown, NSW, Australia
| | - Camilla M Hoyos
- The University of Sydney, Faculty of Science, School of Psychology, Camperdown, NSW, Australia; The University of Sydney, Brain and Mind Centre, Camperdown, NSW, Australia; The University of Sydney, Woolcock Institute of Medical Research, Centre for Sleep and Chronobiology, Camperdown, NSW, Australia
| | - Michael T Bowen
- The University of Sydney, Faculty of Science, School of Psychology, Camperdown, NSW, Australia; The University of Sydney, Brain and Mind Centre, Camperdown, NSW, Australia.
| |
Collapse
|
11
|
Iacovides S, Kamerman P, Baker FC, Mitchell D. Why It Is Important to Consider the Effects of Analgesics on Sleep: A Critical Review. Compr Physiol 2021; 11:2589-2619. [PMID: 34558668 DOI: 10.1002/cphy.c210006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
We review the known physiological mechanisms underpinning all of pain processing, sleep regulation, and pharmacology of analgesics prescribed for chronic pain. In particular, we describe how commonly prescribed analgesics act in sleep-wake neural pathways, with potential unintended impact on sleep and/or wake function. Sleep disruption, whether pain- or drug-induced, negatively impacts quality of life, mental and physical health. In the context of chronic pain, poor sleep quality heightens pain sensitivity and may affect analgesic function, potentially resulting in further analgesic need. Clinicians already have to consider factors including efficacy, abuse potential, and likely side effects when making analgesic prescribing choices. We propose that analgesic-related sleep disruption should also be considered. The neurochemical mechanisms underlying the reciprocal relationship between pain and sleep are poorly understood, and studies investigating sleep in those with specific chronic pain conditions (including those with comorbidities) are lacking. We emphasize the importance of further work to clarify the effects (intended and unintended) of each analgesic class to inform personalized treatment decisions in patients with chronic pain. © 2021 American Physiological Society. Compr Physiol 11:1-31, 2021.
Collapse
Affiliation(s)
- Stella Iacovides
- Brain Function Research Group, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Peter Kamerman
- Brain Function Research Group, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Fiona C Baker
- Brain Function Research Group, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.,Human Sleep Research Program, SRI International, Menlo Park, California, USA
| | - Duncan Mitchell
- Brain Function Research Group, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| |
Collapse
|
12
|
Towards the endotyping of the sleep-pain interaction: a topical review on multitarget strategies based on phenotypic vulnerabilities and putative pathways. Pain 2021; 162:1281-1288. [PMID: 33105436 DOI: 10.1097/j.pain.0000000000002124] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Accepted: 10/20/2020] [Indexed: 12/17/2022]
|
13
|
Herrero Babiloni A, Beetz G, Bruneau A, Martel MO, Cistulli PA, Nixdorf DR, Conway JM, Lavigne GJ. Multitargeting the sleep-pain interaction with pharmacological approaches: A narrative review with suggestions on new avenues of investigation. Sleep Med Rev 2021; 59:101459. [PMID: 33601274 DOI: 10.1016/j.smrv.2021.101459] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 01/18/2021] [Accepted: 01/19/2021] [Indexed: 12/21/2022]
Abstract
The multimorbidity formed by sleep disturbances and pain conditions is highly prevalent and has a significant impact in global health and in the socioeconomic system. Although different approaches have been directed toward its management, evidence regarding an optimal treatment is lacking, and pharmacological options are often preferred. Health professionals (e.g., pain and sleep clinicians) tend to focus on their respective expertise, targeting a single symptom with a single drug. This may increase polypharmacy and the risk of drug interactions, adverse events, and mortality. Hence, the use of medications that can directly or indirectly improve sleep, pain, and other possible accompanying conditions without exacerbating them becomes especially relevant. The objectives of this comprehensive review are to: a) describe the beneficial or deleterious effects that some commonly used medications to manage pain have on sleep and sleep disorders; and b) describe the beneficial or deleterious effects that frequently prescribed medications for sleep may have on pain. Moreover, medications targeting some specific sleep-pain interactions will be suggested and future directions for improving sleep and alleviating pain of these patients will be provided with clinical and research perspectives.
Collapse
Affiliation(s)
- Alberto Herrero Babiloni
- Division of Experimental Medicine, McGill University, Montreal, Québec, Canada; Center for Advanced Research in Sleep Medicine, Research Centre, Hôpital du Sacré-Coeur de Montréal (CIUSSS du Nord de-l'Île-de-Montréal), Québec, Canada; Faculty of Dental Medicine, Université de Montréal, Québec, Canada.
| | - Gabrielle Beetz
- Center for Advanced Research in Sleep Medicine, Research Centre, Hôpital du Sacré-Coeur de Montréal (CIUSSS du Nord de-l'Île-de-Montréal), Québec, Canada
| | - Alice Bruneau
- Division of Experimental Medicine, McGill University, Montreal, Québec, Canada
| | - Marc O Martel
- Division of Experimental Medicine, McGill University, Montreal, Québec, Canada; Faculty of Dentistry & Department of Anesthesia, McGill University, Canada
| | - Peter A Cistulli
- Sleep Research Group, Charles Perkins Centre, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia; Centre for Sleep Health and Research, Department of Respiratory and Sleep Medicine, Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - Donald R Nixdorf
- Division of TMD and Orofacial Pain, Department of Diagnostic and Biological Sciences, School of Dentistry, University of Minnesota, Minneapolis, MN, USA; Department of Neurology, Medical School, University of Minnesota, Minneapolis, MN, USA; HealthPartners Institute for Education and Research, Bloomington, MN, USA
| | | | - Gilles J Lavigne
- Division of Experimental Medicine, McGill University, Montreal, Québec, Canada; Center for Advanced Research in Sleep Medicine, Research Centre, Hôpital du Sacré-Coeur de Montréal (CIUSSS du Nord de-l'Île-de-Montréal), Québec, Canada; Faculty of Dental Medicine, Université de Montréal, Québec, Canada
| |
Collapse
|
14
|
Freynhagen R, Baron R, Kawaguchi Y, Malik RA, Martire DL, Parsons B, Rey RD, Schug SA, Jensen TS, Tölle TR, Ushida T, Whalen E. Pregabalin for neuropathic pain in primary care settings: recommendations for dosing and titration. Postgrad Med 2021; 133:1-9. [PMID: 33423590 DOI: 10.1080/00325481.2020.1857992] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Pregabalin is one of the first-line treatments approved for the management of neuropathic pain (NeP). While many patients benefit from treatment with pregabalin, they are often treated with suboptimal doses, possibly due to unfamiliarity around prescribing the drug and/or side effects that can occur with up-titration. This narrative review discusses key aspects of initiating, titrating, and managing patients prescribed pregabalin therapy, and addresses concerns around driving and the potential for abuse, as well as when to seek specialist opinion. To ensure that patients derive maximum therapeutic benefit from the drug, we suggest a 'low and slow' dosing approach to limit common side effects and optimize tolerability alongside patients' expectations. When requiring titration to higher doses, we recommend initiating 'asymmetric dosing,' with the larger dose in the evening. Fully engaging patients in order for them to understand the expected timeline for efficacy and side effects (including their resolution), can also help determine the optimal titration tempo for each individual patient. The 'low and slow' approach also recognizes that patients with NeP are heterogeneous in terms of their optimal therapeutic dose of pregabalin. Hence, it is recommended that general practitioners closely monitor patients and up-titrate according to pain relief and side effects to limit suboptimal dosing or premature discontinuation.
