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Tavanaei R, Rezaee-Naserabad SS, Alizadeh S, Yazdani KO, Zali A, Farsani HA, Oraee-Yazdani S. Analgesic Effects of Preoperative Combination of Oral Pregabalin and Intravenous Magnesium Sulfate on Postoperative Pain in Patients Undergoing Posterolateral Spinal Fusion Surgery: A 4-arm, Randomized, Double-blind, Placebo-controlled Trial. J Neurosurg Anesthesiol 2024; 36:134-141. [PMID: 36603131 DOI: 10.1097/ana.0000000000000893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 08/31/2022] [Indexed: 01/07/2023]
Abstract
BACKGROUND Multimodal perioperative pain management including nonopioid analgesia is a major pillar of enhanced recovery after surgery programs. The aim of this study was to investigate the analgesic efficacy of the preoperative combination of 2 nonopioid drugs, oral pregabalin and intravenous magnesium sulfate, in patients undergoing posterolateral lumbar spinal fusion. METHODS This 4-arm, randomized, double-blind, placebo-controlled trial included 104 patients randomly allocated to receive: magnesium sulfate and pregabalin (MP), magnesium sulfate and oral placebo (M), 0.9% saline and oral pregabalin (P), and 0.9% saline and oral placebo (C). The study drugs were administered 1 hour preoperatively. The primary outcome was the cumulative morphine consumption on postoperative day 1. Secondary outcomes included visual analog scale scores for leg pain at rest and with movement, and postoperative nausea and vomiting (PONV) in the first 48 hours after surgery. RESULTS Cumulative morphine consumption on postoperative day 1 was lower in group MP (19.6±8.0 mg) compared with group M (32.6±9.5 mg; P <0.001), group P (28.9±9.4 mg; P =0.001), or group C (38.8±10.3 mg; P <0.001). Multiple linear regression demonstrated a significant association between group MP and cumulative morphine consumption (B=-5.4 [95% CI, -7.1, -3.7], P <0.001). Visual analog scale scores for leg pain at rest and with movement were lower in group MP compared with other groups ( P =0.006 and <0.001). The incidence of PONV was also lowest in group MP ( P =0.032). CONCLUSIONS Preoperative administration of oral pregabalin and intravenous magnesium sulfate resulted in reduced morphine consumption and greater analgesic effect than the use of each drug individually or placebo in patients undergoing posterolateral lumbar spinal fusion.
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Affiliation(s)
- Roozbeh Tavanaei
- Functional Neurosurgery Research Center, Shohada Tajrish Comprehensive Neurosurgical Center of Excellence, Shahid Beheshti University of Medical Sciences
| | - Seyyed S Rezaee-Naserabad
- Functional Neurosurgery Research Center, Shohada Tajrish Comprehensive Neurosurgical Center of Excellence, Shahid Beheshti University of Medical Sciences
| | - Sajjad Alizadeh
- Functional Neurosurgery Research Center, Shohada Tajrish Comprehensive Neurosurgical Center of Excellence, Shahid Beheshti University of Medical Sciences
| | - Kaveh O Yazdani
- Department of Cardiovascular Diseases, Zahedan University of Medical Science, Zahedan, Iran
| | - Alireza Zali
- Functional Neurosurgery Research Center, Shohada Tajrish Comprehensive Neurosurgical Center of Excellence, Shahid Beheshti University of Medical Sciences
| | - Hamidreza A Farsani
- Department of Anesthesiology, Shohada Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran
| | - Saeed Oraee-Yazdani
- Functional Neurosurgery Research Center, Shohada Tajrish Comprehensive Neurosurgical Center of Excellence, Shahid Beheshti University of Medical Sciences
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Naguy A, Pridmore S, Alamiri B. Pregabalin Adjuventia Helped Risperidone-Induced Extrapyramidal Syndrome and Augmented Antipsychotic Response in an Adolescent with Schizophrenia. Psychopharmacol Bull 2024; 54:40-42. [PMID: 38449476 PMCID: PMC10913867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 03/08/2024]
Abstract
Here, authors report on an interesting case of early-onset of schizophrenia where adjunctive pregabalin alleviated risperidone-induced pseudoparkinsonism, helped with insomnia and agitation and boosted antipsychotic response with great tolerability. We wager that gabapentenoids can be a viable option in the niche of psychopharmacotherapy of schizophrenia in CAP population.
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Affiliation(s)
- Ahmed Naguy
- Naguy, MBBch, MSc, MRCPsych (UK), Al-Manara CAP Centre, Kuwait Centre for Mental Health (KCMH), Jamal Abdul-Nassir St, Shuwaikh, State of Kuwait
| | - Saxby Pridmore
- Pridmore, MD, FRANZCP, Discipline of Psychiatry, University of Tasmania, Hobart, Tasmania, Australia and TMS Unit, Saint Helens Private Hospital, Hobart, Tasmania
| | - Bibi Alamiri
- Alamiri, MD, ABPN, ScD, Al-Manara CAP Centre, Kuwait Centre for Mental Health (KCMH), Jamal Abdul-Nassir St, Shuwaikh, State of Kuwait
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Bragg S, Marrison ST, Haley S. Diabetic Peripheral Neuropathy: Prevention and Treatment. Am Fam Physician 2024; 109:226-232. [PMID: 38574212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/06/2024]
Abstract
Diabetic peripheral neuropathy occurs in up to 50% of patients with diabetes mellitus and increases the risk of diabetic foot ulcers and infections. Consistent screening and clear communication are essential to decrease disparities in assessment of neuropathic symptoms and diagnosis. Physicians should address underlying risk factors such as poor glycemic control, vitamin B12 deficiency, elevated blood pressure, and obesity to reduce the likelihood of developing neuropathy. First-line drug therapy for painful diabetic peripheral neuropathy includes duloxetine, gabapentin, amitriptyline, and pregabalin; however, these medications do not restore sensation to affected extremities. Evidence for long-term benefit and safety of first-line treatment options is lacking. Second-line drug therapy includes nortriptyline, imipramine, venlafaxine, carbamazepine, oxcarbazepine, topical lidocaine, and topical capsaicin. Periodic, objective monitoring of medication response is critical because patients may not obtain desired pain reduction, adverse effects are common, and serious adverse effects can occur. Opioids should generally be avoided. Nondrug therapies with low- to moderate-quality evidence include exercise and neuromodulation with spinal cord stimulation or transcutaneous electrical nerve stimulation. Peripheral transcutaneous electrical nerve stimulation is well tolerated and inexpensive, but benefits are modest. Other treatments, such as acupuncture, alpha-lipoic acid, acetyl-L-carnitine, cannabidiol, and onabotulinumtoxinA need further study in patients with diabetic peripheral neuropathy.
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Affiliation(s)
- Scott Bragg
- Medical University of South Carolina, Charleston, South Carolina
| | | | - Sean Haley
- Medical University of South Carolina, Charleston, South Carolina
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Madan RD, Cenani A, Montgomery E, Azevedo T, Vernau KM, Brosnan RJ. Pregabalin produces similar effects as gabapentin for preanesthetic sedation in cats. J Am Vet Med Assoc 2024; 262:359-363. [PMID: 38134455 DOI: 10.2460/javma.23.09.0493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Accepted: 11/10/2023] [Indexed: 12/24/2023]
Abstract
OBJECTIVE To compare the effects of oral pregabalin versus gabapentin on sedation quality and anesthesia recovery times in cats in a typical perioperative setting. ANIMALS 50 healthy cats with > 1 kg body weight presenting for elective surgery. METHODS In this randomized, prospective clinical trial, cats presenting to the University of California-Davis Veterinary Medical Teaching Hospital were assigned to receive buprenorphine 0.02 mg/kg IM followed by 1 of 2 oral sedation treatments: pregabalin 4 mg/kg or gabapentin 10 mg/kg. Cats were then anesthetized using a standardized protocol. Physical examination parameters and behavioral scores were measured by 2 treatment-blinded veterinarians to compare sedation levels before and after drug administration. Inadequate sedation for handling or IV catheter placement was addressed by dexmedetomidine administration. After surgery was completed, anesthesia recovery times and quality were assessed by the same veterinarians. The effects of pregabalin versus gabapentin on body temperature, respiratory rate, and heart rate were analyzed using Student t tests; behavioral assessments were analyzed using Wilcoxon signed-rank tests; and drug treatment effects on dexmedetomidine sedation rescue and frequency of delirium during anesthetic recovery were analyzed using Fisher exact tests. A P < .05 indicated statistical significance. RESULTS There was no significant difference in change of physiologic parameters or sedation scores before and after sedation between groups. The need for rescue sedation for IV catheter placement and the incidence of emergence delirium were infrequent and similar for both treatments. CLINICAL RELEVANCE At the doses studied, oral pregabalin and gabapentin produced indistinguishable effects as adjunctive perioperative sedation agents in cats.
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Affiliation(s)
- Rahul D Madan
- 1Veterinary Medical Teaching Hospital, School of Veterinary Medicine, University of California-Davis, Davis, CA
| | - Alessia Cenani
- 2Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California-Davis, Davis, CA
| | - Elizabeth Montgomery
- 1Veterinary Medical Teaching Hospital, School of Veterinary Medicine, University of California-Davis, Davis, CA
| | - Tatiana Azevedo
- 1Veterinary Medical Teaching Hospital, School of Veterinary Medicine, University of California-Davis, Davis, CA
| | - Karen M Vernau
- 2Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California-Davis, Davis, CA
| | - Robert J Brosnan
- 2Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California-Davis, Davis, CA
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Gilron I, Robb S, Tu D, Holden RR, Jackson AC, Duggan S, Milev R. Randomized, double-blind, controlled trial of a combination of alpha-lipoic acid and pregabalin for neuropathic pain: the PAIN-CARE trial. Pain 2024; 165:461-469. [PMID: 37678556 DOI: 10.1097/j.pain.0000000000003038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Accepted: 07/22/2023] [Indexed: 09/09/2023]
Abstract
ABSTRACT We compared a combination of the nonsedating antioxidant, alpha-lipoic acid (ALA), with the sedating anticonvulsant, pregabalin, vs each monotherapy to treat neuropathic pain due to peripheral neuropathies. In this randomized, double-blind, 3-period crossover trial, participants received oral ALA, pregabalin, and their combination-each for 6 weeks. The primary outcome was mean daily pain intensity at maximal tolerated doses (MTD); secondary outcomes included quality of life (SF-36), sleep (Medical Outcomes Study-Sleep Scale), adverse effects, drug doses, and other measures. Of 55 participants randomized (20-diabetic neuropathy, 19-small fiber neuropathy, and 16-other neuropathies), 46 completed 2 periods, and 44 completed 3. At MTD, the primary outcome of mean pain intensity (0-10) was 5.32 (standard error, SE = 0.18), 3.96 (0.25), 3.25 (0.25), and 3.16 (0.25) at baseline, ALA, pregabalin, and combination, respectively ( P < 0.01 for ALA vs combination and pregabalin). Treatment differences were similar in subgroups with diabetic neuropathy and with other neuropathies. SF-36 total scores (higher number indicates better quality of life) were 66.6 (1.88), 70.1 (1.88), and 69.4 (1.87) with ALA, pregabalin, and combination ( P < 0.05 for ALA vs combination and pregabalin). At MTD, there were no statistically significant treatment differences in adverse effects or drug doses. This trial demonstrates superiority of pregabalin vs ALA but provides no evidence to suggest added benefit of combining ALA with pregabalin to treat neuropathic pain.
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Affiliation(s)
- Ian Gilron
- Departments of Anesthesiology & Perioperative Medicine and Biomedical & Molecular Sciences, Queen's University, Kingston, ON, Canada
- Providence Care Hospital, Queen's University, Kingston, ON, Canada
| | - Sylvia Robb
- Departments of Anesthesiology & Perioperative Medicine and Biomedical & Molecular Sciences, Queen's University, Kingston, ON, Canada
| | - Dongsheng Tu
- Departments of Public Health Sciences and Mathematics and Statistics, and the Cancer Research Institute, Queen's University, Kingston, ON, Canada
| | - Ronald R Holden
- Department of Psychology, Queen's University, Kingston, ON, Canada
| | - Alan C Jackson
- Department of Internal Medicine (Section of Neurology), University of Manitoba, Health Sciences Centre, Winnipeg, MB, Canada. Jackson is now with the Department of Clinical Neurosciences (Section of Neurology), University of Calgary, Calgary, AB, Canada
| | - Scott Duggan
- Departments of Anesthesiology & Perioperative Medicine and Biomedical & Molecular Sciences, Queen's University, Kingston, ON, Canada
| | - Roumen Milev
- Providence Care Hospital, Queen's University, Kingston, ON, Canada
- Department of Psychology, Queen's University, Kingston, ON, Canada
- Departments of Psychiatry and Psychology, Queen's University, Kingston, ON, Canada
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Benassayag Kaduri N, Dressler R, Abu Ahmad W, Rotshild V. Trends in Pregabalin Use and Prescribing Patterns in the Adult Population: A 10-Year Pharmacoepidemiologic Study. CNS Drugs 2024; 38:153-162. [PMID: 38273137 PMCID: PMC10881619 DOI: 10.1007/s40263-024-01064-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/10/2024] [Indexed: 01/27/2024]
Abstract
BACKGROUND AND OBJECTIVE Pregabalin is steadily gaining popularity worldwide, with epidemiological studies indicating an increase in labeled, off-labeled, and recreational uses. In Israel, pregabalin prescriptions are not regulated by the controlled substances legislations, prompting a need to examine its usage trends for potential policy adjustments. The objective of this study was to assess trends in pregabalin prescribing during a 10-year period, to characterize demographic and clinical characteristics of individuals prescribed pregabalin, and to identify risk factors associated with high-intensity pregabalin use. METHODS This retrospective, longitudinal study examined trends in pregabalin prescribing from 2010 to 2019 based on data extracted from the Clalit Health Services (CHS) electronic database. Annual pregabalin prescribing rate was calculated individually for each reporting year. A univariable analysis was conducted to compare the demographic and clinical characteristics of pregabalin users in 2019 with those in 2010. Multivariable regression analysis was performed to assess dose-related patterns by specific demographic and clinical characteristics. RESULTS Pregabalin prescription rate more than doubled over 10 years [odds ratio (OR) 2.3, p = 0.001], reaching 7.2 [95% confidence interval (CI) 7.18-7.28] prescriptions per 100 CHS members in 2019. The highest prescription rates were observed among the elderly population (13.2 and 24.1 prescriptions per 100 CHS members for those aged 55-74 and over 75 years old, respectively). Same-year administration of pregabalin with opioids, benzodiazepines, and Z-drugs was common; however, the percentage of patients using these drugs together declined in 2019 compared with 2010 (p < 0.001). Males, patients with low socioeconomic status, patients aged 35-54 years, and those who consumed opioids, benzodiazepines, and Z-drugs received higher pregabalin doses. CONCLUSION Pregabalin use has increased significantly in the Israeli adult-based CHS population, consistent with worldwide data. A growing use over time may indicate overprescription. More studies are needed on misuse patterns to identify populations most susceptible to high-dose and high-intensity pregabalin use.
