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Kricek F, Ruf C, Meghani P, Souza IA, Gandini MA, Zamponi GW, Skouteris G. A next generation peripherally restricted Cavα2δ-1 ligand with inhibitory action on Cav2.2 channels and utility in neuropathic pain. Biomed Pharmacother 2024; 174:116472. [PMID: 38531121 DOI: 10.1016/j.biopha.2024.116472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Revised: 03/10/2024] [Accepted: 03/18/2024] [Indexed: 03/28/2024] Open
Abstract
The Voltage-Gated Calcium Channel (VGCC) auxiliary subunit Cavα2δ-1 (CACNA2D1) is the target/receptor of gabapentinoids which are known therapeutics in epilepsy and neuropathic pain. Following damage to the peripheral sensory nervous system, Cavα2δ-1 is upregulated in dorsal root ganglion (DRG) neurons in several animal models of chronic neuropathic pain. Gabapentinoids, such as gabapentin and pregabalin, engage with Cavα2δ-1 via binding an arginine residue (R241) within an RRR motif located at the N-terminus of human Cavα2δ-1. A novel, next generation gabapentinoid, engineered not to penetrate the brain, was able to generate a strong analgesic response in Chronic Constriction Injury animal model of chronic neuropathic pain and showed binding specificity for Cavα2δ-1 versus the Cavα2δ-2 subunit. This novel non-brain penetrant gabapentinoid, binds to R241 and a novel binding site on Cavα2δ-1, which is located within the VGCC_α2 domain, identified as a lysine residue within an IKAK amino acid motif (K634). The overall whole cell current amplitudes were diminished by the compound, with these inhibitory effects being diminished in R241A mutant Cavα2δ-1 subunits. The functional effects occurred at lower concentrations than those needed for inhibition by gabapentin or pregabalin, which apparently bound the Cavα2δ-1 subunit only on the R241 and not on the K634 residue. Our work sets the stage for the identification and characterisation of novel compounds with therapeutic properties in neuropathic pain and possibly in other disorders and conditions which require engagement of the Cavα2δ-1 target.
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Affiliation(s)
- Franz Kricek
- Department of Experimental Neurosciences, Novassay SA, Biopôle, Epalinges 1066, Switzerland; NBS-C BioScience GmbH, Vienna 1230, Austria
| | | | - Premji Meghani
- Department of Experimental Neurosciences, Novassay SA, Biopôle, Epalinges 1066, Switzerland
| | - Ivana A Souza
- Department of Clinical Neurosciences, Hotchkiss Brain Institute and Alberta Children's Hospital Research Institute, University of Calgary, T2N 4N1, Canada
| | - Maria A Gandini
- Department of Clinical Neurosciences, Hotchkiss Brain Institute and Alberta Children's Hospital Research Institute, University of Calgary, T2N 4N1, Canada
| | - Gerald W Zamponi
- Department of Clinical Neurosciences, Hotchkiss Brain Institute and Alberta Children's Hospital Research Institute, University of Calgary, T2N 4N1, Canada
| | - George Skouteris
- Department of Experimental Neurosciences, Novassay SA, Biopôle, Epalinges 1066, Switzerland; 3A Laboratories, Stevenage Bioscience Catalyst (SBC), Stevenage SG1 2FX, United Kingdom.
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Shekhar A, Srivastava A, Verma N, Verma A, Chaturvedi TP. The Comparative Efficacy of Palmitoylethanolamide (PEA) With the Combination of Pregabalin and Nortriptyline on Post-extraction Trigeminal Neuropathy by Using Magnetic Resonance (MR) Neurography: A Randomized Clinical Trial. Cureus 2024; 16:e54843. [PMID: 38533175 PMCID: PMC10963896 DOI: 10.7759/cureus.54843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/24/2024] [Indexed: 03/28/2024] Open
Abstract
Aim The aim of this randomized clinical trial is to compare the efficacy of palmitoylethanolamide (PEA) with the combination of pregabalin and nortriptyline in treating post-extraction trigeminal neuropathy using magnetic resonance neurography (MRN). Methods The present prospective, randomized controlled trial was conducted on 60 patients (20 in each group). In group I (positive control group), a combination of 75 mg of pregabalin and 10 mg of nortriptyline was administered once daily for the duration of 12 weeks. In group II, 600 mg of palmitoylethanolamide was given twice a day. In group III, a combination therapy of the abovementioned drugs was given. The efficacy of the drug was assessed by measuring pain intensity in terms of the numeric rating scale (NRS) (primary outcome) and changes (signal intensity and nerve thickness) in magnetic resonance neurography (secondary outcome) at various intervals of time. The data was collected and subjected to statistical analysis using the Statistical Package for Social Sciences (SPSS) version 25 (IBM SPSS Statistics, Armonk, NY) at the significance level of P<0.05. Results A significant decrease in post-drug mean NRS scores was observed in all three groups. In terms of reduction in the mean NRS, the combination group showed the highest reduction. Palmitoylethanolamide significantly reduces pain scores with negligible side effects. Conclusion Palmitoylethanolamide helps in the reduction of mild to moderate pain of painful post-traumatic trigeminal neuropathy (PTTN) with minimal side effects, suggesting that it may be used where the use of the conventional drug is either contraindicated or not feasible.
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Affiliation(s)
- Amlendu Shekhar
- Department of Oral Medicine and Radiology, Faculty of Dental Sciences, Institute of Medical Sciences, Banaras Hindu University (BHU), Varanasi, IND
| | - Adit Srivastava
- Department of Oral Medicine and Radiology, Faculty of Dental Sciences, Institute of Medical Sciences, Banaras Hindu University (BHU), Varanasi, IND
| | - Nimisha Verma
- Department of Anesthesiology, Institute of Medical Sciences, Banaras Hindu University (BHU), Varanasi, IND
| | - Ashish Verma
- Department of Radiology, Institute of Medical Sciences, Banaras Hindu University (BHU), Varanasi, IND
| | - T P Chaturvedi
- Department of Orthodontics, Faculty of Dental Sciences, Institute of Medical Sciences, Banaras Hindu University (BHU), Varanasi, IND
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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] [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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Zhu C, Lan X, Wei Z, Yu J, Zhang J. Allosteric modulation of G protein-coupled receptors as a novel therapeutic strategy in neuropathic pain. Acta Pharm Sin B 2024; 14:67-86. [PMID: 38239234 PMCID: PMC10792987 DOI: 10.1016/j.apsb.2023.07.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Revised: 06/09/2023] [Accepted: 07/12/2023] [Indexed: 01/22/2024] Open
Abstract
Neuropathic pain is a debilitating pathological condition that presents significant therapeutic challenges in clinical practice. Unfortunately, current pharmacological treatments for neuropathic pain lack clinical efficacy and often lead to harmful adverse reactions. As G protein-coupled receptors (GPCRs) are widely distributed throughout the body, including the pain transmission pathway and descending inhibition pathway, the development of novel neuropathic pain treatments based on GPCRs allosteric modulation theory is gaining momentum. Extensive research has shown that allosteric modulators targeting GPCRs on the pain pathway can effectively alleviate symptoms of neuropathic pain while reducing or eliminating adverse effects. This review aims to provide a comprehensive summary of the progress made in GPCRs allosteric modulators in the treatment of neuropathic pain, and discuss the potential benefits and adverse factors of this treatment. We will also concentrate on the development of biased agonists of GPCRs, and based on important examples of biased agonist development in recent years, we will describe universal strategies for designing structure-based biased agonists. It is foreseeable that, with the continuous improvement of GPCRs allosteric modulation and biased agonist theory, effective GPCRs allosteric drugs will eventually be available for the treatment of neuropathic pain with acceptable safety.
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Affiliation(s)
- Chunhao Zhu
- School of Pharmacy, Ningxia Medical University, Yinchuan 750004, China
- School of Basic Medical Science, Ningxia Medical University, Yinchuan 750004, China
| | - Xiaobing Lan
- School of Pharmacy, Ningxia Medical University, Yinchuan 750004, China
| | - Zhiqiang Wei
- Medicinal Chemistry and Bioinformatics Center, Ocean University of China, Qingdao 266100, China
| | - Jianqiang Yu
- School of Pharmacy, Ningxia Medical University, Yinchuan 750004, China
| | - Jian Zhang
- School of Pharmacy, Ningxia Medical University, Yinchuan 750004, China
- Medicinal Chemistry and Bioinformatics Center, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
- State Key Laboratory of Pharmaceutical Biotechnology, Nanjing University, Nanjing 210023, China
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Zhou X, Li Z, Xing B. Efficacy and safety of TRPV1-related preparations in the treatment of inflammatory arthralgia. Medicine (Baltimore) 2023; 102:e36268. [PMID: 38013379 PMCID: PMC10681444 DOI: 10.1097/md.0000000000036268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 11/01/2023] [Indexed: 11/29/2023] Open
Abstract
BACKGROUND Currently, medications for the treatment of inflammatory arthralgia are limited. The role and safety of transient receptor potential vanilloid subtype 1 (TRPV1)-related preparations in reducing inflammatory arthralgia have not yet been fully established. Thus, we aimed to review the efficacy and safety of TRPV1-related preparations for the treatment of inflammatory arthralgia. METHODS We searched PubMed, Web of Science, Cochrane, and Embase databases for relevant studies, and the primary outcome was pain score (VAS, PI, NRS, and WOMAC). RESULTS Six randomized controlled trials involving 481 patients were analyzed. Patients with inflammatory arthralgia who received TRPV1-related preparations had lower pain scores after treatment than those who received placebo or nonsteroidal anti-inflammatory agents (standardized mean difference = -0.525; 95% confidence interval [CI], -0.789 to -0.261; P < .001). There was no significant difference in the incidence of total adverse reactions between the TRPV1-related preparations and control groups (relative risk = 1.225; 95% CI, 0.685 to 2.191; P = .494). CONCLUSION TRPV1-related preparations are clinically safe and effective in the treatment of inflammatory arthralgia and are superior to placebo or nonsteroidal drugs. This may be the preferred treatment for patients with inflammatory arthralgia.