Collapse
Affiliation(s)
- Rainer Freynhagen
- Center for Anaesthesiology, Intensive Care, Pain Medicine & Palliative Medicine, Benedictus Hospital, Feldafing, Germany
| | - Ralf Baron
- Department of Anaesthesiology, Technische Universtät München, Munich, Germany
| | - Yoshiharu Kawaguchi
- Division of Neurological Pain Research and Therapy, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Rayaz A Malik
- Department of Orthopaedic Surgery, Toyama University Hospital, Toyama, Japan; eWeill Cornell Medicine, Qatar, Doha, Qatar
| | | | | | | | - Stephan A Schug
- Argentine Institute for Neurological Research (IADIN), Buenos Aires, Argentina
| | | | - Thomas R Tölle
- Anaesthesiology and Pain Medicine, Medical School, University of Western Australia, Perth, WA, Australia
| | - Takahiro Ushida
- Department of Neurology and Diabetic Neuropathy Consortium, Aarhus University Hospital, Aarhus, Denmark
| | - Ed Whalen
- Department of Neurology, Technische Universität München, Munich, Germany.,Multidisciplinary Pain Center, Aichi Medical University Hospital, Nagakute, Japan
| |
Collapse
|
15
|
Kwong PPK, Chan EYK, Cheung EYW, Fong SYY, Nip W, Cheung HHK, Yip IPL, Chong KY, Pao RSY, Tam KL, Tang MH, Chan SKC, Mak KY. Consensus statements on the clinical uses of pregabalin for Hong Kong. Asia Pac Psychiatry 2020; 12:e12403. [PMID: 32830438 DOI: 10.1111/appy.12403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Accepted: 06/15/2020] [Indexed: 11/29/2022]
Abstract
To facilitate the understanding of pregabalin and optimize its clinical usage in Hong Kong, an expert panel (11 psychiatrists, one family physician and one anesthesiologist) experienced in treating anxiety and somatic symptoms was invited to establish a set of consensus statements based on several discussion areas. A non-systematic literature search for relevant articles was conducted. The panelists addressed the discussion areas by sharing their clinical experience and available literature in a couple of meetings. At the last meeting, consensus statements derived from the proceedings were discussed and finalized. A total of 11 statements were ultimately accepted by panel voting based on their practicability of recommendation in Hong Kong. These statements are aimed to act as a practical reference for local clinicians when they consider prescribing pregabalin in different clinical situations.
Collapse
Affiliation(s)
- Patrick Po-Keung Kwong
- Asian Association of Neuropsychopharmacology (AANP), Anxiety Hong Kong Study Group Panelists
| | - Eric Yan-Kwong Chan
- Asian Association of Neuropsychopharmacology (AANP), Anxiety Hong Kong Study Group Panelists
| | - Eric Yat-Wo Cheung
- Asian Association of Neuropsychopharmacology (AANP), Anxiety Hong Kong Study Group Panelists
| | - Samson Yat-Yuk Fong
- Asian Association of Neuropsychopharmacology (AANP), Anxiety Hong Kong Study Group Panelists
| | - Wai Nip
- Asian Association of Neuropsychopharmacology (AANP), Anxiety Hong Kong Study Group Panelists
| | - Henry Hon-Kee Cheung
- Asian Association of Neuropsychopharmacology (AANP), Anxiety Hong Kong Study Group Panelists
| | - Isaac Pui-Lam Yip
- Asian Association of Neuropsychopharmacology (AANP), Anxiety Hong Kong Study Group Panelists
| | - King-Yee Chong
- Asian Association of Neuropsychopharmacology (AANP), Anxiety Hong Kong Study Group Panelists
| | - Ronnie Sze-Yuan Pao
- Asian Association of Neuropsychopharmacology (AANP), Anxiety Hong Kong Study Group Panelists
| | - Ka-Lok Tam
- Asian Association of Neuropsychopharmacology (AANP), Anxiety Hong Kong Study Group Panelists
| | - Man-Ho Tang
- Asian Association of Neuropsychopharmacology (AANP), Anxiety Hong Kong Study Group Panelists
| | - Simon Kin-Cheong Chan
- Asian Association of Neuropsychopharmacology (AANP), Anxiety Hong Kong Study Group Panelists
| | - Ki-Yan Mak
- Asian Association of Neuropsychopharmacology (AANP), Anxiety Hong Kong Study Group Panelists
| |
Collapse
|
16
|
Prevalence of sleep disturbance in patients with lumbar spinal stenosis and analysis of the risk factors. Spine J 2020; 20:1239-1247. [PMID: 32061837 DOI: 10.1016/j.spinee.2020.02.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Revised: 01/18/2020] [Accepted: 02/08/2020] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Although sleep quality is indispensable for good quality of life, it has not been properly measured or treated in patients with lumbar spinal stenosis (LSS). Studies that investigate the prevalence of sleep disturbances and identify high-risk patients are essential to help understand mechanisms of sleep disturbance in patients with LSS, develop multimodal treatment strategies, and eventually improve the clinical outcome for LSS. PURPOSE The purpose of the study was to investigate the prevalence and status of sleep disturbance in patients with LSS and understand its mechanism by identifying the risk factors. STUDY DESIGN/SETTING Cross-sectional study. PATIENT SAMPLE Patients diagnosed with LSS. OUTCOME MEASURES Pittsburgh sleep quality index (PSQI). METHODS A study was performed on patients diagnosed with LSS. Sleep disturbance was evaluated using the PSQI. Clinical and radiologic risk factors of sleep disturbance were investigated by comparing its presence and absence in patients with LSS. Multivariate logistic regression analysis was conducted to identify significant risk factors related to sleep disturbance. RESULTS A total of 230 patients with LSS were analyzed in our study, 141 of whom (61.3%) were women, and the average age was 67.7 years. Sleep disturbance (PSQI score≥6) was identified in 66.1% of the patients (152 out of 230). After a multivariate analysis, sleep disturbance was consistently associated with the female sex, a negative score on the depression scale, and a severe foraminal-type stenosis. Oswestry disability index, visual analogue pain scale, and presence of nocturnal pain were not independently associated with sleep disturbance. CONCLUSIONS This study identified potential high-risk groups for sleep disturbance among patients with LSS. Proper caution and evaluation for these patients, along with further studies about their treatment outcomes, are required.