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Affiliation(s)
- Nofar Benassayag Kaduri
- Division of Clinical Pharmacy, Faculty of Medicine, School of Pharmacy, Institute for Drug Research, The Hebrew University of Jerusalem, Jerusalem, Israel.
| | - Reuven Dressler
- Jerusalem District, Clalit Health Services, Jerusalem, Israel
| | - Wiessam Abu Ahmad
- School of Public Health, Hadassah Medical Center, Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Victoria Rotshild
- Division of Clinical Pharmacy, Faculty of Medicine, School of Pharmacy, Institute for Drug Research, The Hebrew University of Jerusalem, Jerusalem, Israel
- Jerusalem District, Clalit Health Services, Jerusalem, Israel
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Xie H, Zheng Y, Wang C, Song S, Dai Y, Huang X, Liu M, Wu X. Managing delayed or missed pregabalin doses in patients with focal epilepsy: a Monte Carlo simulation study. Int J Clin Pharm 2024; 46:150-157. [PMID: 37991662 DOI: 10.1007/s11096-023-01657-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Accepted: 09/28/2023] [Indexed: 11/23/2023]
Abstract
BACKGROUND Delayed or missed doses are inevitable in epilepsy pharmacotherapy. The current remedial measures recommended by the United States Food and Drug Administration (FDA) for non-adherence are generic and lack clinical evidence. AIM To assess remedial strategies for delayed or missed pregabalin doses in patients with epilepsy using Monte Carlo simulations. METHOD Monte Carlo simulations were performed using a published population pharmacokinetic model for pregabalin. The applicability of five proposed remedial regimens as well as FDA recommendations was evaluated by simulating various poor adherence scenarios in eight populations, including those with renal dysfunction. RESULTS All proposed remedial strategies were associated with delay duration and renal function. When delays are relatively short, an immediate regular dose is advised. The cut-off time points for taking the regular dose as a remedial regimen were 1, 2, 4, and 12 h for patients with mild renal impairment and normal renal function, moderate renal impairment, severe renal impairment, and end-stage renal disease, respectively. However, when delay aligns closely with a dosing interval, a regular dose combined with a partial dose proves effective. Generally, supplementing 1.3-fold the regular dose at the next scheduled time adequately compensates for the missed dose. CONCLUSION Model-based simulations provided quantitative evidence for the effectiveness and feasibility of remedial strategies for missed or delayed pregabalin doses.
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Affiliation(s)
- Helin Xie
- Department of Pharmacy, Fujian Medical University Union Hospital, Gulou District, 29 Xinquan Road, Fuzhou, 350001, Fujian, China
| | - You Zheng
- Department of Pharmacy, Fujian Medical University Union Hospital, Gulou District, 29 Xinquan Road, Fuzhou, 350001, Fujian, China
- School of Pharmacy, Fujian Medical University, 88 Jiaotong Road, Fuzhou, 350000, Fujian, China
| | - Chenyu Wang
- Department of Pharmacy, Shanghai Chest Hospital, Shanghai Jiao Tong University, 241 West Huaihai Road, Shanghai, 200000, China
| | - Shiwei Song
- Department of Neurosurgery, Fujian Medical University Union Hospital, 29 Xinquan Road, Gulou District, Fuzhou, 350001, Fujian, China
| | - Yihai Dai
- Department of Neurosurgery, Fujian Medical University Union Hospital, 29 Xinquan Road, Gulou District, Fuzhou, 350001, Fujian, China
| | - Xian Huang
- Department of Neurosurgery, Fujian Medical University Union Hospital, 29 Xinquan Road, Gulou District, Fuzhou, 350001, Fujian, China
| | - Maobai Liu
- Department of Pharmacy, Fujian Medical University Union Hospital, Gulou District, 29 Xinquan Road, Fuzhou, 350001, Fujian, China
| | - Xuemei Wu
- Department of Pharmacy, Fujian Medical University Union Hospital, Gulou District, 29 Xinquan Road, Fuzhou, 350001, Fujian, China.
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Novotny M, Bulla J, Hubl D, Fischer SKM, Grosshans M, Gutzeit A, Bilke-Hentsch O, Seifritz E, Mutschler J. Pregabalin use in forensic hospitals and prisons in German speaking countries-a survey study of physicians. Front Public Health 2024; 11:1309654. [PMID: 38259798 PMCID: PMC10800468 DOI: 10.3389/fpubh.2023.1309654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2023] [Accepted: 12/11/2023] [Indexed: 01/24/2024] Open
Abstract
Background Pregabalin is a gamma-aminobutyric acid (GABA) analog that was approved in the EU in 2004 for the treatment of neuropathic pain, generalized anxiety disorder and epilepsy. Since its introduction, pregabalin abuse and misuse has increased significantly. In Switzerland, clinical reports suggest that pregabalin misuse is common among patients in forensic hospitals and prisons. However, data on pregabalin use is scarce, especially in these settings. Therefore, we conducted a study to explore patterns of pregabalin use among prison and forensic patients. Methods We used a questionnaire to survey physicians working in prison and forensic medicine in German-speaking countries. A total of 131 responses were received. Results According to the physicians' subjective assessment, 82.5% of them had observed a recent increase in pregabalin use by their patients and 89.1% of them reported that their patients requested pregabalin without a clear medical indication. Patients misusing pregabalin in combination with other illicit substances were observed by 93.3% of the physicians surveyed. According to 73.5% of the physicians surveyed, they had already encountered patients on pregabalin doses of more than 600 mg/day (the maximum recommended daily dose); the highest dose reported was 4,200 mg/day. According to 85.0% of physicians surveyed, they have observed patients experiencing withdrawal symptoms from pregabalin, with the most commonly reported symptoms being displeasure and high aggression. Regarding the nationality of pregabalin-misusing patients, 58.3% of the interviewed physicians reported to be rather in contact with foreign patients, mainly from Northwest Africa (Maghreb). Only 45.0% of the surveyed physicians prescribe pregabalin. Among patients who developed behavioral problems while taking pregabalin, none of the physicians (0.0%) showed a tendency to continue pregabalin at the same dose; all respondents chose to reduce/substitute/discontinue. Conclusion Our study has provided confirmatory evidence that the use of pregabalin presents a significant issue in forensic and prison medicine across German-speaking countries. Prescribing pregabalin in this field can compound use disorder problems and exacerbate challenges in daily life for those in forensic institutions or prisons. It is necessary that all physicians who prescribe pregabalin are clearly informed about the management (including the risks) of this drug.
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Affiliation(s)
- Michal Novotny
- Private Clinic Meiringen, Willigen, Switzerland
- Faculty of Medicine, University of Zurich, Zurich, Switzerland
| | - Jan Bulla
- Clinic of Forensic Psychiatry and Psychotherapy, Reichenau Centre of Psychiatry, Reichenau, Germany
| | - Daniela Hubl
- Center of Forensic Psychiatry and Psychology, Universitäre Psychiatrische Dienste Bern (UPD), Bern, Switzerland
| | | | - Martin Grosshans
- Department of Global Health, Safety and Well-Being, Systemanalyse Programmentwicklung Societas Europaea (SAP SE), Walldorf, Germany
| | - Andreas Gutzeit
- Department of Radiology, Paracelsus Medical University, Salzburg, Austria
- Department of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
- Institute of Radiology and Nuclear Medicine and Breast Center St. Anna, Hirslanden Klinik St. Anna, Lucerne, Switzerland
| | | | - Erich Seifritz
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Zurich, Switzerland
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Zhang L, Zhang H. The efficacy of pregabalin for pain control after thoracic surgery: a meta-analysis. J Cardiothorac Surg 2024; 19:4. [PMID: 38172988 PMCID: PMC10765724 DOI: 10.1186/s13019-023-02449-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 11/04/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND Pregabalin may have some potential in alleviating pain after thoracic surgery, and this meta-analysis aims to explore the impact of pregabalin on pain intensity for patients undergoing thoracic surgery. METHODS PubMed, EMbase, Web of science, EBSCO and Cochrane library databases were systematically searched, and we included randomized controlled trials (RCTs) assessing the effect of pregabalin on pain intensity after thoracic surgery. RESULTS Five RCTs were finally included in the meta-analysis. Overall, compared with control intervention for thoracic surgery, pregabalin was associated with significantly reduced pain scores at 0 h (mean difference [MD]=-0.70; 95% confidence interval [CI]=-1.10 to -0.30; P = 0.0005), pain scores at 24 h (MD=-0.47; 95% CI=-0.75 to -0.18; P = 0.001) and neuropathic pain (odd ratio [OR] = 0.24; 95% CI = 0.12 to 0.47; P < 0.0001), but demonstrated no obvious impact on the incidence of dizziness (OR = 1.07; 95% CI = 0.15 to 7.46; P = 0.95), headache (OR = 1.00; 95% CI = 0.30 to 3.35; P = 1.00) or nausea (OR = 1.24; 95% CI = 0.46 to 3.35; P = 0.68). CONCLUSIONS Pregabalin may be effective to alleviate the pain after thoracic surgery.
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Affiliation(s)
- Li Zhang
- Anesthesia Department Operating Room, Chongqing Liangjiang New Area People's Hospital, Chongqing, China.
| | - Hong Zhang
- Anesthesia Department Operating Room, Chongqing Liangjiang New Area People's Hospital, Chongqing, China.
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Young J, Rattan D, Cheung A, Lazarakis S, McGilvray S. Pain management for persistent pain post radiotherapy in head and neck cancers: systematic review. Scand J Pain 2024; 24:sjpain-2023-0069. [PMID: 38126203 DOI: 10.1515/sjpain-2023-0069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 10/26/2023] [Indexed: 12/23/2023]
Abstract
OBJECTIVES To systematically review the existing literature for evidence of efficacy around interventions in the management of persistent pain post radiotherapy for head and neck cancers. METHODS A systematic review of the literature was conducted to assess the effectiveness and safety of interventions for the management of persistent post-radiotherapy pain in head and neck cancers. The primary outcome evaluated whether an intervention resulted in a reduction in pain which was determined using validated pain tools. RESULTS Two randomised controlled trials involving 196 participants fulfilled the inclusion criteria, one evaluating the effect of hypnotherapy and the other evaluating the effect of pregabalin on radiotherapy related pain in head and neck cancer patients. In one study by Thuma et al. (2016) there was a decrease in pain scores in the hypnotherapy group (p<0.001). In the other study, by Jiang et al. (2018) patients treated with pregabalin had a greater reduction in pain intensity, pain severity and a reduction in pain functional interference (p<0.001). CONCLUSIONS The findings of our review suggest that in chronic post-radiotherapy pain for head and neck cancers there is very-low level evidence for the use of hypnotherapy in reducing pain scores and for the use of pregabalin in reducing pain intensity, severity, functional interference and psychological distress with significant improvement in quality of life.
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Affiliation(s)
- Jamie Young
- Peter Mac: Peter MacCallum Cancer Centre, Melbourne, Australia
- Department of Critical Care, University of Melbourne, Melbourne, Victoria
| | - Divya Rattan
- Peter Mac: Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Ada Cheung
- Peter Mac: Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Smaro Lazarakis
- Peter Mac: Peter MacCallum Cancer Centre, Melbourne, Australia
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Gaertner J, Witte KK. Potential role of pregabalin in the treatment of episodic breathlessness. Ann Palliat Med 2024; 13:200-201. [PMID: 38073296 DOI: 10.21037/apm-23-547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 10/30/2023] [Indexed: 02/07/2024]
Affiliation(s)
- Jan Gaertner
- Palliative Care Center Basel, Basel, Switzerland; Department of Clinical Research, University of Basel, Basel, Switzerland
| | - Klaus K Witte
- Department of Cardiology, Angiology and Critical Care (Medical Clinic 1), University Hospital RWTH Aachen, Aachen, Germany; Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
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Rodrigues RS, Sakata RK, da Silva WV, Raimundo CR, Cerqueira CF, Leal PDC. Exploring the analgesic effects of pregabalin for post-chikungunya arthralgia: a comparative double-blind study. Braz J Anesthesiol 2024; 74:744463. [PMID: 37717925 PMCID: PMC10877331 DOI: 10.1016/j.bjane.2023.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 09/02/2023] [Accepted: 09/04/2023] [Indexed: 09/19/2023]
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Özalp Horsanalı B, Yımaz H, Uyar M, Eyigör C. Gabapentinoids and lactation: Review of the literature. Agri 2024; 36:64-67. [PMID: 38239114 DOI: 10.14744/agri.2021.55531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2024]
Abstract
Gabapentin and pregabalin, which belong to the gabapentinoid drug family, are widely used, especially in neuropathic pain treatment, due to their effectiveness in pain management. Although many of the comorbidities and symptoms that limit the use of gabapentinoids are clearly described in the literature, there is limited data on their use during lactation. A 33-year-old female patient was admitted to our clinic with neuropathic pain and muscle weakness in her left lower extremity following spinal anesthesia for a cesarean section. We aimed to present the gabapentin treatment of a breastfeeding patient with persistent neuropathic pain in light of a literature review.
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Affiliation(s)
| | - Hüsnü Yımaz
- Department of Algology, Ege University Faculty of Medicine, İzmir, Türkiye
| | - Meltem Uyar
- Department of Algology, Ege University Faculty of Medicine, İzmir, Türkiye
| | - Can Eyigör
- Department of Algology, Ege University Faculty of Medicine, İzmir, Türkiye
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Song S, Wang Q, Qu Y, Gao W, Li D, Xu X, Yue S. Pregabalin inhibits purinergic P2Y 2 receptor and TRPV4 to suppress astrocyte activation and to relieve neuropathic pain. Eur J Pharmacol 2023; 960:176140. [PMID: 37925132 DOI: 10.1016/j.ejphar.2023.176140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2023] [Revised: 10/18/2023] [Accepted: 10/19/2023] [Indexed: 11/06/2023]
Abstract
BACKGROUNDS Transient receptor potential vanilloid 4 (TRPV4)-mediated astrocyte activation is critical to neuropathic pain. Pregabalin, a widely used drug to treat chronic pain, is reported to lower the intracellular calcium level. However, the molecular mechanism by which pregabalin decreases the intracellular calcium level remains unknown. Purinergic P2Y2 receptor-a member of the G protein-coupled receptor (GPCR) family-regulates calcium-related signal transduction in astrocyte activation. We investigated whether P2Y2 receptor is involved in the pharmacological effects of pregabalin on neuropathic pain. METHODS Neuropathic pain was induced by chronic compression of the dorsal root ganglion (CCD) in rats. Paw withdrawal mechanical threshold (PWMT) was used for behavioral testing. Intracellular calcium concentration was measured using a fluorescent calcium indicator (Fluo-4 AM). RESULTS We found that P2Y2 receptor protein was upregulated and astrocytes were activated in the experimental rats after CCD surgery. Lipopolysaccharide (LPS) increased the intracellular calcium concentration and induced astrocyte activation in cultured astrocytes but was prevented via P2Y2 receptor inhibitor AR-C118925 or pregabalin. Furthermore, plasmid-mediated P2Y2 receptor overexpression induced an elevation of the intracellular calcium levels and inflammation in astrocytes, which was abolished by the TRPV4 inhibitor HC-067047. AR-C118925, HC-067047, and pregabalin relieved neuropathic pain and inflammation in rats after CCD surgery. Finally, plasmid-mediated P2Y2 receptor overexpression induced neuropathic pain in rats, which was abolished by pregabalin administration. CONCLUSIONS Pathophysiological variables that upregulated the P2Y2 receptor/TRPV4/calcium axis contribute to astrocyte activation in neuropathic pain. Pregabalin exerts an analgesic effect by inhibiting this pathway.
