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CNS Update: Neuropathic Pain in Adults

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eMediNexus    31 January 2023

Neuropathic Pain is the result of damage to the nervous system. A Cochrane review assessed pregabalin for neuropathic pain, defining a good result as a high level of pain relief and treatment adherence.

 

The review searched clinical trials using pregabalin to treat adult neuropathic pain. In total, it included 45 studies randomizing 11,906 participants to treatment with pregabalin, placebo, or other drugs. The review included studies that lasted for 2 to 16 weeks and found beneficial outcomes crucial to patients with neuropathic Pain. The results were mainly for Pain after shingles and diabetic neuropathy.

 

The study observed that-

For Pain after shingles:

  • 3 in 10 people experienced Pain reduction by half or more with pregabalin 300 mg or 600 mg daily, and 2 in 10 with placebo. 
  • 5 in 10 people with pregabalin 300 mg or 600 mg daily, and 3 in 10 with placebo experienced Pain reduction by a third or more. 

 

 For Pain caused by diabetes:

  • 3 or 4 in 10 people experienced pain reduction by half or more with pregabalin 300 mg or 600 mg daily, and 2 or 3 in 10 with placebo.
  • The Pain reduced by a third or more for 5 or 6 in 10 people with pregabalin 300 mg or 600 mg daily and 4 or 5 in 10 with placebo. 

 

  • Pregabalin also improved Pain in people with a mixed diagnosis (Pain after shingles and with diabetes) and people with Pain after stroke. 
  • It did not benefit people with HIV with neuropathic Pain.
  • It found no reliable evidence for any other type of neuropathic Pain.
  • Adverse effects were reported more frequently with pregabalin (6 in 10) than with placebo (5 in 10). 
  • 1 to 3 in 10 people reported dizziness and sleepiness after taking pregabalin. 
  • Serious side effects were rare and similar between pregabalin and placebo. 
  • About 1 in 10 people taking pregabalin terminated the treatment due to its adverse effects.
  • Pregabalin is beneficial for some people with chronic neuropathic Pain.
  • Predicting its beneficial effects on all people is not possible.
  • A short course of treatment (perhaps four weeks) may be the best.

 

This study found Moderate‐quality evidence regarding the effect of oral pregabalin (300 mg or 600 mg daily) on Pain in some people with moderate or severe neuropathic Pain after shingles or diabetes. Further, it found Low‐quality evidence on the effectiveness of oral pregabalin after trauma due to stroke or spinal cord injury. Pregabalin may not be effective in neuropathic Pain associated with HIV. There is very limited evidence for neuropathic back pain, neuropathic cancer pain, and other forms of neuropathic Pain.

 

Derry S, Bell RF, Straube S, Wiffen PJ, Aldington D, Moore RA. Pregabalin for neuropathic Pain in adults. Cochrane Database of Systematic Reviews 2019(1). DOI: 10.1002/14651858.CD007076.

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