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Affiliation(s)
- Xin Zhou
- Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
| | - Ziping Li
- Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
| | - Bingfeng Xing
- The First Affiliated Hospital/School of Clinical Medicine of Guangdong Pharmaceutical University, Guangzhou, Guangdong, China
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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] [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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Zhang Q, Jiang Q, Sa K, Liang J, Sun D, Li H, Chen L. Research progress of plant-derived natural alkaloids in central nervous system diseases. Phytother Res 2023; 37:4885-4907. [PMID: 37455555 DOI: 10.1002/ptr.7955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 05/14/2023] [Accepted: 06/30/2023] [Indexed: 07/18/2023]
Abstract
Central nervous system (CNS) disease is one of the most important causes of human death. Because of their complex pathogenesis, more and more attention has been paid to them. At present, drug treatment of the CNS is the main means; however, most drugs only relieve symptoms, and some have certain toxicity and side effects. Natural compounds derived from plants can provide safer and more effective alternatives. Alkaloids are common nitrogenous basic organic compounds found in nature, which exist widely in many kinds of plants and have unique application value in modern medicine. For example, Galantamine and Huperzine A from medicinal plants are widely used drugs on the market to treat Alzheimer's disease. Therefore, the main purpose of this review is to provide the available information on natural alkaloids with the activity of treating central nervous system diseases in order to explore the trends and perspectives for the further study of central nervous system drugs. In this paper, 120 alkaloids with the potential effect of treating central nervous system diseases are summarized from the aspects of sources, structure types, mechanism of action and structure-activity relationship.
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Affiliation(s)
- Qingqing Zhang
- Wuya College of Innovation, Key Laboratory of Structure-Based Drug Design & Discovery, Ministry of Education, Shenyang Pharmaceutical University, Shenyang, China
| | - Qinghua Jiang
- Department of Pharmacy, Shengjing Hospital of China Medical University, Shenyang, China
| | - Kuiru Sa
- Wuya College of Innovation, Key Laboratory of Structure-Based Drug Design & Discovery, Ministry of Education, Shenyang Pharmaceutical University, Shenyang, China
| | - Junming Liang
- Wuya College of Innovation, Key Laboratory of Structure-Based Drug Design & Discovery, Ministry of Education, Shenyang Pharmaceutical University, Shenyang, China
| | - Dejuan Sun
- Wuya College of Innovation, Key Laboratory of Structure-Based Drug Design & Discovery, Ministry of Education, Shenyang Pharmaceutical University, Shenyang, China
| | - Hua Li
- Wuya College of Innovation, Key Laboratory of Structure-Based Drug Design & Discovery, Ministry of Education, Shenyang Pharmaceutical University, Shenyang, China
- College of Pharmacy, Fujian University of Traditional Chinese Medicine, Fuzhou, China
| | - Lixia Chen
- Wuya College of Innovation, Key Laboratory of Structure-Based Drug Design & Discovery, Ministry of Education, Shenyang Pharmaceutical University, Shenyang, China
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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] [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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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] [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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Zhang ZL, Wang ZT, Shi J, Pu XP, Zhai SD. Tetrandrine attenuates SNI-induced mechanical allodynia by inhibiting spinal CKLF1. Neuropharmacology 2023:109673. [PMID: 37517461 DOI: 10.1016/j.neuropharm.2023.109673] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 07/11/2023] [Accepted: 07/27/2023] [Indexed: 08/01/2023]
Abstract
Neuropathic pain (NP) is a prevalent clinical problem for which satisfactory treatment options are unavailable. Tetrandrine (TET), a bisbenzylisoquinoline alkaloid extracted from Stephania tetrandra S. Moore, possesses anti-inflammatory and immune-modulatory properties. Chemokine-like factor 1 (CKLF1) is known to play a crucial role in both peripheral and central inflammatory processes. This study aimed to investigate the potential anti-NP effects of TET and the involvement of CKLF1 in the action of TET. A male C57BL/6J mice model of NP caused by spared nerve injury (SNI) was established and mechanical withdrawal thresholds were measured using von Frey filaments. The results showed that TET improved mechanical allodynia in SNI mice and the propofol-induced sleep assay demonstrated that the TET group did not exhibit central inhibition, while the pregabalin (PGB) group showed significant central inhibition. Western blotting and immunofluorescence staining showed that TET significantly inhibited spinal protein expression levels of CKLF1, p-NF-κB/NF-κB, p-IKK/IKK, pro-inflammatory cytokines IL-1β and TNF-α, and increased protein expression levels of the anti-inflammatory cytokine IL-10, while inhibiting the expression levels of microglia and astrocyte markers IBA-1 and GFAP of SNI mice. Moreover, immunofluorescence double-labeling results revealed that CKLF1 was predominantly colocalized with microglia of the spinal cord (SC) in SNI mice. C19 (an antagonism peptide of CKLF1) alleviated SNI-induced mechanical pain hypersensitivity, while C27 (an analog peptide of CKLF1) induced mechanical allodynia in normal mice. TET significantly attenuated mechanical allodynia induced by C27 in mice. TET may effectively alleviate NP by reducing neuroinflammation and decreasing CKLF1.
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Affiliation(s)
- Zhi-Ling Zhang
- Department of Pharmacy, Peking University Third Hospital, Beijing, China
| | - Zhi-Tong Wang
- Department of Pharmacy, Peking University Third Hospital, Beijing, China
| | - Jing Shi
- Department of Pharmacy, Peking University Third Hospital, Beijing, China
| | - Xiao-Ping Pu
- National Key Research Laboratory of Natural and Biomimetic Drugs, Peking University, Beijing, China
| | - Suo-Di Zhai
- Department of Pharmacy, Peking University Third Hospital, Beijing, China.
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11
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Rakusa M, Marolt I, Stevic Z, Rebrina SV, Milenkovic T, Stepien A. Efficacy of Pregabalin and Duloxetine in Patients with Painful Diabetic Peripheral Neuropathy (PDPN): A Multi-Centre Phase IV Clinical Trial-BLOSSOM. Pharmaceuticals (Basel) 2023; 16:1017. [PMID: 37513930 PMCID: PMC10386018 DOI: 10.3390/ph16071017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Revised: 06/28/2023] [Accepted: 07/03/2023] [Indexed: 07/30/2023] Open
Abstract
INTRODUCTION Our trial (ClinicalTrials.gov Identifier: NCT04246619) evaluates the efficacy of two generic medications, pregabalin and duloxetine, for treating pain in PDPN patients. METHODS The patients were randomised either into the pregabalin (99) or the duloxetine (102) arm. Pain was evaluated using the DN-4 questionnaire, and visual analogue scales (VASs, 0-100 mm) were used to measure the average pain intensity (API), worst pain intensity (WPI) in the last 24 h and current pain intensity (CPI). RESULTS The proportion of patients with a clinically significant improvement in the API at Week 12 was 88.3% [CI 81.7%, 94.8%] in the pregabalin arm and 86.9% [CI 76.7%, 97.1%] in the duloxetine arm. After 12 weeks, the CPI, API, and WPI decreased by -35.3 [-40.5, -30.0], -37.0 [-41.4, -32.6], and -41.6 [-46.6, -36.5] in the pregabalin arm, and by -35.0 [-39.2, -30.7], -36.9 [-41.5, -32.3], and -40.0 [-44.8, -35.2] in the duloxetine arm (all in mm, all p < 0.001). CONCLUSION Our results demonstrate that pregabalin and duloxetine are effective medications for treating pain in PDPN in more than 86% of all randomised patients.