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Affiliation(s)
- Shasha Song
- Rehabilitation Center, Qilu Hospital of Shandong University, Jinan, Shandong, China
| | - Qianwen Wang
- The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, The State and Shandong Province Joint Key Laboratory of Translational Cardiovascular Medicine, Department of Cardiology, Qilu Hospital of Shandong University, Jinan, Shandong, China
| | - Yujuan Qu
- Rehabilitation Center, Qilu Hospital of Shandong University, Jinan, Shandong, China
| | - Wenshuang Gao
- Rehabilitation Center, Qilu Hospital of Shandong University, Jinan, Shandong, China
| | - Danyang Li
- Rehabilitation Center, Qilu Hospital of Shandong University, Jinan, Shandong, China
| | - Xiaoqian Xu
- Rehabilitation Center, Qilu Hospital of Shandong University, Jinan, Shandong, China
| | - Shouwei Yue
- Rehabilitation Center, Qilu Hospital of Shandong University, Jinan, Shandong, China.
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Sevimli N, Kurna SA, Şilte Karamanlıoğlu AD, Ünlü Özkan F, Aktaş İ, Çakır M. Characteristics of the retina and choroid in fibromyalgia patients and their correlation with disease severity and quality of life. Photodiagnosis Photodyn Ther 2023; 44:103819. [PMID: 37797910 DOI: 10.1016/j.pdpdt.2023.103819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 09/09/2023] [Accepted: 09/26/2023] [Indexed: 10/07/2023]
Abstract
BACKGROUND To evaluate retinal and choroidal characteristics of fibromyalgia (FM) patients using spectral-domain optical coherence tomography (SD-OCT), to compare them with healthy controls, and to determine the correlation of these measurements with disease severity and quality of life. METHODS Thirty-nine eyes of 39 patients with FM and 44 eyes of 44 age- and sex-matched healthy subjects were enrolled. The retinal nerve fiber layer (RNFL), central macular thickness (CMT), and choroidal thickness (CT) measurements of the subjects were obtained using SD-OCT (Maestro, Topcon Co. Tokyo, Japan), choroidal vascular index (CVI) was calculated by using the binarization method and the results were compared. Disease duration (DD), widespread pain index (WPI), symptom severity scale (SSS), visual analog scale (VAS), ocular pain assessment survey (OPAS), FM impact questionnaire (FIQ), European Quality of Life-5 Dimensions-3 level (EQ-5D-3 L), European Quality VAS score (EQ-VAS) and use of pregabalin were recorded. Correlations between the SD-OCT results and the FM parameters were evaluated. RESULTS No significant difference was found in terms of age and gender (p = 0.612, p = 0.244 respectively). Patients in the FM group had significantly thinner RNFL superior quadrant and CT (p = 0,009 and p < 0.001, respectively). CVI was significantly higher in the FM group (p < 0.001). There was an inverse correlation between OPAS and CT (r = -0.379, p = 0.027) and between VAS and CVI (r = -0.398, p = 0.020). The use of pregabalin had no effect on SD-OCT (p > 0.05). CONCLUSION Patients with FM demonstrated reduced RNFL superior quadrant and CT and increased CVI. Ocular and general body pain in FM was found to be associated with SD-OCT.
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Affiliation(s)
- Neslihan Sevimli
- Department of Ophthalmology, Fatih Sultan Mehmet Training and Research Hospital, Ataşehir, İstanbul, Turkey.
| | - Sevda Aydın Kurna
- Department of Ophthalmology, Fatih Sultan Mehmet Training and Research Hospital, Ataşehir, İstanbul, Turkey
| | - Ayşe Duygu Şilte Karamanlıoğlu
- Department of Physical Medicine and Rehabilitation, Fatih Sultan Mehmet Training and Research Hospital, Ataşehir, İstanbul, Turkey
| | - Feyza Ünlü Özkan
- Department of Physical Medicine and Rehabilitation, Fatih Sultan Mehmet Training and Research Hospital, Ataşehir, İstanbul, Turkey
| | - İlknur Aktaş
- Department of Physical Medicine and Rehabilitation, Fatih Sultan Mehmet Training and Research Hospital, Ataşehir, İstanbul, Turkey
| | - Muhammet Çakır
- Department of Ophthalmology, Fatih Sultan Mehmet Training and Research Hospital, Ataşehir, İstanbul, Turkey
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Asbat A, Saleem F, Najm S, Iqbal J, Syed MA, Azeem M, Asbat SJ, Shoukat S. In-vivo anti-epileptic study of newly synthesized pregabalin derivatives based on docking studies. Neurol Res 2023; 45:1136-1143. [PMID: 37751764 DOI: 10.1080/01616412.2023.2257440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Accepted: 07/06/2023] [Indexed: 09/28/2023]
Abstract
OBJECTIVE The goal of the present study is to examine pretreatment with Schiff bases and derivatives of pregabalin along with their metal (Zn and Cu) complexes on the severity of epilepsy, latency time, duration of convulsions, seizure score and survival rate in mice. METHODS To achieve the goal, a molecular docking study of analogues was carried out on a specific molecular target, such as the alpha-2δ receptor (PDB ID: 6ND9); which revealed the significant binding affinity of the analogs to their respective target. Based on the docking information, all pregabalin derivatives were synthesized and in-vivo antiepileptic effect was confirmed by applying the PTZ model that prioritized the most crucial significant points responsible for biological activity. RESULTS The test compounds markedly increased the latency of the first seizure and reduced the frequency of seizures throughout the body and frequent spinning and jumps. Additionally, treatment with pregabalin derivatives in mice that received PTZ significantly reduced the duration of seizures and seizure score. However, it increased the survival rate of the mice. DISCUSSION Since the newly synthesized compounds were more active as compared to the parent drug in some respects; therefore, the expansion of the project can be planned to explore clinical side of the drugs in the future.
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Affiliation(s)
- Ayesha Asbat
- Faculty of Pharmacy, The University of Lahore, Lahore, Pakistan
| | - Farooq Saleem
- Faculty of Pharmacy, The University of Lahore, Lahore, Pakistan
| | - Saima Najm
- Faculty of Pharmacy, Lahore College of Pharmaceutical Sciences, Lahore, Pakistan
| | - Javed Iqbal
- Faculty of Pharmacy, The University of Lahore, Lahore, Pakistan
| | | | - Muhammad Azeem
- Faculty of Pharmacy, The University of Lahore, Lahore, Pakistan
| | - Syeda Javeria Asbat
- Institute of Molecular Biology and Biotechnology, The University of Lahore, Lahore, Pakistan
| | - Sadia Shoukat
- Faculty of Pharmacy, The University of Lahore, Lahore, Pakistan
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Cain SM, Alles SRA, Gopaul R, Bernier LP, Yung AC, Bauman A, Yang Y, Baker GB, Kozlowski P, MacVicar BA, Snutch TP. Chronic pregabalin treatment protects against spreading depolarization and alters hippocampal synaptic characteristics in a model of familial hemiplegic migraine-type 1. Mol Brain 2023; 16:76. [PMID: 37924146 PMCID: PMC10623724 DOI: 10.1186/s13041-023-01062-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 10/04/2023] [Indexed: 11/06/2023] Open
Abstract
Familial hemiplegic migraine type-1 (FHM-1) is a form of migraine with aura caused by mutations in the P/Q-type (Cav2.1) voltage-gated calcium channel. Pregabalin, used clinically in the treatment of chronic pain and epilepsy, inhibits P/Q-type calcium channel activity and recent studies suggest that it may have potential for the treatment of migraine. Spreading Depolarization (SD) is a neurophysiological phenomenon that can occur during migraine with aura by propagating a wave of silenced neuronal function through cortex and sometimes subcortical brain structures. Here, utilizing an optogenetic stimulation technique optimized to allow for non-invasive initiation of cortical SD, we demonstrate that chronic pregabalin administration [12 mg/kg/day (s.c.)] in vivo increased the threshold for cortical spreading depolarization in transgenic mice harboring the clinically-relevant Cav2.1S218L mutation (S218L). In addition, chronic pregabalin treatment limited subcortical propagation of recurrent spreading depolarization events to the striatum and hippocampus in both wild-type and S218L mice. To examine contributing underlying mechanisms of action of chronic pregabalin, we performed whole-cell patch-clamp electrophysiology in CA1 neurons in ex vivo brain slices from mice treated with chronic pregabalin vs vehicle. In WT mice, chronic pregabalin produced a decrease in spontaneous excitatory postsynaptic current (sEPSC) amplitude with no effect on frequency. In contrast, in S218L mice chronic pregabalin produced an increase in sEPSC amplitude and decreased frequency. These electrophysiological findings suggest that in FHM-1 mice chronic pregabalin acts through both pre- and post-synaptic mechanisms in CA1 hippocampal neurons to elicit FHM-1 genotype-specific inhibitory action. The results highlight the potential of chronic pregabalin to limit recurrent SD to subcortical brain structures during pathophysiological events in both the genetically-normal and FHM-1 brain. The work further provides insights into FHM-1 pathophysiology and the potential for chronic pregabalin treatment to prevent SD in migraineurs.
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Affiliation(s)
- Stuart M Cain
- Michael Smith Laboratories, University of British Columbia, 219-2185 East Mall, Vancouver, BC, V6T 1Z4, Canada
- Djavad Mowafaghian Center for Brain Health, University of British Columbia, Vancouver, Canada
| | - Sascha R A Alles
- Michael Smith Laboratories, University of British Columbia, 219-2185 East Mall, Vancouver, BC, V6T 1Z4, Canada
- Djavad Mowafaghian Center for Brain Health, University of British Columbia, Vancouver, Canada
- Department of Anesthesiology and Critical Care Medicine, University of New Mexico School of Medicine, Albuquerque, NM, USA
| | - Ray Gopaul
- Michael Smith Laboratories, University of British Columbia, 219-2185 East Mall, Vancouver, BC, V6T 1Z4, Canada
- Djavad Mowafaghian Center for Brain Health, University of British Columbia, Vancouver, Canada
| | - Louis-Philippe Bernier
- Djavad Mowafaghian Center for Brain Health, University of British Columbia, Vancouver, Canada
| | - Andrew C Yung
- UBC MRI Research Facility, University of British Columbia, Vancouver, Canada
| | - Andrew Bauman
- UBC MRI Research Facility, University of British Columbia, Vancouver, Canada
| | - Yi Yang
- Michael Smith Laboratories, University of British Columbia, 219-2185 East Mall, Vancouver, BC, V6T 1Z4, Canada
- Djavad Mowafaghian Center for Brain Health, University of British Columbia, Vancouver, Canada
| | - Glen B Baker
- Neurochemical Research Unit, Department of Psychiatry, University of Alberta, Edmonton, Canada
| | - Piotr Kozlowski
- UBC MRI Research Facility, University of British Columbia, Vancouver, Canada
| | - Brian A MacVicar
- Djavad Mowafaghian Center for Brain Health, University of British Columbia, Vancouver, Canada
| | - Terrance P Snutch
- Michael Smith Laboratories, University of British Columbia, 219-2185 East Mall, Vancouver, BC, V6T 1Z4, Canada.
- Djavad Mowafaghian Center for Brain Health, University of British Columbia, Vancouver, Canada.
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Samarah BM, Shehada FA, Qaddumi J, Almasry NA, Alkhawaldeh A, ALBashtawy M, Alyahya M, ALBashtawy S, Al-Awamreh K, Saifan A, ALBashtawy B, Abdalrahim A, ALBashtawy Z. A comparison of the preemptive effects of oral pregabalin and gabapentin on acute postoperative sedation and complications in patients undergoing lumbar spine surgery. J Perioper Pract 2023; 33:358-364. [PMID: 36705003 DOI: 10.1177/17504589221141799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
BACKGROUND Gabapentinoids are often administered preoperatively, as they have been shown to reduce postoperative opioid consumption and pain scores however sedation has always been a concern because of sedative side effect. OBJECTIVE This study was intended to compare oral gabapentin versus oral pregabalin sedative effects and complications in patients undergoing lumbar spine surgery under general anaesthesia. METHODS This study was a true experimental randomised, placebo-controlled, prospective study, conducted at Rafedia Government Surgical Hospital in Nablus, Palestine. The sample consisted of 60 male and female patients undergoing elective lumbar spine surgeries in the department of neurology and aged from 18 to 70 years. The patients were divided into three groups (20 patients each): The pregabalin 150mg group, the gabapentin group and the placebo group. FINDINGS Nearly 51.7% of the participants reported that they experienced a feeling of nausea or vomiting after the operation. There were statistically significant differences (p-value = 0.008) between the groups in how often complications happen after surgery. CONCLUSIONS Preemptive pregabalin (150mg) was established to have a more sedative effect and lowered complications than gabapentin (300mg).
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Affiliation(s)
| | - Fatema Amer Shehada
- CRNA, NICU, Rafidia Hospital, Palestinian Ministry of Health, Nablus, Palestine
| | - Jamal Qaddumi
- Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine
| | - Nour Aldin Almasry
- Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine
| | - Abdullah Alkhawaldeh
- Department of Community and Mental Health, Princess Salma Faculty of Nursing, Al al-Bayt University, Mafraq, Jordan
| | - Mohammed ALBashtawy
- Department of Community and Mental Health, Princess Salma Faculty of Nursing, Al al-Bayt University, Mafraq, Jordan
| | - Mohammed Alyahya
- Health Management and Policy, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | | | - Khetam Al-Awamreh
- Department of Maternal and Child Health, Princess Salma Faculty of Nursing, Al al-Bayt University, Mafraq, Jordan
| | - Ahmad Saifan
- Faculty of Nursing, Applied Science Private University, Amman, Jordan
| | | | - Asem Abdalrahim
- Department of Community and Mental Health, Princess Salma Faculty of Nursing, Al al-Bayt University, Mafraq, Jordan
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McCampbell LE, Zaino ML, Ranpariya M, Patel T, Feldman SR. Systemic Medication for the Treatment of Prurigo Nodularis-A Systematic Review. J Cutan Med Surg 2023; 27:641-645. [PMID: 37987710 DOI: 10.1177/12034754231211797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2023]
Abstract
IMPORTANCE Prurigo nodularis (PN) is a debilitating inflammatory skin disease characterized by red to violaceous pruritic lesions. The goal of therapy is to break the scratch-itch cycle. Treatment varies and often requires a multimodal approach to target both immune and neural mediated aspects of disease. OBJECTIVES To review the efficacy of systemic treatment used to treat PN. EVIDENCE REVIEW A systematic search of keywords and Medical Subject Headings was performed in Ovid MEDLINE, Embase, Scopus, and ClinicalTrials.gov. The first 200 results of an abbreviated search in Google Scholar were also included. PRISMA guidelines were followed and the review was registered on PROSPERO (CRD42023412012). GRADE criteria were used to assess articles for quality of evidence. FINDINGS The search resulted in 1153 articles; 382 were duplicates, 643 were irrelevant, 19 were not retrieved, 21 were abstract only, and 88 are included in this review. There were 24 studies on dupilumab, 16 on thalidomide, 8 on cyclosporin, 7 on methotrexate, 3 each on lenalidomide and aprepitant, 2 each on alitretinoin, apremilast, baricitinib, gabapentin, intravenous (IV) immunoglobulins, pregabalin, tofacitinib, and 1 each on amitriptyline, azathioprine, butorphanol, isoquercitin, IV dexamethasone-cyclophosphamide/ oral cyclophosphamide, ketotifen, metronidazole, montelukast, nalbuphine, nemolizumab, serolopitant, tacrolimus, and herose derma zima capsule. CONCLUSIONS AND RELEVANCE Dupilumab reduces pruritus and appearance of lesions and is associated with the fewest number of side effects. Thalidomide and pregabalin are also effective, but their long-term use is limited by muscle and nerve pain. Janus Kinase inhibitors may be beneficial, but large population studies are lacking.
