Pregabalin in the treatment of refractory neuropathic pain: results of a 15-month open-label trial.
OBJECTIVE
Neuropathic pain associated with postherpetic neuralgia (PHN) and painful diabetic peripheral neuropathy (DPN) can be intractable and may not respond to commonly used treatments, such as tricyclic antidepressants (TCAs) and opioids. This long-term, open-label study was a preliminary evaluation of pregabalin for patients whose pain had been judged refractory to other treatments for neuropathic pain.


METHODS
Patients had previously participated in double-blind, placebo-controlled, randomized trials of pregabalin in DPN and PHN. They had moderate to severe neuropathic pain despite treatment with gabapentin, a TCA, and a third medication (e.g., other anticonvulsants, opioid, selective serotonin reuptake inhibitor, tramadol). Flexible-dosage pregabalin 150-600 mg/day was taken for 3-month periods followed by 3- to 28-day pregabalin "drug holidays," with an analysis up to 15 months (five treatment cycles). Pain intensity was measured using the visual analog scale of the Short-Form McGill Pain Questionnaire.


RESULTS
In total, 81 patients were included in this analysis. Pregabalin 150-600 mg/day was associated with clinically meaningful and sustained pain reduction during each treatment cycle. During pregabalin "drug holidays," pain quickly returned to baseline levels; it was reduced again when pregabalin was reinstated.


CONCLUSIONS
These results suggest that pregabalin may be beneficial in patients with neuropathic pain who have had an unsatisfactory response to treatment with other medications.
Stacey
Brett R
BR
Department of Comprehensive Pain Center, Anesthesiology and Peri-Operative Medicine, Oregon Health & Science University, Portland, Oregon 97239, USA. staceyb@ohsu.edu
Dworkin
Robert H
RH
Murphy
Kevin
K
Sharma
Uma
U
Emir
Birol
B
Griesing
Teresa
T
D000700:Analgesics / Q000627:therapeutic use*; D003929:Diabetic Neuropathies / Q000150:complications; D004311:Double-Blind Method; D006801:Humans; D009437:Neuralgia / Q000188:drug therapy* / Q000209:etiology; D051474:Neuralgia, Postherpetic / Q000150:complications; D010147:Pain Measurement; D010148:Intractable Pain / Q000188:drug therapy* / Q000209:etiology; D010919:Placebos; D000069583:Pregabalin; D016032:Randomized Controlled Trials as Topic; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D005680:gamma-Aminobutyric Acid / Q000031:analogs & derivatives* / Q000627:therapeutic use
D000700:Analgesics; D010919:Placebos; D000069583:Pregabalin; D005680:gamma-Aminobutyric Acid