Collapse
|
17
|
Morano A, Palleria C, Citraro R, Nesci V, De Caro C, Giallonardo AT, De Sarro G, Russo E, Di Bonaventura C. Immediate and controlled-release pregabalin for the treatment of epilepsy. Expert Rev Neurother 2019; 19:1167-1177. [PMID: 31623493 DOI: 10.1080/14737175.2019.1681265] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Introduction: Epilepsy is a common neurological disease requiring complex therapies, which are unable to achieve seizure control in 30% of patients. Poor adherence has been recognized as a possible determinant of drug-resistance. Prolonged-release formulations of antiepileptic drugs might help increase adherence and minimize side effects.Areas covered: Pregabalin (PGB) has peculiar pharmacodynamics and almost ideal pharmacokinetics, except for a short half-life and therefore requiring multiple daily dosing. PGB immediate-release (IR) is effective in focal-onset epilepsy (FOE), neuropathic pain, generalized anxiety disorder, and fibromyalgia, despite some tolerability issues, especially at higher doses. The controlled-release formulation (CR) shares PGB IR advantages and requires slight dose adjustments to guarantee bioavailability. In 2014, PGB CR (165 and 330 mg/day) failed to prove superior to placebo in a randomized placebo-controlled trial on 323 subjects with drug-resistant FOE, although it was just as tolerable. Therefore, PGB CR is not currently licensed for epilepsy.Expert opinion: Considering the disappointing results of the only controlled trial, PGB CR is unlikely to become an established epilepsy treatment anytime soon. Nevertheless, given its peculiar properties and potential advantages, PGB (in either formulation) should be further evaluated in specific populations of patients, especially fragile subjects with several comorbidities and complex polytherapies.
Collapse
Affiliation(s)
- Alessandra Morano
- Neurology Unit, Department of Human Neurosciences, "Sapienza" University, Rome, Italy
| | - Caterina Palleria
- Science of Health Department, School of Medicine, University of Catanzaro, Catanzaro, Italy
| | - Rita Citraro
- Science of Health Department, School of Medicine, University of Catanzaro, Catanzaro, Italy
| | - Valentina Nesci
- Science of Health Department, School of Medicine, University of Catanzaro, Catanzaro, Italy
| | - Carmen De Caro
- Science of Health Department, School of Medicine, University of Catanzaro, Catanzaro, Italy
| | | | | | - Emilio Russo
- Science of Health Department, School of Medicine, University of Catanzaro, Catanzaro, Italy
| | - Carlo Di Bonaventura
- Neurology Unit, Department of Human Neurosciences, "Sapienza" University, Rome, Italy
| |
Collapse
|
18
|
Nakashima H, Kanemura T, Ando K, Kobayashi K, Yoneda M, Ishiguro N, Imagama S. Is Pregabalin Effective Against Acute Lumbar Radicular Pain ? Spine Surg Relat Res 2018; 3:61-66. [PMID: 31435553 PMCID: PMC6690119 DOI: 10.22603/ssrr.2018-0003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Accepted: 05/22/2018] [Indexed: 01/01/2023] Open
Abstract
Introduction Nonsteroidal anti-inflammatory drugs (NSAIDs) are the first-line treatment for acute lumbar radicular pain accompanying lumbar disc herniation (LDH), but their effects are minimal. The purpose of this study was to evaluate the efficacy and safety of pregabalin (PGB) as an alternative therapy for this condition. Methods Patients with acute lumbar radicular pain accompanying LDH were randomly administered either NSAIDs plus PGB (30 patients) or NSAIDs alone (30 patients) for up to 4 weeks. The primary outcome was leg pain at 2 and 4 weeks. Secondary outcomes were reduction in sleep disturbances and patient global impressions of change (PGIC) at 2 and 4 weeks. Results Four patients in the NSAIDs plus PGB group were deemed ineligible and excluded from the study. Fewer sleep disturbances were reported by patients administered NSAIDs plus PGB compared with the NSAID monotherapy group at both 2 and 4 weeks. Additionally, the NSAIDs plus PGB group showed greater improvement in pain than the NSAID monotherapy group at 4 weeks, although this difference was not significant. PGIC was also significantly better in the NSAIDs plus PGB group than in the NSAID monotherapy group at 4 weeks. The incidence of adverse events was significantly greater in the NSAIDs plus PGB group than in the NSAID monotherapy group. Conclusions The combination of NSAIDs plus PGB is more effective against sleep disturbance than NSAIDs alone in patients with acute LDH, although the control of sciatic pain is minimal. Patients reported satisfactory recoveries could also be obtained, and thus, this combination therapy could be a good option for the conservative treatment of acute lumbar radicular pain, including LDH.