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Affiliation(s)
| | - Mallory L Zaino
- Center for Dermatology Research, Department of Dermatology, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | | | - Tejesh Patel
- University of Tennessee Health Science Center, Memphis, TN, USA
| | - Steven R Feldman
- Center for Dermatology Research, Department of Dermatology, Wake Forest School of Medicine, Winston-Salem, NC, USA
- Department of Pathology, Wake Forest School of Medicine, Winston-Salem, NC, USA
- Department of Social Sciences & Health Policy, Wake Forest School of Medicine, Winston-Salem, NC, USA
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Panwar A, Vaidyanathan S, Udupa ST, Munoli RN, Praharaj SK. Anticraving Effect of N-Acetyl Cysteine in a Patient With Pregabalin and Alcohol Dependence. Am J Ther 2023; 30:e597-e598. [PMID: 35972898 DOI: 10.1097/mjt.0000000000001544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Abhinav Panwar
- Department of Psychiatry, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka
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Bismaya K, Singh VK, Pathak A, Kumar A, Mishra VN, Joshi D, Chaurasia RN. Evaluating the Effect of Pregabalin in the Treatment of Carpal Tunnel Syndrome: A Prospective, Randomized, Triple-Blinded, Placebo-controlled Trial. Clin J Pain 2023; 39:604-610. [PMID: 37584413 DOI: 10.1097/ajp.0000000000001154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2022] [Accepted: 08/01/2023] [Indexed: 08/17/2023]
Abstract
OBJECTIVE This study aimed to determine the effectiveness of pregabalin for the control of symptoms in mild to moderate idiopathic Carpal tunnel syndrome (CTS). METHODS In this randomized, placebo-controlled trial, 146 mild to moderate idiopathic CTS patients were randomized into pregabalin (n=74) and placebo groups (n=72). Per protocol, analysis was conducted with 131 patients; pregabalin (n=65) and placebo (n=66). The drug titration dose was 50 mg once daily for the first week, twice daily for the second week and thrice daily for the next 6 weeks. The primary outcome included a change in the Symptom Severity Scale and Functional Status Scale (FSS) of the Boston Carpal Tunnel Questionnaire after the eighth week. The secondary outcome was the change in clinical and electrophysiological grading after 8 weeks of therapy. RESULTS There was a statistically significant improvement in the mean Symptom Severity Scale (14.92±3.72 vs. 16.55±4.45; P =0.025) and FSS (10.77±2.64 vs. 12.0±2.55; P =0.007) in the pregabalin group after 8 weeks. Mean clinical and electrophysiological grading changed significantly from 2.3±0.7 to 2.1±0.8 ( P =0.001) and 1.9±0.7 to 1.8±0.8 ( P =0.020), respectively in the pregabalin group but not in the placebo group. DISCUSSION The results of this study demonstrates that pregabalin is effective in ameliorating symptoms and improving functional outcomes in mild to moderate idiopathic CTS.
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Affiliation(s)
- Kumar Bismaya
- Department of Neurology, Institute of Medical Science, Banaras Hindu University, Varanasi, UP, India
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22
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Saint-Pierre MD. Predictors of treatment response to pregabalin in unexplained or refractory chronic cough. Respir Med 2023; 218:107396. [PMID: 37657533 DOI: 10.1016/j.rmed.2023.107396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2023] [Revised: 08/11/2023] [Accepted: 08/23/2023] [Indexed: 09/03/2023]
Abstract
BACKGROUND Patients with chronic cough (>8 weeks) often remain symptomatic after appropriate investigations and therapeutic trials. Prior research has shown a benefit in certain individuals from pregabalin, but clinical improvement is quite unpredictable and variable. OBJECTIVE The main objective of this study was to identify the demographic and clinical characteristics associated with a higher likelihood of cough improvement with a trial of pregabalin therapy. METHODS 50 consecutive patients with chronic cough were enrolled in this prospective cohort study. Subjects were prescribed pregabalin 75 mg oral qhs for 4 weeks followed by 75 mg oral bid. Leicester Cough Questionnaire (LCQ) was completed at treatment initiation and after 3 months of therapy. A comparison was performed between treatment responders (LCQ total score improvement ≥1.3) and non-responders. RESULTS 56% of patients reported a LCQ total score improvement ≥1.3 (minimal clinically important difference). Responders to pregabalin therapy were more likely to have refractory (with underlying pulmonary disease) versus unexplained chronic cough (p = 0.01). Patients with significant improvement were also on average more symptomatic at baseline (mean LCQ total score 10.2 versus 13.0, p < 0.01). No significant relationship was identified with age, gender, body mass index, history of anxiety and/or depression, cigarette smoking history, or cough duration (p > 0.05). The unexplained chronic cough group had a strong female predominance (85.7% versus 40.9% for refractory cough, p < 0.01). CONCLUSION This is the first study that has investigated clinical predictors of treatment response to pregabalin in chronic cough patients. Further research is needed to develop therapies for subjects who do not improve with currently available neuromodulating medications.
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Affiliation(s)
- Mathieu D Saint-Pierre
- University of Ottawa, Faculty of Medicine, Ottawa, ON, Canada; Institut du Savoir Montfort, Ottawa, ON, Canada; Montfort Hospital, Division of Respirology, Ottawa, ON, Canada.
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23
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Umman V, Kepil N, Uzun H, Goksoy E. Pre-treatment with pregabalin reduces liver ischemia-reperfusion injury in rats: tissue protection with an analgesic. Eur Rev Med Pharmacol Sci 2023; 27:10322-10333. [PMID: 37975356 DOI: 10.26355/eurrev_202311_34307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 11/19/2023]
Abstract
OBJECTIVE Ischemia-reperfusion injury is thought to be the most important factor affecting the success of liver surgery. Pregabalin has been studied to prevent ischemic reperfusion injury in many organs. The aim of this study was to investigate the role of pregabalin in preventing liver ischemic injury. MATERIALS AND METHODS 40 male Wistar-Albino rats, 6-8 weeks old, were divided into 5 groups. Four groups other than the sham group were subjected to hepatic ischemia for 1 hour, followed by 2 hours of reperfusion. Effects of 30 mg/and 60 mg/kg pregabalin were evaluated by aspartate aminotransferase (AST), alanine aminotransferase (ALT), tumor necrosis factor α (TNF-α), nuclear factor-kappa B (NF-кB), interleukin (IL)-6 levels, measured in blood samples collected before and after ischemia. Apoptosis was measured by caspase-3, and tissue samples were evaluated for ischemia by histopathologic examination. RESULTS The 60 mg pregabalin group was significantly superior (p=0.024) to the N-acetylcysteine group and the 30 mg pregabalin group for AST levels (p=0.612 and p=0.807, respectively). The difference between before and after ischemia-reperfusion blood TNF-α levels was higher in the 60 mg pregabalin group, but not significantly different from the 30 mg pregabalin and N-acetylcysteine groups (p>0.05). Tissue TNF-α levels showed that 60 mg and 30 mg pregabalin treatment was more effective than no-treatment (p=0.011, p=0.033, respectively), but not superior to N-acetylcysteine (p>0.05). CONCLUSIONS It has been found that ischemia-reperfusion causes damage to the liver, and this damage may be irreversible if no treatment is given. Our study group, pregabalin molecule was found to be significantly effective in preventing ischemia-reperfusion injury and may have a therapeutic advantage over N-acetylcysteine.
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Affiliation(s)
- V Umman
- Department of General Surgery, Istanbul University Cerrahpasa School of Medicine, Istanbul, Turkey.
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Lucarini E, Micheli L, Rajagopalan R, Ciampi C, Branca JJ, Pacini A, Leandri M, Rajagopalan P, Ghelardini C, Di Cesare Mannelli L. Broad-spectrum neuroprotection exerted by DDD-028 in a mouse model of chemotherapy-induced neuropathy. Pain 2023; 164:2581-2595. [PMID: 37556385 PMCID: PMC10578426 DOI: 10.1097/j.pain.0000000000002963] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Revised: 03/28/2023] [Accepted: 05/02/2023] [Indexed: 08/11/2023]
Abstract
ABSTRACT Neurotoxicity of chemotherapeutics involves peculiar alterations in the structure and function, including abnormal nerve signal transmission, of both the peripheral and central nervous system. The lack of effective pharmacological approaches to prevent chemotherapy-induced neurotoxicity necessitates the identification of innovative therapies. Recent evidence suggests that repeated treatment with the pentacyclic pyridoindole derivative DDD-028 can exert both pain-relieving and glial modulatory effects in mice with paclitaxel-induced neuropathy. This work is aimed at assessing whether DDD-028 is a disease-modifying agent by protecting the peripheral nervous tissues from chemotherapy-induced damage. Neuropathy was induced in animals by paclitaxel injection (2.0 mg kg -1 i.p). DDD-028 (10 mg kg -1 ) and the reference drug, pregabalin (30 mg kg -1 ), were administered per os daily starting concomitantly with the first injection of paclitaxel and continuing 10 days after the end of paclitaxel treatment. The behavioural tests confirmed the antihyperalgesic efficacy of DDD-028 on paclitaxel-induced neuropathic pain. Furthermore, the electrophysiological analysis revealed the capacity of DDD-028 to restore near-normal sensory nerve conduction in paclitaxel-treated animals. Histopathology evidence indicated that DDD-028 was able to counteract effectively paclitaxel-induced peripheral neurotoxicity by protecting against the loss of intraepidermal nerve fibers, restoring physiological levels of neurofilament in nerve tissue and plasma, and preventing morphological alterations occurring in the sciatic nerves and dorsal root ganglia. Overall, DDD-028 is more effective than pregabalin in preventing chemotherapy-induced neurotoxicity. Thus, based on its potent antihyperalgesic and neuroprotective efficacy, DDD-028 seems to be a viable prophylactic medication to limit the development of neuropathies consequent to chemotherapy.
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Affiliation(s)
- Elena Lucarini
- Department of Neuroscience, Psychology, Drug Research and Child Health (NEUROFARBA), Pharmacology and Toxicology Section, University of Florence, Florence, Italy
| | - Laura Micheli
- Department of Neuroscience, Psychology, Drug Research and Child Health (NEUROFARBA), Pharmacology and Toxicology Section, University of Florence, Florence, Italy
| | | | - Clara Ciampi
- Department of Neuroscience, Psychology, Drug Research and Child Health (NEUROFARBA), Pharmacology and Toxicology Section, University of Florence, Florence, Italy
| | - Jacopo J.V. Branca
- Department of Experimental and Clinical Medicine, Anatomy and Histology Section, University of Florence, Florence, Italy
| | - Alessandra Pacini
- Department of Experimental and Clinical Medicine, Anatomy and Histology Section, University of Florence, Florence, Italy
| | - Massimo Leandri
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy
| | | | - Carla Ghelardini
- Department of Neuroscience, Psychology, Drug Research and Child Health (NEUROFARBA), Pharmacology and Toxicology Section, University of Florence, Florence, Italy
| | - Lorenzo Di Cesare Mannelli
- Department of Neuroscience, Psychology, Drug Research and Child Health (NEUROFARBA), Pharmacology and Toxicology Section, University of Florence, Florence, Italy
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Nagakura Y, Hayashi M, Kajioka S. Analysis of Japanese nationwide health datasets: association between lifestyle habits and prevalence of neuropathic pain and fibromyalgia with reference to dementia-related diseases and Parkinson's disease. Scand J Pain 2023; 23:662-669. [PMID: 37439280 DOI: 10.1515/sjpain-2023-0010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2023] [Accepted: 06/27/2023] [Indexed: 07/14/2023]
Abstract
OBJECTIVES Chronic pain is defined as pain that persists or recurs for more than 3 months. This study focuses on neuropathic pain (NP) and fibromyalgia (FM) which are chronic pain states, and aims to identify lifestyle habits associated with their prevalence. Other neurological disorders are also analyzed as references. METHODS Association between the variable referring to disease prevalence (number of claims for reimbursement of marker drugs) and the variable for lifestyle habits/health examination results (collected from insured individuals aged 40-74 years) was determined by analyzing Japanese nationwide datasets, which were collected in 2018 and aggregated by prefecture. Pregabalin, donepezil, and levodopa were used as marker drugs for the chronic pain states, dementia-related diseases (Alzheimer's disease and Lewy body dementia) and Parkinson's disease (PD), respectively. Pearson's correlation analysis and multiple linear regression analysis were conducted. RESULTS Variables showing correlation coefficient (|r|)>0.5 were put into the multiple linear regression. Exercise habits (ꞵ=-0.3182), smoking habits (0.3218), daily drinking (0.2683), and alanine aminotransferase>51 U/L (0.2309) were finally incorporated in the equation for pregabalin (R 2=0.7268). Walking speed (-0.4543) and daily drinking (0.5077) were incorporated in the equation for donepezil (R 2=0.5718). CONCLUSIONS The prevalence of chronic pain states is associated with lifestyle habits, just like the dementia-related diseases. Exercise in daily life is negatively associated with the prevalence of the chronic pain states, although excessive alcohol drinking, smoking, and high serum ALT are positively associated with it. The prevalence of PD seems less associated with lifestyle habits.