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Affiliation(s)
- Martin Rakusa
- Division of Neurology, University Medical Centre Maribor, 2000 Maribor, Slovenia
- Faculty of Medicine, University of Maribor, 2000 Maribor, Slovenia
| | - Iris Marolt
- Outpatient Diabetes Clinic, Community Health Centre Koper, 6000 Koper, Slovenia
| | - Zorica Stevic
- Neuropathy Center, Neurology Clinic, Clinical Center of Serbia, 11000 Belgrade, Serbia
- School of Medicine, University of Belgrade, 11000 Belgrade, Serbia
| | | | - Tatjana Milenkovic
- University Clinic of Endocrinology, Diabetes and Metabolic Disorders, 1000 Skopje, North Macedonia
- Faculty of Medicine, Ss. Cyril and Methodius University in Skopje, 1000 Skopje, North Macedonia
| | - Adam Stepien
- Department of Neurology, Military Institute of Medicine-National Institute of Science, 04-052 Warsaw, Poland
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12
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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] [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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13
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Chen J, Lan L, Wang W, Xu X. Efficacy and safety of pulsed radiofrequency combined with pregabalin for herpetic neuralgia: A systematic review and meta-analysis. Medicine (Baltimore) 2023; 102:e33932. [PMID: 37335664 DOI: 10.1097/md.0000000000033932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/21/2023] Open
Abstract
BACKGROUND Pulsed radiofrequency (PRF), as a new technique, is used to treat a variety of chronic pain syndromes, but it has a high recurrence rate for herpetic neuralgia and is often combined with drugs therapy. The aim of this study was to comprehensively evaluate the efficacy and safety of PRF combined with pregabalin in the treatment of herpetic neuralgia. METHODS The electronic databases, including CNKI, Wanfang data, PubMed, Embase, web of science, and Cochrane Library were searched from inception to January 31, 2023. The outcomes were pain scores, sleep quality and side effects. RESULTS Fifteen studies with 1817 patients were included in this meta-analysis. PRF combined with pregabalin significantly reduced the visual analogue scale/score in patients with postherpetic neuralgia or herpes zoster neuralgia when compared with pregabalin or PRF monotherapy [P < .00001, standardized mean difference (SMD) = -2.01, confidence intervals (CI) = -2.36 to -1.66; P < .00001, SMD = -0.69, CI = -0.77 to -0.61]. Compared with pregabalin monotherapy, PRF combined with pregabalin significantly decreased the pittsburgh sleep quality index score, the dosage and number of days of using pregabalin (P < .00001, SMD = -1.68, CI = -2.19 to -1.17; P < .00001, SMD = -0.94, CI = -1.25 to -0.64; P < .00001, SMD = -1.52, CI = -1.85 to -1.19). However, there was no significant difference in the effect of PRF combined with pregabalin versus PRF alone on pittsburgh sleep quality index score in patients with postherpetic neuralgia (P = .70, SMD = -1.02, CI = -6.11 to 4.07). In addition, PRF combined with pregabalin could significantly decrease the incidence of dizziness, somnolence, ataxia and pain at puncture site when compared with pregabalin monotherapy (P = .0007, odds ratio [OR] = 0.56, CI = 0.40 to 0.78; P = .008, OR = 0.60, CI = 0.41 to 0.88; P = .008, OR = 0.52, CI = 0.32 to 0.84; P = .0007, OR = 12.39, CI = 2.87 to 53.43), but no significant difference was observed when compared with PRF alone. CONCLUSIONS PRF combined with pregabalin can effectively alleviate the pain intensity and improve sleep quality in patients with herpetic neuralgia, and the incidence of complications was low, so it was worthy of clinical application.
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Affiliation(s)
- Jun Chen
- Department of Pharmacy, Hangzhou Third People' s Hospital, Affiliated Hangzhou Dermatology Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Lan Lan
- Department of dermatology, Affiliated Hangzhou Dermatology Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Wei Wang
- Department of Pharmacy, Hangzhou Third People' s Hospital, Affiliated Hangzhou Dermatology Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Xinchang Xu
- Department of Pharmacy, Hangzhou Third People' s Hospital, Affiliated Hangzhou Dermatology Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
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14
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Duo L, Yu X, Hu R, Duan X, Zhou J, Wang K. Sleep disorders in chronic pain and its neurochemical mechanisms: a narrative review. Front Psychiatry 2023; 14:1157790. [PMID: 37324825 PMCID: PMC10267346 DOI: 10.3389/fpsyt.2023.1157790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Accepted: 05/15/2023] [Indexed: 06/17/2023] Open
Abstract
Chronic pain (CP) is a prevalent problem, and more than half of patients with CP have sleep disorders. CP comorbidity with sleep disorders imposes immense suffering and seriously affects the patient's quality of life, which is a challenging issue encountered by clinicians. Although the reciprocal interactions between pain and sleep have been studied to some degree, there is still a lack of awareness and comprehensive description of CP comorbidity with sleep disorders. In this narrative review article, we summarize the current knowledge about the present estimates of the prevalence of comorbid sleep disorders in CP patients, sleep detection methods, sleep characterization in CP, and the effect of sleep disorders on CP and current therapies. We also summarize current knowledge of the neurochemical mechanisms of CP comorbidity with sleep disorders. In conclusion, insufficient attention has been paid to the role of sleep disorders in CP patients, and CP patients should be screened for sleep disorders in the clinic. Special attention should be given to a possible risk of drug-drug interaction when using two types of drugs targeting pain and sleep simultaneously. The current insight into the neurobiological mechanisms underlying CP comorbidity with sleep disorders is still rather limited.
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15
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Ushida T, Katayama Y, Hiasa Y, Nishihara M, Tajima F, Katoh S, Tanaka H, Maeda T, Furusawa K, Richardson M, Kakehi Y, Kikumori K, Kuroha M. Mirogabalin for Central Neuropathic Pain After Spinal Cord Injury: A Randomized, Double-Blind, Placebo-Controlled, Phase 3 Study in Asia. Neurology 2023; 100:e1193-e1206. [PMID: 36517235 PMCID: PMC10074464 DOI: 10.1212/wnl.0000000000201709] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 11/07/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Patients with spinal cord injury (SCI) commonly experience central neuropathic pain (CNeP), which is challenging to treat. Mirogabalin is effective for peripheral neuropathic pain, but evidence for CNeP is lacking. METHODS This randomized, double-blind, placebo-controlled, phase 3 study investigated mirogabalin efficacy and safety for the treatment of CNeP in patients with traumatic SCI. Adult patients from 120 sites throughout Japan, Korea, and Taiwan were randomized (1:1) to receive placebo or mirogabalin (5 mg twice daily [BID] for 1 week, 10 mg BID for 1 week, and 10 or 15 mg BID for 12 weeks). Patients with moderate renal impairment received half the dosage. The primary efficacy endpoint was change from baseline in the weekly average daily pain score (ADPS) at week 14. The secondary endpoints included ADPS responder rates, the Short-Form McGill Pain Questionnaire (SF-MPQ), average daily sleep interference score (ADSIS), and Neuropathic Pain Symptom Inventory (NPSI). Adverse events were monitored for safety. RESULTS Each treatment group comprised 150 patients. Mirogabalin elicited a statistical and clinically relevant improvement in change from baseline in the weekly ADPS at week 14 (least-squares mean difference [95% CI] vs placebo -0.71 [-1.08 to -0.34], p = 0.0001). Responder rates at week 14 were higher for mirogabalin than those for placebo (odds ratio [95% CI] 1.91 [1.11-3.27] for the ≥30% responder rate; 2.52 [1.11-5.71] for the ≥50% responder rate). Statistical improvements (i.e., least-squares mean difference [95% CI] vs placebo) were also observed in the SF-MPQ (-2.4 [-3.8 to -1.1]), ADSIS -0.71 (-1.04 to -0.38), and NPSI -7.7 (-11.1 to -4.4) scores. Most treatment-emergent adverse events were mild; no serious adverse drug reactions were reported. DISCUSSION Mirogabalin elicited clinically relevant decreases in pain and was well tolerated, suggesting that mirogabalin is a promising treatment for patients with CNeP due to SCI. TRIAL REGISTRATION INFORMATION ClinicalTrials.gov (NCT03901352); first submitted April 3, 2019; first patient enrolled March 14, 2019; available at clinicaltrials.gov/ct2/show/NCT03901352. CLASSIFICATION OF EVIDENCE This study provides Class I evidence that in adult patients with CNeP due to traumatic SCI, mirogabalin, 10 or 15 mg BID, effectively improves weekly ADPS at week 14.