Collapse
Affiliation(s)
- Hiroaki Nakashima
- Department of Orthopedic Surgery, Konan Kosei Hospital, Konan, Japan.,Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Tokumi Kanemura
- Department of Orthopedic Surgery, Konan Kosei Hospital, Konan, Japan
| | - Kei Ando
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Kazuyoshi Kobayashi
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Minoru Yoneda
- Department of Orthopedic Surgery, Yoneda Hospital, Nagoya, Japan
| | - Naoki Ishiguro
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Shiro Imagama
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| |
Collapse
|
19
|
Karaarslan N, Yilmaz I, Sirin DY, Ozbek H, Kaplan N, Kaya YE, Akyuva Y, Gurbuz MS, Oznam K, Ates O. Pregabalin treatment for neuropathic pain may damage intervertebral disc tissue. Exp Ther Med 2018; 16:1259-1265. [PMID: 30112057 PMCID: PMC6090477 DOI: 10.3892/etm.2018.6289] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2017] [Accepted: 03/23/2018] [Indexed: 12/22/2022] Open
Abstract
The aim of the present study was to determine whether pharmaceutical preparations with pregabalin (PGB) as an active ingredient, which are widely prescribed by clinicians, exert toxic effects on human primary nucleus pulposus (NP) and annulus fibrosis (AF). Primary human cell cultures were obtained from intact (n=6) and degenerated (n=6) tissues resected from the two groups of patients. Different doses of PGB were applied to these cultures and cells were subjected to molecular analyses at 0, 24 and 48 h. Cell vitality, toxicity and proliferation were assessed using a spectrophotometer. The expression of chondroadherin (CHAD), a (member of the NP-specific protein family), hypoxia-inducible factor-1α (HIF-1α) and type II collagen (COL2A1) was measured using reverse transcription-quantitative polymerase chain reaction. The results revealed that cell intensity increased in a time-dependent manner and cell vitality continued in the cultures without pharmaceuticals. Cell proliferation was suppressed in the PGB-treated cultures independent from the dose and duration of application. PGB was demonstrated to suppress the expression of CHAD and HIF-1α. In contrast, COL2A1 gene expression was not revealed in any experimental group. The present study utilized an in vitro model and the PGB active ingredient used herein may not be representative of clinical applications; however, the results demonstrated that PGB has a toxic effect on NP/AF cell cultures containing primary human intervertebral disc tissue. In summary, the use of pharmacological agents containing PGB may suppress the proliferation and differentiation of NP/AF cells and/or tissues, which should be considered when deciding on an appropriate treatment regime.
Collapse
Affiliation(s)
- Numan Karaarslan
- Department of Neurosurgery, Namik Kemal University School of Medicine, Tekirdag 59100, Turkey
| | - Ibrahim Yilmaz
- Department of Medical Pharmacology, Istanbul Medipol University School of Medicine, Istanbul 34810, Turkey
| | - Duygu Yasar Sirin
- Department of Molecular Biology and Genetics, Faculty of Arts and Sciences, Namik Kemal University, Tekirdag 59030, Turkey
| | - Hanefi Ozbek
- Department of Medical Pharmacology, Istanbul Medipol University School of Medicine, Istanbul 34810, Turkey
| | - Necati Kaplan
- Department of Neurosurgery, Istanbul Rumeli University, Corlu Reyap Hospital, Tekirdag 59860, Turkey
| | - Yasin Emre Kaya
- Department of Orthopedic and Traumatology, Abant Izzet Basal University School of Medicine, Bolu 14000, Turkey
| | - Yener Akyuva
- Department of Neurosurgery, Gaziosmanpasa Taksim Training and Research Hospital, Istanbul 34433, Turkey
| | - Mehmet Sabri Gurbuz
- Department of Neurosurgery, Istanbul Medeniyet University School of Medicine, Istanbul 34730, Turkey
| | - Kadir Oznam
- Department of Orthopedic and Traumatology, Istanbul Medipol University School of Medicine, Istanbul 34214, Turkey
| | - Ozkan Ates
- Department of Neurosurgery, Istanbul Esenyurt University, Esencan Hospital, Istanbul 34517, Turkey
| |
Collapse
|
20
|
Davis F, Gostine M, Roberts BA, Risko R, Cappelleri JC, Sadosky A. Interpreting the Effectiveness of Opioids and Pregabalin for Pain Severity, Pain Interference, and Fatigue in Fibromyalgia Patients. Pain Pract 2017; 18:611-624. [PMID: 29064627 DOI: 10.1111/papr.12651] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Revised: 09/27/2017] [Accepted: 10/17/2017] [Indexed: 01/09/2023]
Abstract
OBJECTIVE To evaluate the effectiveness of opioids and/or pregabalin on patient-reported outcomes among fibromyalgia (FM) patients based on levels of improvement. METHODS A total of 1,421 FM patients were identified, with 3,082 observational periods of opioids with or without pregabalin use between April 2008 and February 2015. Patients were categorized by opioids, and pregabalin with and without opioids; opioids were designated by morphine equivalent dose (MED) of ≤ 20 (low MED), > 20 to < 100 (moderate MED), ≥ 100 (high MED), and pregabalin doses of ≤ 150 mg, 151 to 300 mg, and 301 to 450 mg. Proportions of patients meeting clinically relevant thresholds of ≥ 30% and ≥ 50% improvement for pain interference (ability to enjoy life; activity; mood; relationships; sleep), pain severity, and fatigue were compared among treatments, and area under the curve (AUC) for improvement and worsening of effects was determined, enabling ranking of treatments. Further analysis compared pregabalin doses. RESULTS Pregabalin without opioids resulted in the highest proportions of patients with ≥ 30% improvement on all pain items and pain interference with "ability to enjoy life," "activity" "mood," and "sleep." For the ≥ 50% threshold, pregabalin alone was highest for all pain interference items and for "average pain" and "worst pain." Pregabalin was consistently lowest across thresholds for fatigue, but showed better results combined with moderate MED opioids. Pregabalin doses recommended for treatment of FM (151 to 450 mg) generally resulted in the highest proportion of patients achieving thresholds relative to opioids. The AUC results were consistent with thresholds; pregabalin without opioids resulted in the greatest benefits with regard to improvement, with the highest ranking for overall improvement and overall effects. CONCLUSION Pregabalin without opioids provided the most favorable outcomes overall based on ≥ 30% and ≥ 50% improvement thresholds and AUC, with support for moderate MED opioids + pregabalin in patients suffering from fatigue. While most patients took less than recommended pregabalin doses, higher doses may lead to improved outcomes.
Collapse
Affiliation(s)
- Fred Davis
- ProCare Systems, Inc., Grand Rapids, Michigan, U.S.A
| | - Mark Gostine
- Michigan Pain Consultants, Grand Rapids, Michigan, U.S.A
| | | | - Rebecca Risko
- ProCare Systems, Inc., Grand Rapids, Michigan, U.S.A
| | | | | |
Collapse
|
21
|
D'Arcy Y, McCarberg B, Parsons B, Behar R, Thorpe A, Alexander A. Pregabalin for the treatment of neuropathic pain: a narrative review for primary care providers. Curr Med Res Opin 2017; 33:1353-1359. [PMID: 28426255 DOI: 10.1080/03007995.2017.1322051] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
BACKGROUND Neuropathic pain (NeP) is a distinct type of pain caused by damage to the nervous system itself. This often severe and chronic type of pain requires specific treatments that target the underlying pain pathophysiology. AIM The purpose of the current narrative review is to provide an overview of pregabalin (Lyrica 1 ) for the treatment of NeP including its effects on pain, pain-related sleep interference, and other health-related outcomes, timing of therapeutic effect, safety and tolerability, and dosing. The information provided here will help primary care providers develop more effective NeP treatment strategies.