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Affiliation(s)
- Yukinori Nagakura
- School of Pharmacy at Fukuoka, International University of Health and Welfare, Okawa-City, Fukuoka, Japan
| | - Maya Hayashi
- The Ministry of Justice in Japan, Correction Bureau, Tokyo, Japan
| | - Shunichi Kajioka
- School of Pharmacy at Fukuoka, International University of Health and Welfare, Okawa-City, Fukuoka, Japan
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Stein AM, Bouché PA, Grimaud O, Vedrenne P, Hardy A. Pregabalin does not reduce postoperative pain after outpatient ACL surgery: A case-control study. Orthop Traumatol Surg Res 2023; 109:103596. [PMID: 36924882 DOI: 10.1016/j.otsr.2023.103596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2022] [Revised: 01/10/2023] [Accepted: 01/17/2023] [Indexed: 03/15/2023]
Abstract
INTRODUCTION In France, prescribing pregabalin requires a secure prescription valid for 6 months since the decree of 12 February 2021, based on recommendations of the French Centre for Evaluation and Information on Pharmacodependence and Addiction vigilance (CEIP-A). This led to discontinuation of this treatment as a postoperative analgesic in the French ACL Study (FAST) cohort. We aimed to evaluate the impact of this change on early postoperative pain. HYPOTHESIS Pregabalin is an important analgesic for reducing early postoperative pain after anterior cruciate ligament (ACL) repair. METHODS At our healthcare facility, 584 patients from the FAST cohort who underwent primary isolated ACL reconstruction were included: 292 patients operated before June 1, 2021 who received pregabalin postoperatively and 292 patients operated after June 1, 2021 who did not receive pregabalin. The patients were matched based on age, sex, preoperative Lysholm and Tegner scores. Pain was evaluated on a visual analog scale (VAS) on D0 in the evening, D0 at night, D1, D2 and D3. RESULTS The patients who did not receive pregabalin had more severe pain at night on D0: 5.21 vs 5.68 (p=.048). There was no difference between groups in the postoperative pain at rest during the evening of D0 (p=.89), D1 (p=.33), D2 (p=.37) and D3 (p=.21). CONCLUSION In the context of outpatient arthroscopic ACL reconstruction, pregabalin does not reduce early postoperative pain in a clinically significant manner. LEVEL OF EVIDENCE IV; case-control study.
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Affiliation(s)
- Alexandra M Stein
- Orthopedics department, Hôpital Cochin Paris, 27, rue du Faubourg Saint-Jacques, 75014 Paris, France.
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Flynn D. Chronic Pain Syndromes: Fibromyalgia. FP Essent 2023; 533:7-15. [PMID: 37812528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 10/11/2023]
Abstract
Fibromyalgia is a chronic pain syndrome that is considered a pain processing disorder; its pathophysiology is not completely understood. The estimated prevalence in the general population varies from 0.5% to 12%, depending on the population studied and diagnostic criteria used. It is more common in females than males. There is no diagnostic laboratory test. The two currently used diagnostic methods are scoring criteria from the American College of Rheumatology (ACR) and the Analgesic, Anesthetic, and Addiction Clinical Trial Translations Innovations Opportunities and Networks (ACTTION)-American Pain Society (APS). These diagnostic criteria include chronic widespread pain of at least 3 months' duration plus poor sleep and/or fatigue and other somatic symptoms. Other pain syndromes also should be considered in the differential diagnosis. A multimodal, targeted symptom management approach that emphasizes self-management is recommended. Nonpharmacotherapies include patient education, exercise, and cognitive behavior therapy. Pharmacotherapy should be based on predominant symptoms. Amitriptyline and pregabalin are effective for management of pain, fatigue, and sleep issues. Milnacipran (Savella) is effective for pain and fatigue. Duloxetine is effective for management of pain and depression. There is no evidence of benefit of analgesics. Common comorbidities, such as regional pain conditions and mental disorders, should be addressed.
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Affiliation(s)
- Diane Flynn
- Department of Family Medicine - F. Edward Hébert School of Medicine - Uniformed Services University of the Health Sciences, Bethesda, MD
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Aydın Ş, Kılıç Tatlıcı C, Çivgin ME, Yazıcı ZG, Yıldırım C, Dinçer Öner S, Kılıç FS. The investigation of antidepressant and anxiolytic effects of pregabalin and its mechanisms of action in rats. Agri 2023; 35:236-243. [PMID: 37886867 DOI: 10.14744/agri.2022.98474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2023]
Abstract
OBJECTIVES Pregabalin (PGB) is used in drug-resistant epilepsy. Also, it has analgesic effects in painful syndromes. Depression and anxiety are commonly seen in epilepsy and neuropathic pain patients. PGB is often combined with anxiolytics and antidepressants. We aimed to investigate the antidepressant and anxiolytic effects of PGB and compare its effects with those of antidepressant and anxiolytic drugs and their combined use. METHODS Wistar Albino rats were used, and PGB (5, 10, 20, and 40 mg/kg), amitriptylin (AMT), fluoxetine (FLX), ketamine (KET), and diazepam (DZM), as well as combinations of PGB (20 mg/kg) with AMT, FLX, KET, and DZM, were administered. Elevated plus maze, forced swimming, and locomotor activity tests were performed. RESULTS In the elevated plus maze, PGB10, 20, 40, AMT, FLX, and DZM increased open arm time. The PGB20+FLX combination increased compared to PGB20. In forced swimming, PGB doses increased immobility time. AMT, FLX, DZM, and KET decreased compared to control and PGB doses. Other combinations of PGB20 reversed immobility time, except FLX. In locomotor activity, PGB20, AMT, KET, and DZM decreased distance. CONCLUSION PGB had a depressant effect in all doses and a dose-dependently anxiolytic effect. In combinations of PGB with AMT, KET, and DZM, it reversed their antidepressant effects. We assumed FLX could be preferred instead of AMT in patients using PGB. When PGB is used in combination, drug interactions should be considered. These results are also very remarkable in terms of pharmacoeconomics.
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Affiliation(s)
- Şule Aydın
- Department of Pharmacology, Eskişehir Osmangazi University Faculty of Medicine, Eskişehir, Türkiye
| | - Cansu Kılıç Tatlıcı
- Department of Pharmacology, Eskişehir Osmangazi University Faculty of Medicine, Eskişehir, Türkiye
| | - Mustafa Erhan Çivgin
- Department of Pharmacology, Eskişehir Osmangazi University Faculty of Medicine, Eskişehir, Türkiye
| | - Zeynep Gül Yazıcı
- Department of Pharmacology, Eskişehir Osmangazi University Faculty of Medicine, Eskişehir, Türkiye
| | - Cafer Yıldırım
- Eskişehir Osmangazi University, Equestrian Vocational School, Eskişehir, Türkiye
| | - Setenay Dinçer Öner
- Department of Bioistatistic, Eskişehir Osmangazi University Faculty of Medicine, Eskişehir, Türkiye
| | - Fatma Sultan Kılıç
- Department of Pharmacology, Eskişehir Osmangazi University Faculty of Medicine, Eskişehir, Türkiye
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Roch C, Para S, Brandhofer C, Seitz AK, Rémi C, Berner J, van Oorschot B. Successful use of Rectal Pregabalin for the Treatment of Chemotherapy-Induced Neuropathic Pain-a Case Report. J Palliat Care 2023; 38:412-415. [PMID: 37455368 DOI: 10.1177/08258597231189151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/18/2023]
Abstract
INTRODUCTION A 65-year-old female patient could no longer take oral food or medications due to a duodenal occlusion associated with metastatic urothelial carcinoma. Her pre-existing chemotherapy-induced polyneuropathy had been well treated with pregabalin orally. METHODS Since only preparations for oral use of pregabalin are available, pregabalin suppositories were compounded by the hospital pharmacy for rectal use in this patient. RESULTS With the rectal administration, the treatment was successfully continued; we measured a good increase in serum levels and the symptoms improved significantly. DISCUSSION Cancer patients often need to be treated with co-analgesics. At the end of life, treatment often cannot be continued due to lack of other than oral administration. Our case adds to the low evidence of pregabalin administered rectally.
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Affiliation(s)
- Carmen Roch
- Interdisciplinary Center for Palliative Medicine, University Hospital Wuerzburg, Wuerzburg, Germany
| | - Servet Para
- Interdisciplinary Center for Palliative Medicine, University Hospital Wuerzburg, Wuerzburg, Germany
| | | | - Anna K Seitz
- Department of Urology and Pediatric Urology, University Hospital Wuerzburg, Wuerzburg, Germany
| | - Constanze Rémi
- Pharmacy University Hospital of Munich, Munich, Germany
- Department for Palliative Medicine, University Hospital of Munich, Munich, Germany
| | - Jennifer Berner
- Pharmacy University Hospital of Munich, Munich, Germany
- Department for Palliative Medicine, University Hospital of Munich, Munich, Germany
| | - Birgitt van Oorschot
- Interdisciplinary Center for Palliative Medicine, University Hospital Wuerzburg, Wuerzburg, Germany
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Holford A, Martin C, Staib A, Harris K, Isoardi KZ. Introduction of QScript real-time prescription monitoring system was associated with a fall in pregabalin poisoning presentations to a clinical toxicology unit. Emerg Med Australas 2023; 35:879-881. [PMID: 37592758 DOI: 10.1111/1742-6723.14297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Accepted: 08/04/2023] [Indexed: 08/19/2023]
Abstract
OBJECTIVE To investigate the impact of QScript implementation on pregabalin-related poisoning presentations to the ED. METHODS This is a retrospective review of pregabalin-related poisoning presentations to a tertiary Australian ED in the 4 years prior to, and 1 year following the introduction of QScript real-time prescription monitoring system. RESULTS Pregabalin-related poisoning presentations fell by 28% from an average of 98 presentations annually over the 4 years prior to QScript implementation to 71 in 2022. The severity of poisonings was similar over the periods. CONCLUSIONS The introduction of QScript was associated with a reduction in pregabalin-related poisoning presentations.
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Affiliation(s)
- Amanda Holford
- Clinical Toxicology Unit, Princess Alexandra Hospital, Brisbane, Queensland, Australia
- Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Christopher Martin
- Clinical Toxicology Unit, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Andrew Staib
- Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Keith Harris
- Clinical Toxicology Unit, Princess Alexandra Hospital, Brisbane, Queensland, Australia
- Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Katherine Z Isoardi
- Clinical Toxicology Unit, Princess Alexandra Hospital, Brisbane, Queensland, Australia
- Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
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Latifi F, Choobsaz P, Yousefi-Koma AA, Yousefi-Koma H, Mirtaleb MH. Comparison of the analgesic effects of single-dose 75 mg oral pregabalin versus single-dose 400 mg oral ibuprofen after impacted third mandibular molar surgery: A randomized, double-blind, split-mouth clinical trial. Dent Med Probl 2023; 60:619-625. [PMID: 37905456 DOI: 10.17219/dmp/158860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Revised: 12/18/2022] [Accepted: 01/02/2023] [Indexed: 11/02/2023] Open
Abstract
BACKGROUND Pain is the most prevalent complication after dentoalveolar surgery. Failure in effective pain control could potentially lead to systemic sequels, such as tachycardia, hypertension, improper nutrition, and central sensitization. Pregabalin is a gamma-aminobutyric acid (GABA) analog with inhibitory and analgesic effects on the central nervous system (CNS). Prescribing gabapentinoids as complementary analgesics reduces the consumption of opioid and non-opioid analgesics, and consequently their side effects. OBJECTIVES The main purpose of the present study was to compare the analgesic effects of pregabalin (single-dose 75 mg) vs. ibuprofen (single-dose 400 mg) on patients' pain levels after impacted third mandibular molar surgery. MATERIAL AND METHODS In this randomized, double-blind, split-mouth clinical trial, 24 patients aged 19-34 years volunteered for 2 consecutive (1 month apart) third mandibular molar surgeries (the contralateral teeth). The patients were randomly placed into 2 groups: group G1 (n = 12) was prescribed pregabalin (single-dose 75 mg) after the 1st surgery and ibuprofen (single-dose 400 mg) after the 2nd surgery; and group G2 (n = 12) was prescribed the exact opposite of the G1 arrangement. During the first 24 h post-surgery, the patients recorded the number of complementary analgesics they took (single-dose 400 mg ibuprofen) and their level of pain on a visual analog scale (VAS) every 2 h. RESULTS The average level of pain at 2 h post-surgery (T1) was significantly lower when pregabalin was prescribed (p < 0.05). Most patients needed complementary analgesics at 4 h post-surgery (T2). However, during the first 24 h post-surgery, the patients required significantly more complementary analgesics when ibuprofen was prescribed. CONCLUSIONS In comparison with oral ibuprofen (single-dose 400 mg), oral pregabalin (single-dose 75 mg) had a stronger analgesic effect at 2 h after impacted third mandibular molar surgery (p < 0.05). Pregabalin resulted in a significantly lower consumption of complementary analgesics in the first 24 h post-surgery as compared to ibuprofen.
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Affiliation(s)
- Fatemeh Latifi
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Parsia Choobsaz
- School of Dentistry, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Mariano XM, de Assis Ferreira LC, Almeida-Leite CM, de Castro Junior CJ, de Lima ME. PnPP-15, a Synthetic Peptide Derived from a Toxin from Phoneutria nigriventer Spider Venom, Alleviates Diabetic Neuropathic Pain and Acts Synergistically with Pregabalin in Mice. Toxins (Basel) 2023; 15:560. [PMID: 37755986 PMCID: PMC10537695 DOI: 10.3390/toxins15090560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 08/28/2023] [Accepted: 08/30/2023] [Indexed: 09/28/2023] Open
Abstract
Diabetic neuropathic pain is one of the complications that affect a wide variety of the diabetic population and is often difficult to treat. Only a small number of patients experience pain relief, which usually comes with onerous side effects and low levels of satisfaction. The search for new analgesic drugs is necessary, given the limitations that current drugs present. Combining drugs to treat neuropathic pain has been attracting interest to improve their efficacy compared to single-drug monotherapies while also reducing dose sizes to minimize side effects. The aim of our study was to verify the antinociceptive effect of a synthetic peptide, PnPP-15, alone and combined with pregabalin, in male Swiss diabetic mice using the von Frey method. PnPP-15 is a synthetic peptide derived from PnPP19, a peptide representing a discontinuous epitope of the primary structure of the toxin PnTx2-6 from the venom of the spider Phoneutria nigriventer. The antinociceptive activity of both compounds was dose-dependent and showed synergism, which was verified by isobolographic analysis. Treatment with PnPP-15 did not cause spontaneous or forced motor changes and did not cause any damage or signs of toxicity in the analyzed organs (pancreas, lung, heart, kidney, brain, or liver). In conclusion, PnPP-15 is a great candidate for an analgesic drug against neuropathic pain caused by diabetes and exerts a synergistic effect when combined with pregabalin, allowing for even more efficient treatment.
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Affiliation(s)
- Xavier Maia Mariano
- Programa de Pós Graduação em Medicina e Biomedicina da Faculdade Santa Casa de Belo Horizonte, Belo Horizonte 30150-240, MG, Brazil; (X.M.M.); (L.C.d.A.F.); (C.J.d.C.J.)
| | - Luana Caroline de Assis Ferreira
- Programa de Pós Graduação em Medicina e Biomedicina da Faculdade Santa Casa de Belo Horizonte, Belo Horizonte 30150-240, MG, Brazil; (X.M.M.); (L.C.d.A.F.); (C.J.d.C.J.)
| | - Camila Megale Almeida-Leite
- Departamento de Morfologia, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Belo Horizonte 31270-901, MG, Brazil;
| | - Célio José de Castro Junior
- Programa de Pós Graduação em Medicina e Biomedicina da Faculdade Santa Casa de Belo Horizonte, Belo Horizonte 30150-240, MG, Brazil; (X.M.M.); (L.C.d.A.F.); (C.J.d.C.J.)
| | - Maria Elena de Lima
- Programa de Pós Graduação em Medicina e Biomedicina da Faculdade Santa Casa de Belo Horizonte, Belo Horizonte 30150-240, MG, Brazil; (X.M.M.); (L.C.d.A.F.); (C.J.d.C.J.)