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Affiliation(s)
- Takahiro Ushida
- From the Multidisciplinary Pain Center (T.U., M.N.), Aichi Medical University, Nagakute; Department of Neurological Surgery (Y. Katayama), Nihon University School of Medicine, Itabashi, Tokyo; Center for Brain and Health Sciences (Y. Katayama), Aomori University; Department of Gastroenterology and Metabology (Y.H.), Ehime University Graduate School of Medicine, Toon, Ehime; Department of Rehabilitation Medicine (F.T.), Wakayama Medical University; Red Cross Tokushima Hinomine Rehabilitation Center for People with Disabilities (S.K.), Komatsushima; Department of Rehabilitation (H.T.), Chubu Rosai Hospital, Nagoya, Aichi; Spinal Injuries Center (T.M.), Iizuka, Fukuoka; Kibikogen Rehabilitation Center for Employment Injuries (K.F.), Kaga, Okayama; Edanz Japan (M.R.), Chuo-ku, Fukuoka; Clinical Development Department III (Y. Kakehi, M.K.), Daiichi Sankyo Co., Ltd.; and Data Intelligence Department (K.K.), Daiichi Sankyo Co., Ltd., Shinagawa, Tokyo, Japan
| | - Yoichi Katayama
- From the Multidisciplinary Pain Center (T.U., M.N.), Aichi Medical University, Nagakute; Department of Neurological Surgery (Y. Katayama), Nihon University School of Medicine, Itabashi, Tokyo; Center for Brain and Health Sciences (Y. Katayama), Aomori University; Department of Gastroenterology and Metabology (Y.H.), Ehime University Graduate School of Medicine, Toon, Ehime; Department of Rehabilitation Medicine (F.T.), Wakayama Medical University; Red Cross Tokushima Hinomine Rehabilitation Center for People with Disabilities (S.K.), Komatsushima; Department of Rehabilitation (H.T.), Chubu Rosai Hospital, Nagoya, Aichi; Spinal Injuries Center (T.M.), Iizuka, Fukuoka; Kibikogen Rehabilitation Center for Employment Injuries (K.F.), Kaga, Okayama; Edanz Japan (M.R.), Chuo-ku, Fukuoka; Clinical Development Department III (Y. Kakehi, M.K.), Daiichi Sankyo Co., Ltd.; and Data Intelligence Department (K.K.), Daiichi Sankyo Co., Ltd., Shinagawa, Tokyo, Japan
| | - Yoichi Hiasa
- From the Multidisciplinary Pain Center (T.U., M.N.), Aichi Medical University, Nagakute; Department of Neurological Surgery (Y. Katayama), Nihon University School of Medicine, Itabashi, Tokyo; Center for Brain and Health Sciences (Y. Katayama), Aomori University; Department of Gastroenterology and Metabology (Y.H.), Ehime University Graduate School of Medicine, Toon, Ehime; Department of Rehabilitation Medicine (F.T.), Wakayama Medical University; Red Cross Tokushima Hinomine Rehabilitation Center for People with Disabilities (S.K.), Komatsushima; Department of Rehabilitation (H.T.), Chubu Rosai Hospital, Nagoya, Aichi; Spinal Injuries Center (T.M.), Iizuka, Fukuoka; Kibikogen Rehabilitation Center for Employment Injuries (K.F.), Kaga, Okayama; Edanz Japan (M.R.), Chuo-ku, Fukuoka; Clinical Development Department III (Y. Kakehi, M.K.), Daiichi Sankyo Co., Ltd.; and Data Intelligence Department (K.K.), Daiichi Sankyo Co., Ltd., Shinagawa, Tokyo, Japan
| | - Makoto Nishihara
- From the Multidisciplinary Pain Center (T.U., M.N.), Aichi Medical University, Nagakute; Department of Neurological Surgery (Y. Katayama), Nihon University School of Medicine, Itabashi, Tokyo; Center for Brain and Health Sciences (Y. Katayama), Aomori University; Department of Gastroenterology and Metabology (Y.H.), Ehime University Graduate School of Medicine, Toon, Ehime; Department of Rehabilitation Medicine (F.T.), Wakayama Medical University; Red Cross Tokushima Hinomine Rehabilitation Center for People with Disabilities (S.K.), Komatsushima; Department of Rehabilitation (H.T.), Chubu Rosai Hospital, Nagoya, Aichi; Spinal Injuries Center (T.M.), Iizuka, Fukuoka; Kibikogen Rehabilitation Center for Employment Injuries (K.F.), Kaga, Okayama; Edanz Japan (M.R.), Chuo-ku, Fukuoka; Clinical Development Department III (Y. Kakehi, M.K.), Daiichi Sankyo Co., Ltd.; and Data Intelligence Department (K.K.), Daiichi Sankyo Co., Ltd., Shinagawa, Tokyo, Japan
| | - Fumihiro Tajima
- From the Multidisciplinary Pain Center (T.U., M.N.), Aichi Medical University, Nagakute; Department of Neurological Surgery (Y. Katayama), Nihon University School of Medicine, Itabashi, Tokyo; Center for Brain and Health Sciences (Y. Katayama), Aomori University; Department of Gastroenterology and Metabology (Y.H.), Ehime University Graduate School of Medicine, Toon, Ehime; Department of Rehabilitation Medicine (F.T.), Wakayama Medical University; Red Cross Tokushima Hinomine Rehabilitation Center for People with Disabilities (S.K.), Komatsushima; Department of Rehabilitation (H.T.), Chubu Rosai Hospital, Nagoya, Aichi; Spinal Injuries Center (T.M.), Iizuka, Fukuoka; Kibikogen Rehabilitation Center for Employment Injuries (K.F.), Kaga, Okayama; Edanz Japan (M.R.), Chuo-ku, Fukuoka; Clinical Development Department III (Y. Kakehi, M.K.), Daiichi Sankyo Co., Ltd.; and Data Intelligence Department (K.K.), Daiichi Sankyo Co., Ltd., Shinagawa, Tokyo, Japan
| | - Shinsuke Katoh
- From the Multidisciplinary Pain Center (T.U., M.N.), Aichi Medical University, Nagakute; Department of Neurological Surgery (Y. Katayama), Nihon University School of Medicine, Itabashi, Tokyo; Center for Brain and Health Sciences (Y. Katayama), Aomori University; Department of Gastroenterology and Metabology (Y.H.), Ehime University Graduate School of Medicine, Toon, Ehime; Department of Rehabilitation Medicine (F.T.), Wakayama Medical University; Red Cross Tokushima Hinomine Rehabilitation Center for People with Disabilities (S.K.), Komatsushima; Department of Rehabilitation (H.T.), Chubu Rosai Hospital, Nagoya, Aichi; Spinal Injuries Center (T.M.), Iizuka, Fukuoka; Kibikogen Rehabilitation Center for Employment Injuries (K.F.), Kaga, Okayama; Edanz Japan (M.R.), Chuo-ku, Fukuoka; Clinical Development Department III (Y. Kakehi, M.K.), Daiichi Sankyo Co., Ltd.; and Data Intelligence Department (K.K.), Daiichi Sankyo Co., Ltd., Shinagawa, Tokyo, Japan
| | - Hirotaka Tanaka
- From the Multidisciplinary Pain Center (T.U., M.N.), Aichi Medical University, Nagakute; Department of Neurological Surgery (Y. Katayama), Nihon University School of Medicine, Itabashi, Tokyo; Center for Brain and Health Sciences (Y. Katayama), Aomori University; Department of Gastroenterology and Metabology (Y.H.), Ehime University Graduate School of Medicine, Toon, Ehime; Department of Rehabilitation Medicine (F.T.), Wakayama Medical University; Red Cross Tokushima Hinomine Rehabilitation Center for People with Disabilities (S.K.), Komatsushima; Department of Rehabilitation (H.T.), Chubu Rosai Hospital, Nagoya, Aichi; Spinal Injuries Center (T.M.), Iizuka, Fukuoka; Kibikogen Rehabilitation Center for Employment Injuries (K.F.), Kaga, Okayama; Edanz Japan (M.R.), Chuo-ku, Fukuoka; Clinical Development Department III (Y. Kakehi, M.K.), Daiichi Sankyo Co., Ltd.; and Data Intelligence Department (K.K.), Daiichi Sankyo Co., Ltd., Shinagawa, Tokyo, Japan
| | - Takeshi Maeda
- From the Multidisciplinary Pain Center (T.U., M.N.), Aichi Medical University, Nagakute; Department of Neurological Surgery (Y. Katayama), Nihon University School of Medicine, Itabashi, Tokyo; Center for Brain and Health Sciences (Y. Katayama), Aomori University; Department of Gastroenterology and Metabology (Y.H.), Ehime University Graduate School of Medicine, Toon, Ehime; Department of Rehabilitation Medicine (F.T.), Wakayama Medical University; Red Cross Tokushima Hinomine Rehabilitation Center for People with Disabilities (S.K.), Komatsushima; Department of Rehabilitation (H.T.), Chubu Rosai Hospital, Nagoya, Aichi; Spinal Injuries Center (T.M.), Iizuka, Fukuoka; Kibikogen Rehabilitation Center for Employment Injuries (K.F.), Kaga, Okayama; Edanz Japan (M.R.), Chuo-ku, Fukuoka; Clinical Development Department III (Y. Kakehi, M.K.), Daiichi Sankyo Co., Ltd.; and Data Intelligence Department (K.K.), Daiichi Sankyo Co., Ltd., Shinagawa, Tokyo, Japan
| | - Kazunari Furusawa
- From the Multidisciplinary Pain Center (T.U., M.N.), Aichi Medical University, Nagakute; Department of Neurological Surgery (Y. Katayama), Nihon University School of Medicine, Itabashi, Tokyo; Center for Brain and Health Sciences (Y. Katayama), Aomori University; Department of Gastroenterology and Metabology (Y.H.), Ehime University Graduate School of Medicine, Toon, Ehime; Department of Rehabilitation Medicine (F.T.), Wakayama Medical University; Red Cross Tokushima Hinomine Rehabilitation Center for People with Disabilities (S.K.), Komatsushima; Department of Rehabilitation (H.T.), Chubu Rosai Hospital, Nagoya, Aichi; Spinal Injuries Center (T.M.), Iizuka, Fukuoka; Kibikogen Rehabilitation Center for Employment Injuries (K.F.), Kaga, Okayama; Edanz Japan (M.R.), Chuo-ku, Fukuoka; Clinical Development Department III (Y. Kakehi, M.K.), Daiichi Sankyo Co., Ltd.; and Data Intelligence Department (K.K.), Daiichi Sankyo Co., Ltd., Shinagawa, Tokyo, Japan
| | - Mary Richardson