Collapse
Affiliation(s)
| | - Bill McCarberg
- b University of California San Diego , San Diego , CA , USA
| | | | | | | | | |
Collapse
|
22
|
Targeting ASIC3 for Relieving Mice Fibromyalgia Pain: Roles of Electroacupuncture, Opioid, and Adenosine. Sci Rep 2017; 7:46663. [PMID: 28440280 PMCID: PMC5404229 DOI: 10.1038/srep46663] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Accepted: 03/21/2017] [Indexed: 01/19/2023] Open
Abstract
Many scientists are seeking better therapies for treating fibromyalgia (FM) pain. We used a mouse model of FM to determine if ASIC3 and its relevant signaling pathway participated in FM pain. We demonstrated that FM-induced mechanical hyperalgesia was attenuated by electroacupuncture (EA). The decrease in fatigue-induced lower motor function in FM mice was also reversed by EA. These EA-based effects were abolished by the opioid receptor antagonist naloxone and the adenosine A1 receptor antagonist rolofylline. Administration of opioid receptor agonist endomorphin (EM) or adenosine A1 receptor agonist N6-cyclopentyladenosine (CPA) has similar results to EA. Similar results were also observed in ASIC3−/− or ASIC3 antagonist (APETx2) injected mice. Using western blotting, we determined that pPKA, pPI3K, and pERK were increased during a dual acidic injection priming period. Nociceptive receptors, such as ASIC3, Nav1.7, and Nav1.8, were upregulated in the dorsal root ganglion (DRG) and spinal cord (SC) of FM mice. Furthermore, pPKA, pPI3K, and pERK were increased in the central thalamus. These aforementioned mechanisms were completely abolished in ASIC3 knockout mice. Electrophysiological results also indicated that acid potentiated Nav currents through ASIC3 and ERK pathway. Our results highlight the crucial role of ASIC3-mediated mechanisms in the treatment of FM-induced mechanical hyperalgesia.
Collapse
|
23
|
Ogawa S, Arakawa A, Hayakawa K, Yoshiyama T. Pregabalin for Neuropathic Pain: Why Benefits Could Be Expected for Multiple Pain Conditions. Clin Drug Investig 2017; 36:877-888. [PMID: 27448285 DOI: 10.1007/s40261-016-0423-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND AND OBJECTIVE Limited research exists to support the extrapolation of the analgesic efficacy of pregabalin from one neuropathic pain condition to another. This retrospective analysis evaluated similarities in the efficacy of pregabalin for treating neuropathic pain associated with post-herpetic neuralgia (PHN), diabetic peripheral neuropathy (DPN), and spinal cord injury (SCI) in a Japanese population, as a basis for considering the extrapolation of these data to other neuropathic pain conditions. METHODS Data were analysed across pregabalin doses within each pain condition, from three comparable 13- to 16-week, randomized, double-blind, placebo-controlled trials (RCTs) and the corresponding 52-week, open-label extension trials of pregabalin in Japanese patients with PHN, DPN or SCI. Efficacy outcomes in the RCTs included endpoint and weekly mean pain and sleep interference scores; endpoint proportions of responders in pain; Patient Global Impression of Change scores; and 36-Item Short Form Health Survey (SF-36) scores or Hospital Anxiety and Depression Scale (HADS) assessments. Study discontinuation rates were compared between treatment groups. The extension trials assessed pain intensity, using the Short-Form McGill Pain Questionnaire. RESULTS In the RCTs for all pain conditions, significant improvements in comparison with placebo in mean pain and sleep interference scores were evident after 1 week with pregabalin and were sustained throughout the treatment periods (p < 0.05). At the study endpoint, in comparison with placebo, a significantly greater percentage of pregabalin-treated patients experienced a ≥30 % reduction in pain across the RCTs (p < 0.05), and pregabalin significantly improved six of 16 SF-36 subscale scores in the PHN and DPN trials (p < 0.05). In the SCI trial, pregabalin-treated patients had numerically better outcomes of HADS scores. In the extension trials, improvements in pain intensity were maintained over a 52-week period. CONCLUSION Similarities in the pregabalin efficacy profiles, including time to onset and magnitude of response, were confirmed regardless of the neuropathic pain condition. These data support the potential for extrapolating analgesic efficacy to other neuropathic pain conditions. CLINICALTRIALS. GOV IDENTIFIERS NCT00394901, NCT00553475, NCT00407745, NCT00424372, NCT00553280, NCT01202227.
Collapse
Affiliation(s)
- Setsuro Ogawa
- Department of Anesthesiology, Nihon University School of Medicine/Surugadai Nihon University Hospital, Tokyo, Japan
| | - Akio Arakawa
- Portfolio and Project Management, Pfizer Japan Inc., Tokyo, Japan
| | | | - Tamotsu Yoshiyama
- Clinical Statistics, Pfizer Japan Inc., 3-22-7 Yoyogi, Shibuya-ku, Tokyo, 151-8589, Japan.
| |
Collapse
|
24
|
Abstract
Laparoscopic surgery is widespread, and an increasing number of surgeries are performed laparoscopically. Early pain after laparoscopy can be similar or even more severe than that after open surgery. Thus, proactive pain management should be provided. Pain after laparoscopic surgery is derived from multiple origins; therefore, a single agent is seldom sufficient. Pain is most effectively controlled by a multimodal, preventive analgesia approach, such as combining opioids with non-opioid analgesics and local anaesthetics. Wound and port site local anaesthetic injections decrease abdominal wall pain by 1-1.5 units on a 0-10 pain scale. Inflammatory pain and shoulder pain can be controlled by NSAIDs or corticosteroids. In some patient groups, adjuvant drugs, ketamine and α2-adrenergic agonists can be helpful, but evidence on gabapentinoids is conflicting. In the present review, the types of pain that need to be taken into account while planning pain management protocols and the wide range of analgesic options that have been assessed in laparoscopic surgery are critically assessed. Recommendations to the clinician will be made regarding how to manage acute pain and how to prevent persistent postoperative pain. It is important to identify patients at the highest risk for severe and prolonged post-operative pain, and to have a proactive strategy in place for these individuals.