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Wang Q, Ma T, Wang L, Zhao C, Kang P. Efficacy of Adding Acetaminophen to Preemptive Multimodal Analgesia in Total Knee Arthroplasty: A Double-blinded Randomized Study. Orthop Surg 2023; 15:2283-2290. [PMID: 37403525 PMCID: PMC10475677 DOI: 10.1111/os.13780] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 05/16/2023] [Accepted: 05/17/2023] [Indexed: 07/06/2023] Open
Abstract
OBJECTIVE Preemptive multimodal analgesia is a frequently utilized method for controlling pain after total knee arthroplasty (TKA). So far, no studies have specifically examined the efficacy of adding acetaminophen to preemptive multimodal analgesia in TKA. The current work aimed to assess the efficacy of adding acetaminophen to preemptive multimodal analgesia for clinical pain management after TKA. METHODS This was a double-blinded randomized study including 80 cases randomized to the acetaminophen and control groups, respectively. The acetaminophen group was administered celecoxib at 400 mg, pregabalin at 150 mg, and acetaminophen at 300 mg 2 h before TKA. Control patients were administered celecoxib, pregabalin, and placebo. The primary outcome was postsurgical use of morphine hydrochloride for rescue analgesia. Secondary outcomes included the time to the initial rescue analgesia, postsurgical pain as determined by a visual analogue scale (VAS), functional recovery as reflected by the range of knee motion and ambulation distance, hospitalization duration, and complication rates. Continuous data with normal and skewed distributions were compared by the Student's t test and the Mann-Whitney U test, respectively. Categorical variables were compared by the Pearson's chi-squared test. RESULTS The control and acetaminophen groups were comparable in postoperative 0-24 h morphine consumption (11.3 ± 6.5 mg vs 12.3 ± 7.7 mg, P = 0.445) and total morphine consumption (17.3 ± 10.1 mg vs 19.3 ± 9.4 mg, P = 0.242). Additionally, time to the initial rescue analgesia, postoperative VAS score at any time point, postoperative functional recovery of the knee, and hospitalization duration were similar in both groups. Both groups also had similar occurrence rates of postoperative complications. CONCLUSIONS In this study, adding acetaminophen to preoperative preemptive multimodal analgesia did not decrease postoperative morphine use or ameliorate pain relief. The efficacy of adding acetaminophen to preemptive multimodal analgesia in TKA need to be further explored in future studies.
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Affiliation(s)
- Qiuru Wang
- Department of Orthopedic SurgeryWest China Hospital, Sichuan UniversityChengduChina
| | - Ting Ma
- Operating RoomWest China Hospital, Sichuan University/West China School of Nursing, Sichuan UniversityChengduChina
| | - Liying Wang
- Operating RoomWest China Hospital, Sichuan University/West China School of Nursing, Sichuan UniversityChengduChina
| | - Chengcheng Zhao
- Department of Orthopedic SurgeryWest China Hospital, Sichuan UniversityChengduChina
| | - Pengde Kang
- Department of Orthopedic SurgeryWest China Hospital, Sichuan UniversityChengduChina
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Cachemaille M, Geering S, Broome M. Cryoneurolysis of alveolar nerves for chronic dental pain: A new technique and a case series. Pain Pract 2023; 23:851-854. [PMID: 37243450 DOI: 10.1111/papr.13254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Accepted: 05/15/2023] [Indexed: 05/28/2023]
Abstract
BACKGROUND Chronic neuropathic dental pain has a poor prognosis with a low chance of significant spontaneous improvement. Local or oral therapies may be efficient, however short in terms of duration with potential side effects. Cryoneurolysis has been described to prevent acute postoperative pain or to treat some chronic pain conditions; however, application to dental orofacial pain has not been reported so far. CASE SERIES Following a positive diagnostic block on the corresponding alveolar nerve, neuroablation was performed using a cryoprobe on three patients suffering from persistent pain after a dental extraction and 1 after multiple tooth surgeries. The effect of treatment was assessed using a Pain Numeric Rating Scale (NRS) and determined by changes in medication dosage and quality of life at day 7 and 3 months. Two patients experienced more than 50% of pain relief at 3 months, 2 by 50%. One patient was able to wean off pregabalin medication, one decreased amitriptyline by 50%, and one decreased tapentadol by 50%. No direct complications were reported. All of them mentioned improvement in sleep and quality of life. CONCLUSION Cryoneurolysis on alveolar nerves is a safe and easy-to-use technique allowing prolonged neuropathic pain relief after dental surgery.
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Affiliation(s)
- Matthieu Cachemaille
- Pain Clinic, Hôpital de la Tour, Meyrin, Switzerland
- Department of Anaesthesiology, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland
| | - Sébastien Geering
- Division of Oral and Maxillofacial Surgery, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland
| | - Martin Broome
- Division of Oral and Maxillofacial Surgery, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland
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Tang J, Zhang Y, Liu C, Zeng A, Song L. Therapeutic Strategies for Postherpetic Neuralgia: Mechanisms, Treatments, and Perspectives. Curr Pain Headache Rep 2023; 27:307-319. [PMID: 37493871 DOI: 10.1007/s11916-023-01146-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/26/2023] [Indexed: 07/27/2023]
Abstract
PURPOSE OF REVIEW Postherpetic neuralgia is an annoying pain that mainly affects older people. In order to give patients more options, this review summarizes the pharmacological and interventional treatments for postherpetic neuralgia and updates the research on the efficacy, thereby providing doctors with more treatment options. The adverse effects and effective doses of its various treatments are also presented so that the therapy can be prescribed according to their concrete physical conditions. In a word, this review is dedicated to providing a comprehensive overview of the treatment options for postherpetic neuralgia and offering patients more choices. RECENT FINDINGS Combinational therapy is more excellent than monotherapy. The local anesthesia and gabapentin comprised outstanding compatibility. In addition, two therapeutic tools for PHN patients, especially for the intractable ones, electroacupuncture (EA), and osteopathic manipulative treatment (OMT), show their efficacy and become potential options to alleviate pain. In terms of treatment, guidelines recommend patients use tricyclic antidepressants (TCAs), gabapentin, pregabalin, and 5% lidocaine patches as the first-line medications, and gabapentin is investigated most, especially the gabapentin enacarbil (GEn). And drug efficacy can be limited by adverse effects and tolerated doses. Interventional treatments, with their invasiveness and operational difficulty, are usually considered for intractable patients. Combinational therapies may be used when a single therapy cannot achieve the desired effect. Therapies such as OMT and EA have also been proposed to palliate pain in some cases, and future directions of treatment may be investigated in Chinese medicine and acupuncture.
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Affiliation(s)
- Jiayu Tang
- School of Medical and Life Sciences, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, 611137, People's Republic of China
| | - Yunchao Zhang
- School of Medical and Life Sciences, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, 611137, People's Republic of China
| | - Chenxin Liu
- School of Medical and Life Sciences, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, 611137, People's Republic of China
| | - Anqi Zeng
- Institute of Translational Pharmacology and Clinical Application, Sichuan Academy of Chinese Medical Science, Chengdu, Sichuan, 610041, People's Republic of China.
| | - Linjiang Song
- School of Medical and Life Sciences, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, 611137, People's Republic of China.
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McNeilage AG, Ashton-James CE, Scholz B. "We were all looking for the magic pill": A qualitative study of patient experiences using gabapentinoids for chronic pain. Int J Drug Policy 2023; 119:104112. [PMID: 37453375 DOI: 10.1016/j.drugpo.2023.104112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 06/21/2023] [Accepted: 06/22/2023] [Indexed: 07/18/2023]
Abstract
BACKGROUND Gabapentinoid medications are increasingly being used in chronic pain management, yet very little is known about the experiences of those using them. The aim of this study was to address this gap in the literature by qualitatively exploring the lived experiences of patients using gabapentinoids for chronic pain. METHODS Semi-structured interviews were conducted with 12 adults prescribed a gabapentinoid medication - either pregabalin or gabapentin - for chronic pain in Australia. Interviews were conducted in May 2022 via telephone or online video chat. Audio recordings of the interviews were transcribed verbatim, and data were analysed using reflexive thematic analysis. The Medication Adherence Model was used as a framework for synthesising the data and organising themes. RESULTS For participants in this study, the initial decision to use gabapentinoids for chronic pain was driven by a level of desperation for pain relief, a perceived lack of pain management alternatives, and a belief that the medication was safer and easier to access than opioids. However, once using gabapentinoids, experiences varied considerably with some viewing the medication as effective and safe, and others viewing it as useless or harmful. Some participants expressed concern that they were not adequately informed by their prescribers about the risks of gabapentinoid use. CONCLUSION These findings emphasise the importance of patient-provider communication and taking a patient-centred approach to gabapentinoid prescribing and de-prescribing. Future qualitative research in this area should involve primary care providers to gain a better understanding of factors driving increased gabapentinoid prescribing in chronic pain management as well as barriers to patient education.
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Affiliation(s)
- Amy G McNeilage
- School of Medicine and Psychology, College of Health and Medicine, Australian National University, Canberra, Australian Capital Territory, Australia; Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia.
| | - Claire E Ashton-James
- Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia.
| | - Brett Scholz
- School of Medicine and Psychology, College of Health and Medicine, Australian National University, Canberra, Australian Capital Territory, Australia
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Polat CS, Konak HE, Akıncı MG, Onat SS, Altas EU. Misuse of gabapentinoids (pregabalin and gabapentin) in patients with neuropathic pain related to spinal cord injury. J Spinal Cord Med 2023; 46:859-864. [PMID: 35108174 PMCID: PMC10446779 DOI: 10.1080/10790268.2021.2024709] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
OBJECTIVE To investigate the misuse of gabapentinoids (pregabalin and gabapentin) in patients with neuropathic pain related to spinal cord injury. STUDY DESIGN Cross-sectional study. SETTING Outpatient clinic in a physical therapy and rehabilitation hospital. PARTICIPANTS 127 patients, aged 18-70 years, who had neuropathic pain related to spinal cord injury (SCI) and disease duration of at least 12 months. OUTCOME MEASURES Gabapentinoid use disorder of the patients was determined based on the DSM-5 diagnostic criteria for substance-related disorders. Patients were divided into 2 groups as those with drug misuse and those without drug misuse. Demographic and clinical information of the patients were compared between the groups. Factors associated with drug misuse were analyzed. RESULTS The misuse rate was 81.9% in patients using pregabalin and 69.69% in patients using gabapentin. Duration of disease and the Leeds assessment of neuropathic symptoms and signs (LANSS) score were statistically significantly higher in the drug misuse group. A statistically significant difference was found between the groups in terms of marital status, education and income level, and smoking and alcohol use. A statistically significant relationship was observed between drug misuse and duration of disease and LANSS score. CONCLUSION Misuse of gabapentinoids is prevalent in patients with neuropathic pain related to spinal cord injury. The duration of disease and the severity of NP are associated with misuse. Clinicians should exercise caution when prescribing gabapentinoids to patients with SCI.
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Affiliation(s)
- Cemile Sevgi Polat
- Ankara Physical Therapy and Rehabilitation Training and Research Hospital, Ankara, Turkey
| | - Hatice Ecem Konak
- Ankara Physical Therapy and Rehabilitation Training and Research Hospital, Ankara, Turkey
| | - Meltem Günes Akıncı
- Ankara Physical Therapy and Rehabilitation Training and Research Hospital, Ankara, Turkey
| | - Sule Sahin Onat
- Ankara Physical Therapy and Rehabilitation Training and Research Hospital, Ankara, Turkey
| | - Elif Umay Altas
- Ankara Physical Therapy and Rehabilitation Training and Research Hospital, Ankara, Turkey
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Basem JI, Bah FN, Mehta ND. A Brief Review on the Novel Therapies for Painful Diabetic Neuropathy. Curr Pain Headache Rep 2023; 27:299-305. [PMID: 37392335 DOI: 10.1007/s11916-023-01126-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/01/2023] [Indexed: 07/03/2023]
Abstract
PURPOSE OF REVIEW Almost half of people diagnosed with diabetes mellitus will develop painful diabetic neuropathy (PDN), a condition greatly impacting quality of life with complicated pathology. While there are different FDA approved forms of treatment, many of the existing options are difficult to manage with comorbities and are associated with unwanted side effects. Here, we summarize the current and novel treatments for PDN. RECENT FINDINGS Current research is exploring alternative pain management treatments from the first line options of pregabalin, gabapentin, duloxetine, and amitriptyline which often have side effects. The use of FDA approved capsaicin and spinal cord stimulators (SCS) has been incredibly beneficial in addressing this. In addition, new treatments looking at different targets, such as NMDA receptor and the endocannabinoid system, show promising results. There are several treatment options that have been shown to be successful in helping treat PDN, but often require adjunct treatment or alterations due to side effects. While there is ample research for standard medications, treatments such as palmitoylethanolamide and endocannabinoid targets have extremely limited clinical trials. We also found that many studies did not evaluate additional variables other than pain relief, such as functional changes nor were there consistent measurement methods. Future research should continue trials comparing treatment efficacies along with more quality of life measures.
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Affiliation(s)
- Jade I Basem
- Pain Medicine, Department of Anesthesiology, Weill Cornell Medicine, New York, NY, USA.
| | - Fatoumata N Bah
- Pain Medicine, Department of Anesthesiology, Weill Cornell Medicine, New York, NY, USA
| | - Neel D Mehta
- Pain Medicine, Department of Anesthesiology, Weill Cornell Medicine, New York, NY, USA
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Liu L, Sun Z, Zhang Y, Ma G, Luo F. Outcomes and Predictors of Response to Pregabalin for the Treatment of Post-Traumatic Trigeminal Neuropathic Pain Following Neuroablative Procedures: A Retrospective Observational Study. Pain Physician 2023; 26:E539-E548. [PMID: 37774191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/01/2023]
Abstract
BACKGROUND Post-traumatic trigeminal neuropathic pain (PTNP) following trigeminal neuralgia (TN)-related neuroablative procedures is relatively rare. Due to the fear of debilitating complications, its treatment has been generally suboptimal. Pregabalin (PGB) has been reported to relieve neuropathic pain. However, the potential role of PGB and the predictors of response of PGB use as a strategy in the treatment of PTNP following TN-related neuroablative procedures have not been identified yet. OBJECTIVES To report the efficacy and safety of PGB and the identification of predictors of PGB for PTNP following TN-related neuroablative procedures. STUDY DESIGN Monocentric, retrospective, observational study. SETTING This study consecutively enrolled patients with PTNP following TN-related neuroablative procedures who were prescribed PGB at Beijing Tiantan Hospital. METHODS From January 2018 to June 2022, a total of 112 patients were included in this study, of whom 10 were excluded because of incomplete follow-up data and side effects immediately after taking PGB. Final analysis included 102 patients. Demographic data, pain-related baseline data, efficacy of patients with PTNP after one month of PGB evaluated by the Barrow Neurological Institute (BNI) scores for pain, and side effects of PGB were extracted and analyzed. The predictors of pain-relieving effects of PGB were identified by logistic regression analysis. RESULTS Within one month after the use of PGB alone, 29 out of the 102 (28.4%) patients achieved pain relief with a significant reduction in the BNI scores (P < 0.01). All of the 73 patients who did not respond to PGB monotherapy either switched to other medications (n = 8) or combined additional oral medications to the existing PGB therapy (n = 65). The main side effect of PGB in our study was dizziness. Binary logistic regression analysis showed that longer disease durations (Adjusted odds ratio [OR] = 0.55, 95% confidence interval [CI] 0.43 to 0.72, P = 0.000) and higher Hospital Anxiety and Depression Scale (HADS) scores (Adjusted OR = 0.29, 95% CI 0.10 to 0.87, P = 0.022) were poor predictors of response to PGB. LIMITATIONS This was a retrospective observational study. Long-term efficacy and safety of PGB in the treatment of PTNP patients were not evaluated. CONCLUSIONS This study confirms that PGB monotherapy is not a very effective treatment for PTNP following TN-related neuroablative procedures. PGB was more beneficial in patients with shorter disease durations and lower HADS scores. KEY WORDS Post-traumatic trigeminal neuropathic pain, efficacy, safety, predictor of response, pregabalin.