- From the Multidisciplinary Pain Center (T.U., M.N.), Aichi Medical University, Nagakute; Department of Neurological Surgery (Y. Katayama), Nihon University School of Medicine, Itabashi, Tokyo; Center for Brain and Health Sciences (Y. Katayama), Aomori University; Department of Gastroenterology and Metabology (Y.H.), Ehime University Graduate School of Medicine, Toon, Ehime; Department of Rehabilitation Medicine (F.T.), Wakayama Medical University; Red Cross Tokushima Hinomine Rehabilitation Center for People with Disabilities (S.K.), Komatsushima; Department of Rehabilitation (H.T.), Chubu Rosai Hospital, Nagoya, Aichi; Spinal Injuries Center (T.M.), Iizuka, Fukuoka; Kibikogen Rehabilitation Center for Employment Injuries (K.F.), Kaga, Okayama; Edanz Japan (M.R.), Chuo-ku, Fukuoka; Clinical Development Department III (Y. Kakehi, M.K.), Daiichi Sankyo Co., Ltd.; and Data Intelligence Department (K.K.), Daiichi Sankyo Co., Ltd., Shinagawa, Tokyo, Japan
| | - Yoshihiro Kakehi
- From the Multidisciplinary Pain Center (T.U., M.N.), Aichi Medical University, Nagakute; Department of Neurological Surgery (Y. Katayama), Nihon University School of Medicine, Itabashi, Tokyo; Center for Brain and Health Sciences (Y. Katayama), Aomori University; Department of Gastroenterology and Metabology (Y.H.), Ehime University Graduate School of Medicine, Toon, Ehime; Department of Rehabilitation Medicine (F.T.), Wakayama Medical University; Red Cross Tokushima Hinomine Rehabilitation Center for People with Disabilities (S.K.), Komatsushima; Department of Rehabilitation (H.T.), Chubu Rosai Hospital, Nagoya, Aichi; Spinal Injuries Center (T.M.), Iizuka, Fukuoka; Kibikogen Rehabilitation Center for Employment Injuries (K.F.), Kaga, Okayama; Edanz Japan (M.R.), Chuo-ku, Fukuoka; Clinical Development Department III (Y. Kakehi, M.K.), Daiichi Sankyo Co., Ltd.; and Data Intelligence Department (K.K.), Daiichi Sankyo Co., Ltd., Shinagawa, Tokyo, Japan
| | - Kunika Kikumori
- From the Multidisciplinary Pain Center (T.U., M.N.), Aichi Medical University, Nagakute; Department of Neurological Surgery (Y. Katayama), Nihon University School of Medicine, Itabashi, Tokyo; Center for Brain and Health Sciences (Y. Katayama), Aomori University; Department of Gastroenterology and Metabology (Y.H.), Ehime University Graduate School of Medicine, Toon, Ehime; Department of Rehabilitation Medicine (F.T.), Wakayama Medical University; Red Cross Tokushima Hinomine Rehabilitation Center for People with Disabilities (S.K.), Komatsushima; Department of Rehabilitation (H.T.), Chubu Rosai Hospital, Nagoya, Aichi; Spinal Injuries Center (T.M.), Iizuka, Fukuoka; Kibikogen Rehabilitation Center for Employment Injuries (K.F.), Kaga, Okayama; Edanz Japan (M.R.), Chuo-ku, Fukuoka; Clinical Development Department III (Y. Kakehi, M.K.), Daiichi Sankyo Co., Ltd.; and Data Intelligence Department (K.K.), Daiichi Sankyo Co., Ltd., Shinagawa, Tokyo, Japan
| | - Masanori Kuroha
- From the Multidisciplinary Pain Center (T.U., M.N.), Aichi Medical University, Nagakute; Department of Neurological Surgery (Y. Katayama), Nihon University School of Medicine, Itabashi, Tokyo; Center for Brain and Health Sciences (Y. Katayama), Aomori University; Department of Gastroenterology and Metabology (Y.H.), Ehime University Graduate School of Medicine, Toon, Ehime; Department of Rehabilitation Medicine (F.T.), Wakayama Medical University; Red Cross Tokushima Hinomine Rehabilitation Center for People with Disabilities (S.K.), Komatsushima; Department of Rehabilitation (H.T.), Chubu Rosai Hospital, Nagoya, Aichi; Spinal Injuries Center (T.M.), Iizuka, Fukuoka; Kibikogen Rehabilitation Center for Employment Injuries (K.F.), Kaga, Okayama; Edanz Japan (M.R.), Chuo-ku, Fukuoka; Clinical Development Department III (Y. Kakehi, M.K.), Daiichi Sankyo Co., Ltd.; and Data Intelligence Department (K.K.), Daiichi Sankyo Co., Ltd., Shinagawa, Tokyo, Japan.
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Maleki MS, Zamani Z, Amiri R, Kakhki S, Jafari M, Amani B, Amani B, Amanat N. Pregabalin in patients with post-traumatic peripheral neuropathic pain: A meta-analysis of randomized controlled trials. Pain Pract 2023. [PMID: 36912703 DOI: 10.1111/papr.13221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 01/19/2023] [Accepted: 02/17/2023] [Indexed: 03/14/2023]
Abstract
OBJECTIVE The aim of the study was to investigate the safety and efficacy of pregabalin versus placebo in post-traumatic peripheral neuropathic pain (PTNP). METHODS PubMed, Cochrane Library, Web of Science, and Google Scholar were searched for relevant evidence up to January 2022. The Cochran tool was used to assess the quality of randomized clinical trials (RCTs). Data analysis was performed using Comprehensive Meta-Analysis software. RESULTS Three RCTs involving 821 patients were included in the meta-analysis. A significant difference was observed between pregabalin and placebo in terms of the pain score (the standardized mean difference [SMD] = -0.14, 95% CI: 0.28 to -0.006, p = 0.04) and sleep interference (MD = -0.25, 95% CI: -0.39 to -0.11, p = 0.00). There was also a significant difference between pregabalin and placebo regarding somnolence (risk ratio [RR] = 2.78; 95% CI: 1.64-4.71, p = 0.00), dizziness (RR = 4.13; 95% CI: 2.71-6.28, p = 0.00), and disturbance in attention (RR: 2.97; 95% CI: 1.02-8.65, p = 0.04). However, no significant difference was observed between pregabalin and placebo in terms of headache (RR = 1.20; 95% CI: 0.70-2.06, p = 0.50), fatigue (RR = 1.42; 95% CI: 0.82-2.47, p = 0.20), nausea (RR = 1.52; 95% CI: 0.88-2.62, p = 0.13), constipation (RR = 1.84; 95% CI: 0.78-4.29, p = 0.15), and discontinuation (RR = 1.52; 95% CI: 0.45-5.06, p = 0.49). CONCLUSION Compared with placebo, pregabalin showed better efficacy in reducing PTNP and improving sleep interference. However, it was associated with higher adverse events. Further RCTs are needed to confirm these findings.
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Affiliation(s)
| | - Zahra Zamani
- Nursing Care Research Center, Semnan University of Medical Sciences, Semnan, Iran
| | - Roya Amiri
- Department of Intensive Care Nursing, Kish Specialty & Subspecialty Hospital, Kish, Iran
| | - Samaneh Kakhki
- Department of Clinical Biochemistry, School of Paramedical Sciences, Torbat Heydariyeh University of Medical Sciences, Torbat Heydariyeh, Iran
| | - Mojtaba Jafari
- Department of Nursing, School of Nursing and Midwifery, Bam University of Medical Sciences, Bam, Iran
| | - Behnam Amani
- Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Bahman Amani
- Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Nasir Amanat
- Nursing Care Research Center, Semnan University of Medical Sciences, Semnan, Iran
- Nursing Care Research Center, Semnan University of Medical Sciences, Semnan, Iran
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17
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Cao X, Shen Z, Wang X, Zhao J, Liu W, Jiang G. A Meta-analysis of Randomized Controlled Trials Comparing the Efficacy and Safety of Pregabalin and Gabapentin in the Treatment of Postherpetic Neuralgia. Pain Ther 2023; 12:1-18. [PMID: 36334235 PMCID: PMC9845451 DOI: 10.1007/s40122-022-00451-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 10/17/2022] [Indexed: 11/07/2022] Open
Abstract
OBJECTIVE To systematically evaluate the clinical efficacy of pregabalin and gabapentin in the treatment of postherpetic neuralgia (PHN), including the difference in pain control and occurrence of adverse reactions. METHODS PubMed, MEDLINE, EMBASE, Cochrane Library, and Web of Science databases were searched for randomized controlled trials (RCTs) comparing the efficacy of pregabalin and gabapentin in patients with PHN. Data from studies meeting the inclusion criteria were extracted and the Cochrane Risk of Bias risk assessment tool was used to evaluate the quality of the included studies. Revman 5.3 and Stata17 were used to perform the meta-analysis and to detect publication bias. RESULTS A total of 14 RCTs with 3545 patients were included in this study, including 926 in the pregabalin treatment group, 1256 in the gabapentin treatment group, and 1363 in the placebo control group. Pregabalin was better than gabapentin in alleviating pain and improving the global perception of change in pain and sleep (P < 0.05). Gabapentin was associated with a lower incidence of adverse events than pregabalin (P < 0.05). Funnel plot and Begg's and Egger's tests showed no significant publication bias. CONCLUSION Pregabalin appears to have a better overall therapeutic effect than gabapentin for patients with PHN, but gabapentin has a lower incidence of adverse reactions and a better safety profile. Clinicians should comprehensively consider patient factors and fully evaluate the advantages and disadvantages of each treatment option to select the most suitable drugs for patient use. Considering the limited quantity and quality of the existing literature, high-quality RCTs are needed to confirm the advantages of pregabalin over gabapentin in the treatment of PHN and guide clinical decision-making.