Collapse
|
25
|
Lu KW, Hsieh CL, Yang J, Lin YW. Effects of electroacupuncture in a mouse model of fibromyalgia: role of N-methyl-D-aspartate receptors and related mechanisms. Acupunct Med 2016; 35:59-68. [PMID: 27381504 PMCID: PMC5466914 DOI: 10.1136/acupmed-2015-010986] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/09/2016] [Indexed: 12/16/2022]
Abstract
Objective N-methyl-D-aspartate receptor (NMDAR) activation and downstream transduction pathways are crucial for pain signalling. Fibromyalgia (FM) is a common pain syndrome of unclear aetiology that is often drug-refractory but may benefit from treatment with electroacupuncture (EA). We examined the contributions of NMDAR signalling to FM pain and EA responses in a mouse model. Methods A model of FM was established by acid saline injection in 32 mice and subgroups (n=8 each) were treated with EA (2 Hz, 15 min daily for 4 days) or minimal acupuncture (MA). Expression of NMDAR subunits, calmodulin-dependent protein kinase II (CaMKII), cyclic AMP response element binding protein (pCREB) and their corresponding phospho-activated forms were measured by Western blotting and immunohistochemistry. Results Acid saline injection induced significant mechanical hyperalgesia (paw withdrawal threshold 2.18±0.27 g, p<0.05 vs controls), which was reversed by EA (4.23±0.33 g, p<0.05 vs FM group) but not by MA (2.37±0.14 g, p<0.05 vs EA group). Expression levels of phosphorylated N-methyl-D-aspartate receptor (pNR)1 and pNR2B were significantly increased in the dorsal root ganglion of FM model mice (132.21±14.4% and 116.69±3.22% of control values), whereas NR1 and NR2B levels were unchanged (97.31±3.79% and 97.07%±2.27%, respectively). Expression levels of pCaMKIIα and pCREB were also higher in the FM group, and these changes were reversed by EA but not by MA. Similar changes in expression were observed in spinal cord neurons. Conclusions Reduced NMDAR−CaMKIIα−pCREB signalling is implicated in the positive effects of EA in FM. NMDAR signalling components may represent promising therapeutic targets for FM treatment.
Collapse
Affiliation(s)
- Kung-Wen Lu
- College of Chinese Medicine, School of Post-Baccalaureate Chinese Medicine, China Medical University, Taichung, Taiwan
- Department of Chinese Medicine, China Medical University Hospital, Taichung, Taiwan
| | - Ching-Liang Hsieh
- Department of Chinese Medicine, China Medical University Hospital, Taichung, Taiwan
- College of Chinese Medicine, Graduate Institute of Integrative Medicine, China Medical University, Taichung, Taiwan
| | - Jun Yang
- Department of Chinese Medicine, China Medical University Hospital, Taichung, Taiwan
| | - Yi-Wen Lin
- College of Chinese Medicine, Graduate Institute of Acupuncture Science, China Medical University, Taichung, Taiwan
- Research Center for Chinese Medicine & Acupuncture, China Medical University, Taichung, Taiwan
| |
Collapse
|
26
|
Efficacy and Safety of Pregabalin in the Treatment of Patients With Painful Diabetic Peripheral Neuropathy and Pain on Walking. Clin J Pain 2016; 31:946-58. [PMID: 25565583 DOI: 10.1097/ajp.0000000000000198] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES This randomized, double-blind, placebo-controlled, multicenter, 2-period crossover study (two 6-week treatment periods separated by a 2-week washout period) evaluated the efficacy and safety of pregabalin (150 to 300 mg/d) for treatment of pain and pain on walking in patients with painful diabetic peripheral neuropathy (DPN) who experienced pain while walking. METHODS Co-primary efficacy endpoints were: (1) mean pain score (last 7 daily pain diary scores, 0 to 10 numeric rating scale at end of each treatment period) and (2) DPN pain on walking (0 to 10 numeric rating scale immediately after walking 50 feet [15.2 m] on flat surface). Secondary endpoints included other pain parameters, patient-reported sleep, health-related quality of life, and safety measures. RESULTS Two hundred three patients were treated (pregabalin, n=198; placebo, n=186), with no statistically significant treatment difference for pregabalin versus placebo in the co-primary efficacy endpoints, mean DPN pain (P=0.0656) and mean DPN pain on walking (P=0.412). A carryover effect was observed. Analysis of co-primary endpoints for period 1 showed significant treatment difference for DPN pain (P=0.034) and DPN pain on walking (P=0.001). Treatment with pregabalin resulted in significant improvements versus placebo on prespecified patient global impression of change (end of period 1; P=0.002), and sleep interference rating scale (end of period 2; P=0.011). Adverse events were more frequent with pregabalin than with placebo and caused discontinuation in 13 (6.6%) pregabalin patients versus 5 (2.7%) placebo patients. DISCUSSION Failure to meet the co-primary objectives may be related to carryover effect from period 1 to period 2, lower pregabalin dose (150 to 300 mg/d), and/or placebo response in painful DPN.
Collapse
|
27
|
|
28
|
Ruiz MA, Álvarez E, Carrasco JL, Olivares JM, Pérez M, Rejas J. Modeling the longitudinal latent effect of pregabalin on self-reported changes in sleep disturbances in outpatients with generalized anxiety disorder managed in routine clinical practice. DRUG DESIGN DEVELOPMENT AND THERAPY 2015; 9:4329-40. [PMID: 26273194 PMCID: PMC4532214 DOI: 10.2147/dddt.s88238] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Background Anxiety disorders are among the most common psychiatric illnesses, with generalized anxiety disorder (GAD) being one of the most common. Sleep disturbances are highly prevalent in GAD patients. While treatment with pregabalin has been found to be associated with significant improvement in GAD-related sleep disturbance across many controlled clinical trials, mediational analysis has suggested that a substantial portion of this effect could be the result of a direct effect of pregabalin. Thus, the objective of this study was to model the longitudinal latent effect of pregabalin or usual care (UC) therapies on changes in sleep in outpatients with GAD under routine clinical practice. Methods Male and female GAD outpatients, aged 18 years or above, from a 6-month prospective noninterventional trial were analyzed. Direct and indirect effects of either pregabalin or UC changes in anxiety symptoms (assessed with Hamilton Anxiety Scale) and sleep disturbances (assessed with Medical Outcomes Study-Sleep Scale [MOS-S]) were estimated by a conditional latent curve model applying structural equation modeling. Results A total of 1,546 pregabalin-naïve patients were analyzed, 984 receiving pregabalin and 562 UC. Both symptoms of anxiety and sleep disturbances were significantly improved in both groups, with higher mean (95% confidence interval) score reductions in subjects receiving pregabalin: −15.9 (−15.2; −16.6) vs −14.5 (−13.5; −15.5), P=0.027, in Hamilton Anxiety Scale; and −29.7 (−28.1; −31.3) vs −24.0 (−21.6; −26.4), P<0.001, in MOS-S. The conditional latent curve model showed that the pregabalin effect on sleep disturbances was significant (γ =−3.99, P<0.001), after discounting the effect on reduction in anxiety symptoms. A mediation model showed that 70% of the direct effect of pregabalin on sleep remained after discounting the mediated effect of anxiety improvement. Conclusion A substantial proportion of the incremental improvements in anxiety-related sleep disturbances with pregabalin vs UC were explained by its direct effect, not mediated by improvements in anxiety symptoms.