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Affiliation(s)
- Lu Liu
- Beijing Tiantan Hospital, Capital Medical University, Pain Management, Beijing, China
| | - Zhe Sun
- Beijing Tiantan Hospital, Capital Medical University, Pain Management, Beijing, China
| | - Yan Zhang
- Beijing Tiantan Hospital, Capital Medical University, Pain Management, Beijing, China
| | - Guofeng Ma
- Beijing Tiantan Hospital, Capital Medical University, Pain Management, Beijing, China
| | - Fang Luo
- Beijing Tiantan Hospital, Capital Medical University, Pain Management, Beijing, China
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Li HQ, Jiang YH, Liu L, Xing XF, Wang J, Ma SH, Xia LJ. [Efficacy and safety of high-voltage pulsed radiofrequency combined with pregabalin on severe thoracic postherpetic neuralgia]. Zhonghua Yi Xue Za Zhi 2023; 103:2440-2444. [PMID: 37599219 DOI: 10.3760/cma.j.cn112137-20230113-00077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 08/22/2023]
Abstract
Objective: To investigate the efficacy and safety of high-voltage pulse radiofrequency combined with pregabalin on severe thoracic postherpetic neuralgia (PHN). Methods: A total of 103 patients with PHN who were admitted to the Department of Pain Medicine of Henan Provincial People's Hospital from May 2020 to May 2022 were retrospectively selected, including 50 males and 53 females, and aged 40 to 79 (65.4±9.2) years. The patients were divided into two groups according to the treatment methods they received: the control group (n=51) and the study group (n=52). The patients in the control group were treated with oral pregabalin, and the patients in the study group received pregabalin plus high-voltage pulse radiofrequency therapy. The pain intensity and efficacy of the two groups were evaluated before treatment and 4 weeks after treatment. The pain intensity, the sleep quality and the efficacy of treatment was evaluated by visual analogue scale (VAS) score, Pittsburgh Sleep Quality Index (PSQI) score and nimodipine method, respectively. The levels of pain mediators including serum neuropeptide Y (NPY), prostaglandin E2 (PGE2), substance P (SP) and β-endorphin were measured. The differences of the above indicators and the incidence of adverse reactions were compared between the two groups. Results: The VAS scores of the study group and the control group before treatment were 7.94±0.76 and 8.20±0.81, and PSQI scores were 16.84±3.90 and 16.29±3.84, respectively, with no statistically significant differences (both P>0.05). After 4 weeks of treatment, the VAS scores of the two groups were 2.84±0.80 and 3.35±0.87, and PSQI scores were 6.78±1.90 and 7.98±2.40, respectively, and the VAS score and PSQI score in the study group were lower than those in the control group (both P<0.05). There were no significant differences of the serum levels of NPY, PGE2, SP and β-endorphin before treatment in the study group and control group (all P>0.05). After 4 weeks of treatment, the levels of NPY, PGE2, SP and β-Endorphin in the study group were (240.7±26.8) ng/L, (74.4±8.6) μg/L, (108.9±15.7) ng/L and (4.4±0.9) ng/L, which were lower than those in the control group [(268.1±29.4) ng/L, (79.7±8.3) μg/L, (115.2±16.2) ng/L, (5.2±1.3) ng/L, respectively], with statistically significant differences (all P<0.05). After treatment, 29 cases were cured, 16 cases were markedly effective and 6 cases were effective in the study group, while 16 cases, 24 cases and 8 cases were cured, markedly effective and effective in the control group, respectively. The overall efficacy of patients in the study group was better than that in the control group (Z=-2.32, P=0.018). The incidence of adverse reactions in the study group and control group was 11.5% (6/52) and 7.8% (4/51), respectively, with no statistically significant difference (χ2=0.40, P=0.527). Conclusion: High-voltage pulse radiofrequency combined with pregabalin can significantly improve the pain intensity and sleep quality of patients with severe thoracic PHN and reduce the levels of pain mediators, with a high safety profile.
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Affiliation(s)
- H Q Li
- Department of Pain Medicine, Henan Provincial People's Hospital, Zhengzhou 450003, China
| | - Y H Jiang
- Department of Pain Medicine, Henan Provincial People's Hospital, Zhengzhou 450003, China
| | - L Liu
- Department of Pain Medicine, Henan Provincial People's Hospital, Zhengzhou 450003, China
| | - X F Xing
- Department of Pain Medicine, Henan Provincial People's Hospital, Zhengzhou 450003, China
| | - J Wang
- Department of Pain Medicine, Henan Provincial People's Hospital, Zhengzhou 450003, China
| | - S H Ma
- Department of Pain Medicine, Henan Provincial People's Hospital, Zhengzhou 450003, China
| | - L J Xia
- Department of Pain Medicine, Henan Provincial People's Hospital, Zhengzhou 450003, China
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Tsai SHL, Hu CW, El Sammak S, Durrani S, Ghaith AK, Lin CCJ, Krzyż EZ, Bydon M, Fu TS, Lin TY. Different Gabapentin and Pregabalin Dosages for Perioperative Pain Control in Patients Undergoing Spine Surgery: A Systematic Review and Network Meta-Analysis. JAMA Netw Open 2023; 6:e2328121. [PMID: 37556139 PMCID: PMC10413173 DOI: 10.1001/jamanetworkopen.2023.28121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2023] [Accepted: 06/20/2023] [Indexed: 08/10/2023] Open
Abstract
IMPORTANCE Patients undergoing spine surgery often experience severe pain. The optimal dosage of pregabalin and gabapentin for pain control and safety in these patients has not been well established. OBJECTIVE To evaluate the associations of pain, opioid consumption, and adverse events with different dosages of pregabalin and gabapentin in patients undergoing spine surgery. DATA SOURCES PubMed/MEDLINE, Embase, Web of Science, Cochrane library, and Scopus databases were searched for articles until August 7, 2021. STUDY SELECTION Randomized clinical trials conducted among patients who received pregabalin or gabapentin while undergoing spine surgery were included. DATA EXTRACTION AND SYNTHESIS Two investigators independently performed data extraction following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) reporting guideline. The network meta-analysis was conducted from August 2022 to February 2023 using a random-effects model. MAIN OUTCOMES AND MEASURES The primary outcome was pain intensity measured using the Visual Analog Scale (VAS), and secondary outcomes included opioid consumption and adverse events. RESULTS Twenty-seven randomized clinical trials with 1861 patients (median age, 45.99 years [range, 20.00-70.00 years]; 759 women [40.8%]) were included in the systematic review and network meta-analysis. Compared with placebo, the VAS pain score was lowest with gabapentin 900 mg per day, followed by gabapentin 1200 mg per day, gabapentin 600 mg per day, gabapentin 300 mg per day, pregabalin 300 mg per day, pregabalin 150 mg per day, and pregabalin 75 mg per day. Additionally, gabapentin 900 mg per day was found to be associated with the lowest opioid consumption among all dosages of gabapentin and pregabalin, with a mean difference of -22.07% (95% CI, -33.22% to -10.92%) for the surface under the cumulative ranking curve compared with placebo. There was no statistically significant difference in adverse events (nausea, vomiting, and dizziness) among all treatments. No substantial inconsistency between direct and indirect evidence was detected for all outcomes. CONCLUSIONS AND RELEVANCE These findings suggest that gabapentin 900 mg per day before spine surgery is associated with the lowest VAS pain score among all dosages. In addition, no differences in adverse events were noted among all treatments.
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Affiliation(s)
- Sung Huang Laurent Tsai
- Department of Orthopaedic Surgery, Chang Gung Memorial Hospital, Keelung Branch, Taiwan
- School of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Ching-Wei Hu
- Department of Orthopaedic Surgery, Chang Gung Memorial Hospital, Keelung Branch, Taiwan
- School of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Sally El Sammak
- Mayo Clinic Neuro-Informatics Laboratory, Mayo Clinic, Rochester, Minnesota
- Department of Neurological Surgery, Mayo Clinic, Rochester, Minnesota
| | - Sulaman Durrani
- Mayo Clinic Neuro-Informatics Laboratory, Mayo Clinic, Rochester, Minnesota
- Department of Neurological Surgery, Mayo Clinic, Rochester, Minnesota
| | - Abdul Karim Ghaith
- Mayo Clinic Neuro-Informatics Laboratory, Mayo Clinic, Rochester, Minnesota
- Department of Neurological Surgery, Mayo Clinic, Rochester, Minnesota
| | - Che Chung Justin Lin
- Department of Orthopaedic Surgery, Chang Gung Memorial Hospital, Keelung Branch, Taiwan
- School of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Ewa Zuzanna Krzyż
- School of Nursing, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan
| | - Mohamad Bydon
- Mayo Clinic Neuro-Informatics Laboratory, Mayo Clinic, Rochester, Minnesota
- Department of Neurological Surgery, Mayo Clinic, Rochester, Minnesota
| | - Tsai Sheng Fu
- School of Medicine, Chang Gung University, Taoyuan, Taiwan
- Department of Orthopaedic Surgery, Chang Gung Memorial Hospital, Linkou Branch, Taiwan
| | - Tung Yi Lin
- Department of Orthopaedic Surgery, Chang Gung Memorial Hospital, Keelung Branch, Taiwan
- School of Medicine, Chang Gung University, Taoyuan, Taiwan
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Sun H, Yu Z. Effect of extracorporeal shock wave combined with pregabalin on patients with post-herpetic neuralgia. Medicine (Baltimore) 2023; 102:e34361. [PMID: 37505177 PMCID: PMC10378967 DOI: 10.1097/md.0000000000034361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Revised: 06/19/2023] [Accepted: 06/26/2023] [Indexed: 07/29/2023] Open
Abstract
Post-herpetic neuralgia (PHN) is a chronic pain that is difficult to treat and lasts a long time, which poses a threat to patients' physical and mental health (MH) and quality of life. To analyze the effectiveness of extracorporeal shock wave (ESW) combined with pregabalin on PHN and its impact on PHN patients' quality of life with the help of a random number table. Totally 164 PHN patients were assigned to a control group (n = 82) or an observation group (n = 82). The observation group was given pregabalin combined with ESW treatment, while the control group was only given pregabalin. In the 2 groups, the general clinical data of the patients were compared. The inflammation levels including erythrocyte sedimentation rate (ESR), CRP, lymphocyte count and albumin level in both groups were compared prior to and following therapy. In addition, the difference between pretreatment and post-treatment in the 2 groups was compared with respect to neuralgia and quality of life. After treatment, the observation group exhibited much lower ESR and CRP but quite higher lymphocyte count and albumin level relative to the control group (P < .05). Additionally, the improvement in visual analogue scale (VAS) scores and short form 36 (SF-36) scale scores including role-emotional (RE), MH, physical function (PF), general health (GH), bodily pain (BP), social function (SF), vitality (VT), and role-physical (RP) scores in the 2 groups were pronounced following treatment, which was more apparent in the observation group (P < .05). The combination of ESW with pregabalin can reduce the inflammation, improve the quality of life of PHN patients and effectively relieve their neuralgia.
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Affiliation(s)
- Haoliang Sun
- Department of Anesthesiology, The First People’s Hospital of Fuyang District, Hangzhou 311400, China
| | - Zhou Yu
- Department of Anesthesiology, The First People’s Hospital of Fuyang District, Hangzhou 311400, China
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Behmer Hansen RA, Behmer Hansen RT, Noureddine C, Behmer VA, Opler D. Reasons for use and experiences of using phenibut, a mixed methods analysis of online reports. Am J Drug Alcohol Abuse 2023; 49:458-469. [PMID: 37184879 DOI: 10.1080/00952990.2023.2204510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Revised: 04/12/2023] [Accepted: 04/15/2023] [Indexed: 05/16/2023]
Abstract
Background: Phenibut is a drug similar in structure to gabapentin and pregabalin. It is available online without prescription, often marketed as a dietary supplement or amino acid derivative. Little is known about phenibut use despite its increased popularity in the United States over the last decade.Objective: To clarify reasons for taking phenibut, circumstances, and effects of use.Methods: Reports of phenibut, gabapentin, and pregabalin use were downloaded from a publicly-available database, Erowid.org. A mixed methods approach utilizing qualitative content analysis was used.Results: Of 229 reports, 211 were from male authors. People usually purchased phenibut online and reportedly used it for recreation, to manage a medical or psychiatric problem (primarily insomnia, anxiety), as a substitute for other drugs (especially benzodiazepines), to manage withdrawal from another substance (including benzodiazepines, opioids), and/or for performance enhancement. While it shared many reported effects with pregabalin and gabapentin such as anxiolysis, increased talkativeness, and impaired motor coordination, reports of gastrointestinal distress and sedation were more commonly attributed to phenibut. Several people reported difficulty in restricting their use and managing withdrawal.Conclusions: Phenibut reports suggest that phenibut may have some benefits for some people. Use also, however, carries risks of adverse effects, a potentially dangerous withdrawal syndrome, and addiction. Not dissimilar to unprescribed gabapentin or pregabalin, self-medication is a common motive for phenibut use. Physicians should continue to ask their patients about use of any non-prescribed medications, dietary supplements, or "amino acid derivatives."Abbreviation: PWUPh: people who use phenibut; PWUG: people who use gabapentin; PWUPr: people who use pregabalin.
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Affiliation(s)
| | | | - Chaden Noureddine
- Department of Psychiatry, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Virginia A Behmer
- Department of Biology, Case Western Reserve University, Cleveland, OH, USA
| | - Douglas Opler
- Department of Psychiatry, Rutgers New Jersey Medical School, Newark, NJ, USA
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Servais L, Richelle L. Misuse of pregabalin: a qualitative study from a patient's perspective. Br J Gen Pract 2023; 73:bjgp23X734061. [PMID: 37479310 DOI: 10.3399/bjgp23x734061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/23/2023] Open
Abstract
BACKGROUND The misuse of pregabalin has been the subject of increasing concerns for several years. The effects sought are multiple and it is rarely taken as a single drug. The most frequent association is with opioids, which may increase the risk of fatal overdose. AIM In the face of this emerging phenomenon, a better understanding was needed of the misuse situation in Belgium and to identify the people involved. METHOD A qualitative study using semi-structured interviews with 20 participants who misuse pregabalin was conducted through all the French-speaking part of Belgium between August 2021 and January 2022. This proceeded to a thematic analysis method with the help of NVivo software. RESULTS A profile of young users, new immigrants, mainly coming from North Africa emerged. They had in common a challenging or even traumatic migration pathway and precarious living conditions on Belgian territory. Most of them had no stable income. Pregabalin seemed to enable them to cope with their daily situation. All had psychiatric and/or somatic comorbidities for which they did not seem to benefit from adequate medical care. It seemed to lead many of them to use pregabalin as self-medication for anxio-depressive disorders and chronic pain. Pregabalin was never used alone. CONCLUSION This study has highlighted a rarely documented profile of pregabalin misuse: self-medication among a group of new immigrants, most of whom have no previous history of opioid-related disorders. Measures should be taken to improve access to health and social care for this population, considering all their biopsychosocial vulnerabilities.