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Affiliation(s)
- Xing Cao
- Department of Neurology, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan China ,Institute of Neurological Diseases, North Sichuan Medical College, Nanchong, Sichuan China
| | - Ziyi Shen
- Department of Neurology, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan China ,Institute of Neurological Diseases, North Sichuan Medical College, Nanchong, Sichuan China
| | - Xiaoming Wang
- Department of Neurology, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan China ,Institute of Neurological Diseases, North Sichuan Medical College, Nanchong, Sichuan China
| | - Jin Zhao
- Department of Neurology, Nanbu County Hospital Affiliated to North Sichuan Medical College, Nanchong, Sichuan China
| | - Wei Liu
- Department of Neurology, Nanbu County Hospital Affiliated to North Sichuan Medical College, Nanchong, Sichuan China
| | - Guohui Jiang
- Department of Neurology, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan China ,Institute of Neurological Diseases, North Sichuan Medical College, Nanchong, Sichuan China
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18
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Cui Y, Zhou X, Li Q, Wang D, Zhu J, Zeng X, Han Q, Yang R, Xu S, Zhang D, Meng X, Zhang S, Sun Z, Yin H. Efficacy of different acupuncture therapies on postherpetic neuralgia: A Bayesian network meta-analysis. Front Neurosci 2023; 16:1056102. [PMID: 36704010 PMCID: PMC9871906 DOI: 10.3389/fnins.2022.1056102] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 12/16/2022] [Indexed: 01/11/2023] Open
Abstract
Background Postherpetic neuralgia (PHN) is a common, complex, and refractory type of neuropathic pain. Several systematic reviews support the efficacy of acupuncture and related treatments for PHN. Nevertheless, the efficacy of various acupuncture-related treatments for PHN remains debatable. Objective We aimed to assess the efficacy and safety of acupuncture-related treatments for PHN, identify the most effective acupuncture-related treatments, and expound on the current inadequacies and prospects in the applications of acupuncture-related therapies. Methods We searched PubMed, Cochrane Central Register of Controlled Trials, Embase, Web of Science, Google Scholar, four Chinese databases (China National Knowledge Infrastructure, China Biomedical, Chongqing VIP, and Wan Fang databases), clinical research registration platform (World Health Organization International Clinical Trial Registration platform, China Clinical Trial Registration Center) for relevant studies. We also examined previous meta-analyses; gray literature; and reference lists of the selected studies. We then evaluated the risk of bias in the included studies and performed a Bayesian multiple network meta-analysis. Results We included 29 randomized controlled trials comprising 1,973 patients, of which five studies showed a high risk of bias. The pairwise meta-analysis results revealed that the efficacy of all acupuncture-related treatments for pain relief related to PHN was significantly better than antiepileptics. The network meta-analysis results showed that pricking and cupping plus antiepileptics were the most effective treatment, followed by electroacupuncture (EA) plus antiepileptics for pain relief in patients with PHN. EA plus antiepileptics ranked the best regarding reduced Pittsburgh Sleep Quality Index (PSQI) and Self-Rating Depression Scale (SDS) scores in patients with PHN. No results were found regarding the total response rate or quality of life in this study. Acupuncture-related treatments showed a lower incidence of adverse events than that of antiepileptics. Conclusion Acupuncture-related therapies are potential treatment options for PHN and are safe. Pricking and cupping plus antiepileptics, are the most effective acupuncture-related techniques for pain relief, while EA plus antiepileptics is the best acupuncture-related technique for improving PHN-related insomnia and depression symptoms. However, owing to the limitations of this study, these conclusions should be cautiously interpreted, and future high-quality studies are needed. Systematic review registration https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021226422, identifier CRD42021226422.
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Affiliation(s)
- Yang Cui
- Heilongjiang University of Chinese Medicine, Harbin, China
| | - Xinyu Zhou
- Heilongjiang University of Chinese Medicine, Harbin, China
| | - Quan Li
- Heilongjiang University of Chinese Medicine, Harbin, China
| | - Delong Wang
- The Second Affiliated Hospital of Heilongjiang University of Chinese Medicine, Harbin, China
| | - Jiamin Zhu
- Heilongjiang University of Chinese Medicine, Harbin, China
| | - Xiangxin Zeng
- The Second Affiliated Hospital of Heilongjiang University of Chinese Medicine, Harbin, China
| | - Qichen Han
- The First Affiliated Hospital of Heilongjiang University of Chinese Medicine, Harbin, China
| | - Rui Yang
- The Second Affiliated Hospital of Heilongjiang University of Chinese Medicine, Harbin, China
| | - Siyu Xu
- The First Affiliated Hospital of Heilongjiang University of Chinese Medicine, Harbin, China
| | - Dongxu Zhang
- Heilongjiang University of Chinese Medicine, Harbin, China
| | - Xiangyue Meng
- Heilongjiang University of Chinese Medicine, Harbin, China
| | - Shuo Zhang
- Heilongjiang University of Chinese Medicine, Harbin, China
| | - Zhongren Sun
- Heilongjiang University of Chinese Medicine, Harbin, China,The Second Affiliated Hospital of Heilongjiang University of Chinese Medicine, Harbin, China,Zhongren Sun,
| | - Hongna Yin
- The Second Affiliated Hospital of Heilongjiang University of Chinese Medicine, Harbin, China,*Correspondence: Hongna Yin,
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Xu R, Wang Y, Han W. Randomized clinical trial: the effects of pregabalin for centrally mediated abdominal pain syndrome. Therap Adv Gastroenterol 2023; 16:17562848231152334. [PMID: 36895281 PMCID: PMC9989377 DOI: 10.1177/17562848231152334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Accepted: 01/05/2023] [Indexed: 03/11/2023] Open
Abstract
Background Pregabalin is worldwidely licensed for the treatment of a variety of pain syndromes and supposed to be a potential candidate for the centrally mediated abdominal pain syndrome (CAPS). Objectives To investigate the efficacy of pregabalin on nociceptive and emotional symptoms in CAPS patients. Design This is an open-label randomized controlled trial. Methods CAPS patients were randomized to receive pregabalin 75 mg (P group), pinaverium bromide 50 mg (PB group), or pregabalin combined pinaverium bromide regimen (P + PB group) three times daily for 4 weeks. Questionnaires were completed biweekly. The primary outcomes were defined as the average abdominal pain scores of severity and frequency at weeks 2 and 4. Secondary outcomes included the reduction in abdominal pain scores, Somatic Self-rating Scale (SSS), Patient Health Questionnaire-15 (PHQ-15), and Generalized Anxiety Disorder Scale 7 (GAD-7) scales obtained at the end of trial to the baseline. Results Totally, 102 eligible patients were recruited and randomized. The mean severity scores of abdominal pain were 1.39 ± 1.28, 0.97 ± 1.43 versus 2.91 ± 1.44 (p < 0.0001) in P or PB + P group versus PB group at week 2 and were 0.90 ± 1.21, 1.28 ± 1.87 versus 2.74 ± 1.75 (p < 0.0001) at week 4. The mean frequency scores were 2.55 ± 2.55, 2.03 ± 2.80 versus 5.12 ± 2.09(p < 0.0001) in P or PB + P group versus PB group at week 2 and were 1.72 ± 2.46, 2.00 ± 2.90 versus 4.55 ± 2.55 (p < 0.0001) at week 4. When comparing the changes in SSS, PHQ-15, and GAD-7 scores, patients accepting pregabalin or pregabalin combination regimen reported a more decrease than pinaverium bromide recipients (p = 0.0002, p = 0.0002, and p = 0.0033). Conclusion This trial suggests that pregabalin may be beneficial for CAPS abdominal pain and concomitant somatic or anxiety symptoms. Registration www.chictr.org.cn (ChiCTR1900028026).
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Affiliation(s)
- Ri Xu
- Department of Pharmacy, Qilu Hospital of Shandong University, Jinan, Shandong, China
| | - Yanyan Wang
- Phase I Clinical Trial Center, Qilu Hospital of Shandong University, Jinan, Shandong, China.,NMPA Key Laboratory for Clinical Research and Evaluation of Innovative Drug, Shandong University, Jinan, Shandong, China
| | - Wei Han
- Center of Health Management, Qilu Hospital of Shandong University, Jinan, Shandong 250012, China
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20
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Li Z, Gan Y, Kang T, Zhao Y, Huang T, Chen Y, Liu J, Ke B. Camphor Attenuates Hyperalgesia in Neuropathic Pain Models in Mice. J Pain Res 2023; 16:785-795. [PMID: 36925623 PMCID: PMC10013580 DOI: 10.2147/jpr.s398607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Accepted: 02/21/2023] [Indexed: 03/12/2023] Open
Abstract
Background The treatment of neuropathic pain is still a major troublesome clinical problem. The existing therapeutic drugs have limited analgesic effect and obvious adverse reactions, which presents opportunities and challenges for the development of new analgesic drugs. Camphor, a kind of monoterpene, has been shown anti-inflammatory and analgesic effects in traditional Chinese medicine. But we know little about its effect in neuropathic pain. In this article, We have verified the reliable analgesic effect of camphor in the neuropathic pain model caused by different predispositions. Methods The nociceptive response of mice was induced by transient receptor potential A1 (TRPA1) agonist to verify the effect of camphor on the nociceptive response. Multiple paclitaxel (PTX) injection models, Single oxaliplatin (OXA) injection models, Chronic constriction injury (CCI) models and Streptozotocin-induced (STZ) diabetic neuropathic pain models were used in this study. We verified the analgesic effect of camphor in mice by acetone test and conditioned place aversion test. At the same time, comparing the adverse reaction of nervous system between camphor and pregabalin at equivalent dose in locomotor activity test and rotarod test. Using patch clamp to verify the effect of camphor on dorsal root ganglion (DRG) excitability. Results In behavioral test, compared with vehicle group, camphor significantly reduced the spontaneous nociception caused by TRPA1 agonist-formalina and allyl isothiocyanate (AITC). Compared with vehicle group, camphor significantly reduced the flinching and licking time in neuropathic pain model mice, including PTX, OXA, STZ and CCI induced peripheral neuralgia models. Compared with vehicle group, pregabalin significantly increased the resting time and reduced the average speed without resting and distance in locomotor activity test, reduced the time stayed on rotarod in rotarod test. In patch clamp test, compared with vehicle group, camphor significantly reduced the action potential (AP) firing frequency of DRG. Conclusion Camphor can alleviate the symptoms of hyperalgesia in various neuropathic pain models, and has no obvious adverse reactions compared with pregabalin. This effect is related to the down-regulation of DRG neuron excitability.