Collapse
Affiliation(s)
- Miguel A Ruiz
- Department of Methodology, School of Psychology, Universidad Autónoma de Madrid, Madrid, Spain
| | - Enrique Álvarez
- Department of Psychiatry, Hospital de la Santa Creu i San Pau, Barcelona, Spain
| | - Jose L Carrasco
- Department of Psychiatry, Hospital Clínico San Carlos, Madrid, Spain
| | - José M Olivares
- Department of Psychiatry, Hospital Meixoeiro, Complejo Hospitalario Universitario, Vigo, Spain
| | - María Pérez
- Medical Department, Pfizer, S.L.U., Alcobendas, Madrid, Spain
| | - Javier Rejas
- Health Economics and Outcomes Research Department, Pfizer, S.L.U., Alcobendas, Madrid, Spain
| |
Collapse
|
29
|
Taguchi T, Igarashi A, Watt S, Parsons B, Sadosky A, Nozawa K, Hayakawa K, Yoshiyama T, Ebata N, Fujii K. Effectiveness of pregabalin for the treatment of chronic low back pain with accompanying lower limb pain (neuropathic component): a non-interventional study in Japan. J Pain Res 2015; 8:487-97. [PMID: 26346468 PMCID: PMC4531006 DOI: 10.2147/jpr.s88642] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Objective To evaluate the impact of pregabalin on sleep, pain, function, and health status in patients with chronic low back pain with accompanying neuropathic pain (CLBP-NeP) under routine clinical practice. Methods This prospective, non-interventional, observational study enrolled Japanese adults (≥18 years) with CLBP-NeP of duration ≥3 months and severity ≥5 on a numerical rating scale (0= no pain, 10= worst possible pain). Treatment was 8 weeks with pregabalin (n=157) or usual care alone (n=174); choice of treatment was determined by the physician. The primary efficacy outcome was change from baseline to 8 weeks in pain-related interference with sleep, assessed using the Pain-Related Sleep Interference Scale (PRSIS; 0= did not interfere with sleep, 10= completely interferes with sleep). Secondary endpoints were changes in PRSIS at week 4, and changes at weeks 4 and 8 in pain (numerical rating scale), function (Roland-Morris Disability Questionnaire), and quality of life (EuroQol 5D-5L); global assessments of change were evaluated from the clinician and patient perspectives at the final visit. Results Demographic characteristics were similar between cohorts, but clinical characteristics suggested greater disease severity in the pregabalin group including a higher mean (standard deviation) pain score, 6.3 (1.2) versus 5.8 (1.1) (P<0.001). For the primary endpoint, pregabalin resulted in significantly greater improvements in PRSIS at week 8, least-squares mean changes of −1.3 versus −0.4 for usual care (P<0.001); pregabalin also resulted in greater PRSIS improvement at week 4 (P=0.012). Relative to usual care at week 8, pregabalin improved pain and function (both P<0.001), and showed global improvements since beginning study medication (P<0.001). Pregabalin was well tolerated. Conclusion In clinical practice in patients with CLBP-NeP, pregabalin showed significantly greater improvements in pain-related interference with sleep relative to usual care. In addition, pregabalin significantly improved pain, function, and health status, suggesting the benefits of pregabalin for overall health and well-being relative to usual care in these patients. (Clinicaltrials. gov identifier NCT02273908).
Collapse
Affiliation(s)
- Toshihiko Taguchi
- Department of Orthopaedic Surgery, Yamaguchi University Graduate School of Medicine, Ube, Yamaguchi, Japan
| | - Ataru Igarashi
- Department of Drug Policy and Management, Graduate School of Pharmaceutical Sciences, The University of Tokyo, Tokyo, Japan
| | | | | | | | | | | | | | | | | |
Collapse
|
30
|
Trenkwalder C, Winkelmann J, Inoue Y, Paulus W. Restless legs syndrome-current therapies and management of augmentation. Nat Rev Neurol 2015. [PMID: 26215616 DOI: 10.1038/nrneurol.2015.122] [Citation(s) in RCA: 64] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Idiopathic restless legs syndrome (RLS) can severely affect quality of life and disturb sleep, so that pharmacological treatment is necessary, especially for elderly patients. Treatment guidelines recommend initiation of therapy with dopamine agonists (pramipexole, ropinirole or the rotigotine transdermal patch, all approved in most countries) or α-2-δ ligands (gabapentin enacarbil, approved in the USA and Japan), depending on the country and availability. Where approved, opioids (prolonged release oxycodone-naloxone, approved in Europe) are also recommended as a second-line therapy for severe RLS. Several iron formulations can be effective but are not yet approved for RLS therapy, whereas benzodiazepines and other anticonvulsants are not recommended or approved. Less is known about effective management of RLS that is associated with other conditions, such as uraemia or pregnancy. Furthermore, very little data are available on the management of RLS when first-line treatment fails or patients experience augmentation. In this Review, we summarize state-of-the-art therapies for RLS in the context of the diagnostic criteria and available guidelines, based on knowledge ranging from Class I evidence for the treatment of idiopathic RLS to Class IV evidence for the treatment of complications such as augmentation. We consider therapies, including combination therapies, that are used in clinical practice for long-term management of RLS, despite a lack of trials and approval, and highlight the need for practical long-term evaluation of current trials.