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Nakajima R, Ooba N, Kamei M, Hashiba H, Miyazaki C. Safety of mirogabalin and pregabalin in Japanese patients with neuropathic pain: a retrospective cohort study. Expert Opin Drug Saf 2023; 22:841-848. [PMID: 36945742 DOI: 10.1080/14740338.2023.2193395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Accepted: 03/15/2023] [Indexed: 03/23/2023]
Abstract
BACKGROUND Few studies have compared the safety risks between the gabapentinoids, pregabalin, and mirogabalin in post-marketing clinical settings. We assessed reported events associated with gabapentinoid use in patients with neuropathic pain. RESEARCH DESIGN AND METHODS We conducted a retrospective cohort study between September 2020 and December 2020 using the community pharmacies records in Japan. The pharmacists identified new vs. prevalent users of mirogabalin and pregabalin in September 2020 and reported data regarding baseline and adverse events to the Japan Pharmaceutical Association using web-based questionnaires. The incidence of events and hazard ratio (HR) were consequently compared. RESULTS New users of mirogabalin and pregabalin were identified (n = 1,650 and 2,244; mean age (SD): 69 (15) and 68 (16) years; women: 59% and 56%, respectively). Although serious events were not reported, a marked difference in HRs of common adverse events, including somnolence (1.6), dizziness (1.3), nausea (2.8), edema (3.1), and acetaminophen (2.0)/antidepressant (2.4) addition, was observed. CONCLUSION No new serious safety concerns were found for mirogabalin and pregabalin use in patients with neuropathic pain, although the HR of some events indicated increased risk among mirogabalin users. However, further studies are needed as estimates for events occurring in small numbers with wide confidence intervals.
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Affiliation(s)
- Rie Nakajima
- Department of Pharmacy Practice in Primary Care, Nihon University School of Pharmacy, Chiba, Japan
| | - Nobuhiro Ooba
- Department of Pharmacoepidemiology, Nihon University School of Pharmacy, Chiba, Japan
| | - Miwako Kamei
- Japan Pharmaceutical Association, Tokyo, Japan
- Faculty of Pharmaceutical Sciences, Teikyo Heisei University, Tokyo, Japan
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Nimmaanrat S, Charuenporn B, Jensen MP, Geater AF, Tanasansuttiporn J, Chanchayanon T. The anxiolytic effects of preoperative administration of pregabalin in comparison to diazepam and placebo. Sci Rep 2023; 13:9680. [PMID: 37322140 PMCID: PMC10272144 DOI: 10.1038/s41598-023-36616-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 06/07/2023] [Indexed: 06/17/2023] Open
Abstract
We aimed to evaluate the potential anxiolytic effects of premedication with pregabalin, compared with diazepam and placebo. We conducted this non-inferiority, double-blind, randomized controlled trial in ASA classification I-II patients aged 18-70 years, scheduled for elective surgery under general anesthesia. They were allocated to receive pregabalin (75 mg the night before surgery and 150 mg 2 h before surgery), diazepam (5 and 10 mg in the same manner) or placebo. Preoperative anxiety was evaluated using verbal numerical rating scale (VNRS) and Amsterdam Preoperative Anxiety and Information Scale (APAIS) before and after premedication. Sleep quality, sedation level, and adverse effects were assessed as secondary outcomes. A total of 231 patients were screened and 224 completed the trial. The mean change (95%CI) in anxiety scores from before to after medication in pregabalin, diazepam, and placebo groups for VNRS were - 0.87 (- 1.43, - 0.30), - 1.17 (- 1.74, - 0.60), and - 0.99 (- 1.56, - 0.41), and for APAIS were - 0.38 (- 1.04, 0.28), - 0.83 (- 1.49, - 0.16), and - 0.27 (- 0.95, 0.40). The difference in change for pregabalin versus diazepam was 0.30 (- 0.50, 1.11) for VNRS and 0.45 (- 0.49, 1.38) for APAIS, exceeding the limit of inferiority for APAIS of 1.3. Sleep quality was statistically different between pregabalin and placebo groups (p = 0.048). Sedation in pregabalin and diazepam groups were significantly higher than placebo group (p = 0.008). No significant differences of other side effects, except dry mouth was higher in placebo group compared with diazepam (p = 0.006). The study filed to provide evidence at non-inferiority of pregabalin compared to diazepam. Furthermore, premedication with either pregabalin or diazepam did not significantly reduce the preoperative anxiety in comparison to placebo, despite the fact that both resulted in higher levels of sedation. Clinicians should weigh the benefits and risks of premedication with these 2 drugs.Thai Clinical Trials Registry: TCTR20190424001 (24/04/2019) Registry URL: https://www.thaiclinicaltrials.org/ .
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Affiliation(s)
- Sasikaan Nimmaanrat
- Department of Anesthesiology, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, 90110, Thailand.
| | - Benjalak Charuenporn
- Department of Anesthesiology, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, 90110, Thailand
| | - Mark P Jensen
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA
| | - Alan F Geater
- Department of Epidemiology, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, 90110, Thailand
| | - Jutarat Tanasansuttiporn
- Department of Anesthesiology, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, 90110, Thailand
| | - Thavat Chanchayanon
- Department of Anesthesiology, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, 90110, Thailand
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Abd Elmaaboud MA, Awad MM, El-Shaer RAA, Kabel AM. The immunomodulatory effects of ethosuximide and sodium butyrate on experimentally induced fibromyalgia: The interaction between IL-4, synaptophysin, and TGF-β1/NF-κB signaling. Int Immunopharmacol 2023; 118:110061. [PMID: 36989891 DOI: 10.1016/j.intimp.2023.110061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 03/01/2023] [Accepted: 03/18/2023] [Indexed: 03/29/2023]
Abstract
BACKGROUND AND AIMS Fibromyalgia is a widespread chronic pain syndrome associated with several comorbid conditions that affect the quality of patients' life. Its pathogenesis is complex, and the treatment strategies are limited by partial efficacy and potential adverse effects. So, our aim was to investigate the possible ameliorative effects of ethosuximide and sodium butyrate on fibromyalgia and compare their effects to pregabalin. MATERIALS AND METHODS In a mouse model of reserpine induced fibromyalgia, the effect of ethosuximide, sodium butyrate, and pregabalin was investigated. Evaluation of mechanical allodynia, cold hypersensitivity, anxiety, cognitive impairment, and depression was performed. Also, the brain and spinal cord tissue serotonin, dopamine and glutamate in addition to the serum levels of interleukin (IL)-4 and transforming growth factor beta 1 (TGF-β1) were assayed. Moreover, the expression of nuclear factor kappa B (NF-κB) synaptophysin was immunoassayed in the hippocampal tissues. KEY FINDINGS Ethosuximide and sodium butyrate restored the behavioral tests to the normal values except for the antidepressant effect which was evident only with ethosuximide. Both drugs elevated the levels of the anti-inflammatory cytokines IL-4 and TGF-β1, reduced the hippocampal NF-κB, and increased synaptophysin expression with superiority of sodium butyrate. Ethosuximide reduced only spinal cord and brain glutamate while improved brain dopamine while sodium butyrate elevated spinal cord dopamine and serotonin with no effect on glutamate. Also, sodium butyrate elevated brain serotonin and reduced glutamate with no effect on brain dopamine. SIGNIFICANCE Each of sodium butyrate and ethosuximide would serve as a promising therapeutic modality for management of fibromyalgia and its comorbid conditions.
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Affiliation(s)
| | - Marwa M Awad
- Department of physiology, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Rehab A A El-Shaer
- Department of physiology, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Ahmed M Kabel
- Department of pharmacology, Faculty of Medicine, Tanta University, Tanta, Egypt.
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Kang SM, Hong JH, Ku BJ. A randomized, active-controlled, parallel, open-label, multicenter, phase 4 study to compare the efficacy and safety of pregabalin sustained release tablet and pregabalin immediate release capsule in type II diabetic patients with peripheral neuropathic pain. Medicine (Baltimore) 2023; 102:e33701. [PMID: 37115054 PMCID: PMC10145715 DOI: 10.1097/md.0000000000033701] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 04/14/2023] [Indexed: 04/29/2023] Open
Abstract
BACKGROUND Diabetic peripheral polyneuropathy is the most common chronic complication of type 2 diabetes. Neuropathic pain is challenging to manage, and various drugs are required to control it, decreasing treatment adherence. Pregabalin, a ligand that binds to alpha-2-delta subunits of the presynaptic calcium channel, has been approved by the Food and Drug Administration for the treatment of diabetic neuropathic pain. In this study, we will compare the efficacy, safety, treatment satisfaction, and compliance between pregabalin sustained-release (SR) tablets and pregabalin immediate-release (IR) capsules in type 2 diabetic patients with peripheral neuropathic pain. METHODS This study is a randomized, active-controlled, parallel, open-label, multicenter, phase 4 clinical trial (trial registration NCT05624853). Type 2 diabetic patients with glycosylated hemoglobin below 10% and peripheral neuropathic pain who have been taking pregabalin 150 mg/d or more for more than 4 weeks will be randomly assigned to pregabalin SR tablet (150 mg once a day, n = 65) or pregabalin IR capsule (75 mg twice a day, n = 65) therapy for 8 weeks. The primary outcome will be the efficacy of SR pregabalin after 8 weeks of treatment, which will be assessed by visual analog scale measurements. The secondary outcomes will include changes in several parameters, such as quality of life, treatment satisfaction, quality of sleep, and drug compliance. DISCUSSION In thus study, we aim to demonstrate that pregabalin SR tablets are associated with better compliance and satisfaction compared with pregabalin IR capsules, despite similar efficacy.
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Affiliation(s)
- Seon Mee Kang
- Department of Internal Medicine, Kangwon National University Hospital, Kangwon National University School of Medicine, Chuncheon, South Korea
| | - Jun Hwa Hong
- Department of Internal Medicine, Eulji University Hospital, Eulji University School of Medicine, Daejeon, South Korea
| | - Bon Jeong Ku
- Department of Internal Medicine, Chungnam National University Hospital, Chungnam National University School of Medicine, Daejeon, South Korea
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Liang Z, Xu Y, Xue Z. The analgesic efficacy of pregabalin versus placebo for septorhinoplasty: A meta-analysis. Medicine (Baltimore) 2023; 102:e33259. [PMID: 37058015 PMCID: PMC10101281 DOI: 10.1097/md.0000000000033259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Accepted: 02/22/2023] [Indexed: 04/15/2023] Open
Abstract
BACKGROUND The analgesic efficacy of pregabalin supplementation for septorhinoplasty remains elusive. This meta-analysis was conducted to compare pregabalin supplementation with placebo for the postoperative pain control of septorhinoplasty. METHODS We systematically searched several databases including PubMed, EMbase, Web of Science, EBSCO and Cochrane library databases, and included randomized controlled trials (RCTs) regarding the effect of pregabalin supplementation versus placebo for pain control after septorhinoplasty. This meta-analysis was conducted by fixed or random-effect model based on the heterogeneity. RESULTS Seven RCTs were included in this meta-analysis. In comparison with control group for septorhinoplasty, pregabalin supplementation was associated with significantly decreased pain scores at 1 h (standard mean difference [SMD] = -1.45; 95% confidence interval [CI] = -2.43 to -0.47; P = .004), pain scores at 2 hours (SMD = -1.01; 95% CI = -1.83 to -0.20; P = .02), pain scores at 6 hours (SMD = -1.00; 95% CI = -1.47 to -0.54; P < .0001), number of rescue analgesics (odd ratio [OR] = 0.18; 95% CI = 0.08-0.39; P < .0001) and analgesic consumption (SMD = -2.78; 95% CI = -5.05 to -0.51; P = .02), but unraveled no obvious impact on the incidence of nausea and vomiting (OR = 0.55; 95% CI = 0.24-1.27; P = .16). CONCLUSIONS Pregabalin supplementation was effective to improve pain relief after septorhinoplasty.
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Affiliation(s)
- Zanmei Liang
- Wenzhou PanHealth International Medica, Wenzhou, China
| | - Yang Xu
- Wenzhou PanHealth International Medica, Wenzhou, China
| | - Zhihui Xue
- Wenzhou PanHealth International Medica, Wenzhou, China
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50
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He D, Li Y, Wang Y. Pregabalin supplementation for the pain relief of septorhinoplasty: a meta-analysis study. Eur Arch Otorhinolaryngol 2023; 280:1201-1207. [PMID: 36048296 DOI: 10.1007/s00405-022-07602-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Accepted: 08/06/2022] [Indexed: 02/07/2023]
Abstract
BACKGROUND Pregabalin supplementation may have some potential in improving pain relief in patients with septorhinoplasty, and this meta-analysis aims to explore the impact of pregabalin supplementation on pain control for septorhinoplasty. METHODS PubMed, EMbase, Web of science, EBSCO and Cochrane library databases were systematically searched, and we included randomized controlled trials (RCTs) assessing the effect of pregabalin supplementation on pain control for septorhinoplasty. RESULTS Six RCTs were finally included in the meta-analysis. Overall, when compared with control intervention for septorhinoplasty, pregabalin intervention showed significantly reduced pain scores at 1 h (SMD - 1.05; 95% CI - 1.85 to - 0.24; P = 0.01), 2 h (SMD - 1.01; 95% CI - 1.83 to - 0.20; P = 0.02), 6 h (SMD - 1.00; 95% CI - 1.47 to - 0.54; P < 0.0001) and 12 h (SMD - 0.69; 95% CI - 1.35 to - 0.02; P = 0.04), as well as rescue analgesics (OR 0.17; 95% CI 0.07 to 0.44; P = 0.0002), but had no notable influence on nausea and vomiting (OR 0.67; 95% CI 0.30 to 1.46; P = 0.31), or drowsiness (OR 1.22; 95% CI 0.64 to 2.35; P = 0.54). CONCLUSIONS Pregabalin supplementation benefits to pain control after septorhinoplasty.
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Affiliation(s)
- Dongsheng He
- Department of Cardiothoracic Surgery, First Affiliated Hospital of Chengdu Medical College, Chengdu, 610500, China.
| | - Ying Li
- Department of Cardiothoracic Surgery, First Affiliated Hospital of Chengdu Medical College, Chengdu, 610500, China
| | - Yan Wang
- Department of Anesthesiology, First Affiliated Hospital of Chengdu Medical College, Chengdu, 610500, China.
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