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Affiliation(s)
- Ziyuan Li
- Department of Anesthesiology, Laboratory of Anesthesia and Critical Care Medicine, National-Local Joint Engineering Research Centre of Translational Medicine of Anesthesiology, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China
| | - Yu Gan
- Department of Anesthesiology, Laboratory of Anesthesia and Critical Care Medicine, National-Local Joint Engineering Research Centre of Translational Medicine of Anesthesiology, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China
| | - Ting Kang
- Department of Anesthesiology, Laboratory of Anesthesia and Critical Care Medicine, National-Local Joint Engineering Research Centre of Translational Medicine of Anesthesiology, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China
| | - Yi Zhao
- Department of Anesthesiology, Laboratory of Anesthesia and Critical Care Medicine, National-Local Joint Engineering Research Centre of Translational Medicine of Anesthesiology, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China
| | - Tianguang Huang
- Frontiers Science Center for Disease-Related Molecular Network, Sichuan University West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China
| | - Yuhao Chen
- West China School of Pharmacy, Sichuan University, Chengdu, Sichuan, People's Republic of China
| | - Jin Liu
- Department of Anesthesiology, Laboratory of Anesthesia and Critical Care Medicine, National-Local Joint Engineering Research Centre of Translational Medicine of Anesthesiology, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China
| | - Bowen Ke
- Department of Anesthesiology, Laboratory of Anesthesia and Critical Care Medicine, National-Local Joint Engineering Research Centre of Translational Medicine of Anesthesiology, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China
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21
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Fundaun J, Thomas ET, Schmid AB, Baskozos G. The power of integrating data: advancing pain research using meta-analysis. Pain Rep 2022; 7:e1038. [PMID: 36213594 PMCID: PMC9534369 DOI: 10.1097/pr9.0000000000001038] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Revised: 07/21/2022] [Accepted: 07/30/2022] [Indexed: 12/03/2022] Open
Abstract
Publications related to pain research have increased significantly in recent years. The abundance of new evidence creates challenges staying up to date with the latest information. A comprehensive understanding of the literature is important for both clinicians and investigators involved in pain research. One commonly used method to combine and analyse data in health care research is meta-analysis. The primary aim of a meta-analysis is to quantitatively synthesise the results of multiple studies focused on the same research question. Meta-analysis is a powerful tool that can be used to advance pain research. However, there are inherent challenges when combining data from multiple sources. There are also numerous models and statistical considerations when undertaking a meta-analysis. This review aims to discuss the planning and preparation for completing a meta-analysis, review commonly used meta-analysis models, and evaluate the clinical implications of meta-analysis in pain research.
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Affiliation(s)
- Joel Fundaun
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom
| | - Elizabeth T. Thomas
- Nuffield Department of Primary Care Health Sciences, Centre for Evidence-Based Medicine, University of Oxford, Oxford, United Kingdom
| | - Annina B. Schmid
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom
| | - Georgios Baskozos
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom
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22
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ALSaeedy M, Hasan A, Al-Adhreai A, Alrabie A, Qaba H, Mashrah A, Öncü-Kaya EM. An overview of liquid chromatographic methods for analyzing new generation anti-epileptic drugs. J LIQ CHROMATOGR R T 2022. [DOI: 10.1080/10826076.2022.2134146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Mohammed ALSaeedy
- Department of Chemistry, Faculty of Applied Sciences, Dhamar University, Dhamar, Yemen
- Department of Chemistry, Faculty of Sciences, Eskisehir Technical University, Eskisehir, Turkey
- Department of Chemistry, Faculty of Education-Albaydha, Albaydha University, Albaydha, Yemen
| | - Ahmed Hasan
- Department of Pharmacology, Graduation School of Health Science, Anadolu University, Eskisehir, Turkey
| | - Arwa Al-Adhreai
- Department of Chemistry, Faculty of Applied Sciences, Dhamar University, Dhamar, Yemen
- Department of Chemistry, Maulana Azad of Arts, Science and Commerce, Aurangabad, India
| | - Ali Alrabie
- Department of Chemistry, Faculty of Education-Albaydha, Albaydha University, Albaydha, Yemen
- Department of Chemistry, Maulana Azad of Arts, Science and Commerce, Aurangabad, India
| | - Hafsah Qaba
- Department of Analytical Chemistry, Graduation School of Health Sciences, Anadolu University, Eskisehir, Turkey
| | - Abdulrahman Mashrah
- Department of Food Science and Technology, Faculty of Agriculture and Food Sciences, Ibb University, Ibb, Yemen
- Department of Food Engineering, Institute of Natural Sciences-Sakarya, Sakarya University, Sakarya, Turkey
| | - Elif Mine Öncü-Kaya
- Department of Chemistry, Faculty of Sciences, Eskisehir Technical University, Eskisehir, Turkey
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23
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Boussageon R, Blanchard C, Charuel E, Menini T, Pereira B, Naudet F, Kassai B, Gueyffier F, Cucherat M, Vaillant-Roussel H. Project rebuild the evidence base (REB): A method to interpret randomised clinical trials and their meta-analysis to present solid benefit-risk assessments to patients. Therapie 2022:S0040-5957(22)00177-9. [PMID: 36371260 DOI: 10.1016/j.therap.2022.10.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2021] [Revised: 09/16/2022] [Accepted: 10/03/2022] [Indexed: 11/11/2022]
Abstract
Evidence-based medicine is the cornerstone of shared-decision making in healthcare today. The public deserves clear, transparent and trust-worthy information on drug efficacy. Yet today, many drugs are prescribed and used without solid evidence of efficacy. Clinical trials and randomised clinical trials (RCTs) are the best method to evaluate drug efficacy and side effects. In a shared medical decision-making approach, general practitioners need drug assessment based on patient-important outcomes. The aim of project rebuild the evidence base (REB) is to bridge the gap between the data needed in clinical practice and the data available from clinical research. The drugs will be assessed on clinical patient important outcomes and for a population. Using the Cochrane tools, we propose to analyse for each population and outcome: 1) a meta-analysis based on RCTs with a low risk of bias overall; 2) an evaluation of results of confirmatory RCTs; 3) a statistical analysis of heterrogeneity between RCTs and 4) an analysis of publication bias. Depending on the results of these analyses, the evidence will be categorized in 4 different levels: firm evidence, evidence (to be confirmed), signal or absence of evidence. Project REB proposes a method for reading and interpreting RCTs and their meta-analysis to produce quality data for general practitioners to focus on risk-benefit assessment in the interest of patients. If this data does not exist, it could enable clinical research to better its aim.
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24
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The effectiveness of pregabalin with or without agomelatine in the treatment of chronic low back pain: a double-blind, placebo-controlled, randomized clinical trial. BMC Pharmacol Toxicol 2022; 23:70. [PMID: 36104745 PMCID: PMC9476640 DOI: 10.1186/s40360-022-00612-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 07/27/2022] [Accepted: 09/06/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Although various pharmacological and nonpharmacological treatments are available for the chronic low back pain (CLBP), there is no consensus on the best optimal treatment for this condition. This study aimed to investigate the efficacy of co-administration of pregabalin and agomelatine versus pregabalin with placebo to treat CLBP.
Methods
Forty-six CLBP patients without the surgical indication referred to the outpatient orthopedic clinic of Rasoul-e-Akram Hospital, Tehran, Iran, were randomly divided into two study groups: Group A [pregabalin (75 mg twice per day) + placebo] and Group B [pregabalin (75 mg twice per day) + agomelatine (25 mg per night)]. Patients were evaluated at weeks 0, 4, and 8. Outcome measures were the Persian versions of the Brief Pain Inventory (BPI) interference scale, Roland-Morris Disability Questionnaire (RMDQ), The Hospital Anxiety and Depression Scale (HADS), 36-Item Short Form Survey (SF-36), and General Health Questionnaire-28 (GHQ-28) were used.
Results
At weeks 4 and 8 after the intervention, all evaluated measures showed significant improvement in both study groups (P < 0.01). The mean improvement of GHQ-28 was 3.7 ± 1.22 in group A and 13.1 ± 4.71 in group B. This difference was statistically significant (P = 0.003). Other outcomes did not vary substantially between the two research groups. Agomelatine treatment was well tolerated, with no significant adverse effects seen in patients. Liver tests of all patients were routine during the study period. Major adverse effect was not seen in any patient. The prevalence of Minor side effects was not significantly different between two study groups.
Conclusion
Compared with the pregabalin and placebo, co-administration of pregabalin and agomelatine had no added effect on improving pain scores in CLBP patients. However, the patients’ general health was significantly improved after the combined administration of pregabalin and agomelatine.
Trial registration
The study protocol was registered in the Iranian Registry of Clinical Trials before starting the study (NO.IRCT20200620047852N1, Registration date: 23/06/2020).
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Gabapentin inhibits the analgesic effects and nerve regeneration process induced by hepatocyte growth factor (HGF) in a peripheral nerve injury model: Implication for the use of VM202 and gabapentinoids for peripheral neuropathy. Mol Cell Neurosci 2022; 122:103767. [PMID: 36007867 DOI: 10.1016/j.mcn.2022.103767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Revised: 07/21/2022] [Accepted: 08/12/2022] [Indexed: 11/24/2022] Open
Abstract
Hepatocyte growth factor (HGF) is a multifunctional protein that plays a critical role in the angiogenic, neurotrophic, antifibrotic, and antiapoptotic activities of various cell types. It has been previously reported that intramuscular injection of pCK-HGF-X7 (or VM202), a plasmid DNA designed to express both native isoforms of human HGF (Pyun et al., 2010), significantly reduced the level of neuropathic pain in clinical studies as well as in a variety of animal models. In clinical studies, it has been observed that pCK-HGF-X7 appeared to give much higher pain-relieving effects in subjects not taking pregabalin or gabapentin, α2δ1 calcium channel blockers frequently prescribed for reducing pain in patients with diabetic peripheral neuropathy. In this study, we tested the effects of gabapentin on HGF-mediated pain reduction and nerve regeneration in vivo. Consistent with the data from clinical studies, gabapentin administration inhibited the pain reduction and axon regeneration effects mediated by HGF expression from pCK-HGF-X7. In the context of nerve regenerative effects, treatment with gabapentin or EGTA, a Ca2+ chelator, inhibited HGF-mediated axon outgrowth of injured sciatic nerves in vivo. Taken together, i.m. injection of HGF-encoding plasmid DNA ameliorated pain symptoms and enhanced the regeneration of injured nerves, and these therapeutic effects of HGF were significantly hindered by gabapentin treatment, suggesting the possible involvement of Ca2+ in the pro-regenerative activities of native HGF derived from treatment with pCK-HGF-X7.