Collapse
Affiliation(s)
- Claudia Trenkwalder
- 1] Paracelsus Elena Klinik, Centre of Parkinsonism and Movement Disorders, Kassel, Klinikstrasse 16, 34128 Kassel, Germany. [2] Department of Neurosurgery, University Medical Centre Göttingen, Robert-Koch-Strasse 40, 37075 Göttingen, Germany
| | - Juliane Winkelmann
- 1] Department of Neurology and Neurological Sciences and Centre for Sleep Sciences and Medicine, Stanford University, 3165 Porter Drive Palo Alto, CA 94304, USA. [2] Neurologische Klinik und Poliklinik, Klinikum rechts der Isar, Technische Universität München, Ismaningerstrasse 22, 81675 Munich, Germany
| | - Yuichi Inoue
- 1] Japan Somnology Center, Neuropsychiatric Research Institute, 1-17-7-301 Yoyogi, Shibuya-ku, Tokyo 151-0053, Japan. [2] Department of Somnology, Tokyo Medical University, Nishi-Shinjuku 6-7-1, Shinjuku-ku, Tokyo 160-0023, Japan
| | - Walter Paulus
- Department of Clinical Neurophysiology, University Medical Centre Göttingen, Robert-Koch-Strasse 40, 37075 Göttingen, Germany
| |
Collapse
|
31
|
Grigg-Damberger MM, Foldvary-Schaefer N. Primary sleep disorders in people with epilepsy: clinical questions and answers. Child Adolesc Psychiatr Clin N Am 2015; 24:145-76. [PMID: 25455580 DOI: 10.1016/j.chc.2014.09.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
The questions facing clinicians with patients with sleep disorder and epilepsy are addressed in this article. Both adult and child epilepsy are discussed in the context of the most typical questions a clinician would have, such as "Are parasomnias more common in people with epilepsy?", "Is sleep architecture abnormal in children with epilepsy", along with outcomes of numerous questionnaire-based, case-based, and double-blind placebo studies on such aspects as sleep duration, daytime sleepiness, anxiety and fears, limb movement, nocturnal seizures, agitation, behavioral disorders, and learning disorders.
Collapse
Affiliation(s)
- Madeleine M Grigg-Damberger
- Department of Neurology, University of New Mexico School of Medicine, MSC10 5620, One University of New Mexico, Albuquerque, NM 87131-0001, USA.
| | - Nancy Foldvary-Schaefer
- Section of Sleep Medicine, Department of Neurology, Cleveland Clinic, S51, 9500 Euclid Avenue, Cleveland, OH 44195, USA
| |
Collapse
|
32
|
Effect of Pregabalin on Cardiovascular Responses to Exercise and Postexercise Pain and Fatigue in Fibromyalgia: A Randomized, Double-Blind, Crossover Pilot Study. PAIN RESEARCH AND TREATMENT 2015; 2015:136409. [PMID: 27026828 PMCID: PMC4710099 DOI: 10.1155/2015/136409] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/24/2015] [Accepted: 12/08/2015] [Indexed: 11/17/2022]
Abstract
Pregabalin, an approved treatment for fibromyalgia (FM), has been shown to decrease sympathetic nervous system (SNS) activity and inhibit sympathetically maintained pain, but its effects on exercise responses have not been reported. Methods. Using a randomized double-blind crossover design, we assessed the effect of 5 weeks of pregabalin (versus placebo) on acute cardiovascular and subjective responses to moderate exercise in 19 FM patients. Blood pressure (BP), heart rate (HR), and ratings of perceived exertion (RPE) during exercise and ratings of pain, physical fatigue, and mental fatigue before, during, and for 48 hours after exercise were compared in patients on pregabalin versus placebo and also versus 18 healthy controls. Results. On placebo, exercise RPE and BP were significantly higher in FM patients than controls (p < 0.04). Pregabalin responders (n = 12, defined by patient satisfaction and symptom changes) had significantly lower exercise BP, HR, and RPE on pregabalin versus placebo (p < 0.03) and no longer differed from controls (p > 0.26). Cardiovascular responses of nonresponders (n = 7) were not altered by pregabalin. In responders, pregabalin improved ratings of fatigue and pain (p < 0.04), but negative effects on pain and fatigue were seen in nonresponders. Conclusions. These preliminary findings suggest that pregabalin may normalize cardiovascular and subjective responses to exercise in many FM patients.
Collapse
|
33
|
|
34
|
Furey SA, Hull SG, Leibowitz MT, Jayawardena S, Roth T. A randomized, double-blind, placebo-controlled, multicenter, 28-day, polysomnographic study of gabapentin in transient insomnia induced by sleep phase advance. J Clin Sleep Med 2014; 10:1101-9. [PMID: 25317091 DOI: 10.5664/jcsm.4110] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVE To evaluate multiple doses of gabapentin 250 mg on polysomnography (PSG) and participant-reported sleep assessments in a 5-h phase advance insomnia model. METHODS Adults reporting occasional disturbed sleep received gabapentin 250 mg (n = 128) or placebo (n = 128). On Days 1 and 28, participants received medication 30 min before bedtime and were in bed from 17:00 to 01:00, ∼5 h before their habitual bedtime. Sleep was assessed by PSG, a post sleep questionnaire, and the Karolinska Sleep Diary. Next-day residual effects and tolerability were evaluated. On Days 2-27, participants took medication at home 30 min before their habitual bedtime. RESULTS Treatment-group demographics were comparable. Gabapentin resulted in significantly less PSG wake after sleep onset (WASO) compared with placebo on Day 1 (primary endpoint, mean: 107.0 versus 149.1 min, p ≤ 0.001) and Day 28 (113.6 versus 152.3 min, p = 0.002), and significantly greater total sleep time (TST; Day 1: 347.6 versus 283.9 min; Day 28: 335.3 versus 289.1 min) (p ≤ 0.001). Participant-reported WASO and TST also showed significant treatment effects on both days. Gabapentin was associated with less %stage1 on Day 1, and greater %REM on Day 28, versus placebo. During home use, gabapentin resulted in significantly less participant-reported WASO and higher ratings of sleep quality. Gabapentin was well tolerated (most common adverse events: headache, somnolence) with no evidence of next-day impairment. CONCLUSION Gabapentin 250 mg resulted in greater PSG and participant-reported sleep duration following a 5-h phase advance on Day 1 and Day 28 of use without evidence of next-day impairment, and greater sleep duration during at-home use.
Collapse
Affiliation(s)
| | - Steven G Hull
- Vince and Associates Clinical Research, Overland Park, KS
| | | | | | - Thomas Roth
- Sleep Disorders and Research Center, Henry Ford Health System, Detroit, MI
| |
Collapse
|