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26
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Ma Y, Liu W, Liang L, Ye J, Huang C, Zhuang T, Zhang G. Synergistic Antinociceptive Effects of Indomethacin-Pregabalin and Meloxicam-Pregabalin in Paclitaxel-Induced Neuropathic Pain. Biomedicines 2022; 10:biomedicines10061413. [PMID: 35740434 PMCID: PMC9219661 DOI: 10.3390/biomedicines10061413] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 06/11/2022] [Accepted: 06/13/2022] [Indexed: 01/05/2023] Open
Abstract
Neuropathic pain is often closely associated with nerve injury or inflammation, and the role of traditional nonsteroidal anti-inflammatory drugs as adjuvants for treating chemotherapy-induced peripheral neuropathic pain remains unclear. In this study, the potential synergistic antinociceptive effects of indomethacin–pregabalin and meloxicam–pregabalin were evaluated in paclitaxel-induced neuropathic pain and carrageenan-induced inflammatory pain in rodents. Although indomethacin and meloxicam alone only slightly relieved mechanical allodynia in the above two models, isobolographic analysis showed that the combination of indomethacin or meloxicam with pregabalin produced significant synergistic antinociceptive effects for paclitaxel-induced neuropathic pain (IN-PGB, experimental ED25 = [4.41 (3.13–5.82)] mg/kg, theoretical ED25 = [8.50 (6.62–10.32)] mg/kg; MEL-PGB, experimental ED25 = [3.96 (2.62–5.46)] mg/kg, theoretical ED25 = [7.52 (5.73–9.39)] mg/kg). In addition, MEL-PGB dosed via intraplantar injection into the left paw, intragastric injection, or intraperitoneal injection reversed paclitaxel-induced allodynia, indicating that they may act at multiple sites in the neuroaxis and periphery. However, indomethacin–pregabalin and meloxicam–pregabalin exerted antagonistic antiallodynic interactions in carrageenan-induced inflammatory pain in rats. Taken together, coadministration of indomethacin or meloxicam with pregabalin may possess potential therapeutic advantages for treating chemotherapy-induced neuropathic pain.
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Affiliation(s)
- Yurong Ma
- Jiangsu Key Laboratory of Marine Pharmaceutical Compound Screening, School of Pharmacy, Jiangsu Ocean University, Lianyungang 222005, China; (Y.M.); (W.L.); (L.L.); (J.Y.); (C.H.)
- Jiangsu Key Laboratory of Marine Biological Resources and Environment, School of Pharmacy, Jiangsu Ocean University, Lianyungang 222005, China
| | - Wenwen Liu
- Jiangsu Key Laboratory of Marine Pharmaceutical Compound Screening, School of Pharmacy, Jiangsu Ocean University, Lianyungang 222005, China; (Y.M.); (W.L.); (L.L.); (J.Y.); (C.H.)
- Jiangsu Key Laboratory of Marine Biological Resources and Environment, School of Pharmacy, Jiangsu Ocean University, Lianyungang 222005, China
| | - Lingzhi Liang
- Jiangsu Key Laboratory of Marine Pharmaceutical Compound Screening, School of Pharmacy, Jiangsu Ocean University, Lianyungang 222005, China; (Y.M.); (W.L.); (L.L.); (J.Y.); (C.H.)
| | - Jiaqi Ye
- Jiangsu Key Laboratory of Marine Pharmaceutical Compound Screening, School of Pharmacy, Jiangsu Ocean University, Lianyungang 222005, China; (Y.M.); (W.L.); (L.L.); (J.Y.); (C.H.)
| | - Chaonan Huang
- Jiangsu Key Laboratory of Marine Pharmaceutical Compound Screening, School of Pharmacy, Jiangsu Ocean University, Lianyungang 222005, China; (Y.M.); (W.L.); (L.L.); (J.Y.); (C.H.)
| | - Tao Zhuang
- Jiangsu Key Laboratory of Marine Pharmaceutical Compound Screening, School of Pharmacy, Jiangsu Ocean University, Lianyungang 222005, China; (Y.M.); (W.L.); (L.L.); (J.Y.); (C.H.)
- Jiangsu Key Laboratory of Marine Biological Resources and Environment, School of Pharmacy, Jiangsu Ocean University, Lianyungang 222005, China
- Correspondence: (T.Z.); (G.Z.); Tel.: +86-27-87792235 (G.Z.)
| | - Guisen Zhang
- Jiangsu Key Laboratory of Marine Pharmaceutical Compound Screening, School of Pharmacy, Jiangsu Ocean University, Lianyungang 222005, China; (Y.M.); (W.L.); (L.L.); (J.Y.); (C.H.)
- Jiangsu Key Laboratory of Marine Biological Resources and Environment, School of Pharmacy, Jiangsu Ocean University, Lianyungang 222005, China
- Systems Biology Theme, Department of Biomedical Engineering, College of Life Science and Technology, Huazhong University of Science and Technology, Wuhan 430074, China
- Correspondence: (T.Z.); (G.Z.); Tel.: +86-27-87792235 (G.Z.)
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Hopkins RE, Campbell G, Degenhardt L, Nielsen S, Blyth F, Cohen M, Gisev N. Use of pharmacological and nonpharmacological treatments for chronic noncancer pain among people using opioids: a longitudinal cohort study. Pain 2022; 163:1049-1059. [PMID: 34538842 DOI: 10.1097/j.pain.0000000000002484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Accepted: 09/07/2021] [Indexed: 11/25/2022]
Abstract
ABSTRACT Although multimodal management of chronic noncancer pain (CNCP) is recommended, long-term treatment utilization patterns among people using opioids are not well known. The Pain and Opioids IN Treatment study recruited Australian adults receiving opioids for CNCP for more than 6 weeks from community pharmacies. Pharmacological (opioid and nonopioid analgesics and psychotropic medicines) and nonpharmacological (physical, mental health, and specialized) treatments used in the previous 12 months and 30 days were collected annually over 4 years (2015-2018). Associations were explored between 30-day treatment use and sociodemographic characteristics and pain measures. Overall, 1334 participants completed at least one annual follow-up. The median pain severity (5.0, interquartile range [IQR] 3.8 to 6.3) and pain interference scores (5.7, IQR 3.9-7.3) indicated moderate pain throughout the study period, despite most participants reporting the use of nonopioid pharmacological (12 month: 97.6% and 30 day: 96.8%) and nonpharmacological treatments (12 month: 91.8% and 30 day: 66.1%). Some treatment use was inconsistent with guidelines: ongoing nonsteroidal anti-inflammatory drugs and sedative-hypnotic use were common, whereas fewer people engaged with pain management programs (12 month: 22.3%). Private health insurance was associated with using physical (adjusted odds ratio 1.61, 99.5% confidence intervals 1.15-2.24) and specialized nonpharmacological treatments (adjusted odds ratio 1.47, 99.5% confidence intervals 1.14-1.91). This study demonstrates that many Australians taking opioids long-term for CNCP also use nonopioid pharmacological and nonpharmacological treatments. The use of pharmacological treatments including nonsteroidal anti-inflammatory drugs, psychotropic medicines, and gabapentinoids, outside guidelines, warrants review. Furthermore, despite Australia's universal healthcare scheme subsidising some nonpharmacological treatments, overall use of these treatments was associated with having private health insurance, highlighting a need for more equitable service provision.
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Affiliation(s)
- Ria E Hopkins
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney Australia
- Centre for Medicine Use and Safety, Monash University, Melbourne, Australia
| | - Gabrielle Campbell
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney Australia
- School of Health and Sports Science, University of the Sunshine Coast, Sunshine Coast, Australia
| | - Louisa Degenhardt
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney Australia
| | - Suzanne Nielsen
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney Australia
- Monash Addiction Research Centre, Monash University, Melbourne, Australia
| | - Fiona Blyth
- Centre for Education and Research on Ageing, University of Sydney, Sydney, Australia
| | - Milton Cohen
- St Vincent's Clinical School, Faculty of Medicine, UNSW Sydney, Sydney, Australia
| | - Natasa Gisev
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney Australia
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de Lima Silva AHB, Radulski DR, Pereira GS, Acco A, Zanoveli JM. A single injection of pregabalin induces short- and long-term beneficial effects on fear memory and anxiety-like behavior in rats with experimental type-1 diabetes mellitus. Metab Brain Dis 2022; 37:1095-1110. [PMID: 35239142 DOI: 10.1007/s11011-022-00936-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Accepted: 02/14/2022] [Indexed: 12/25/2022]
Abstract
Anxiety Disorders and Posttraumatic Stress Disorders (PTSD) associated with type-1 diabetes mellitus (T1DM) are increasingly common comorbidities and the treatment is quite challenging. In that sense, evidence indicates that the anticonvulsant pregabalin is highly effective in treating severe cases of anxiety, as well as PTSD and diabetic neuropathic pain which is also very prevalent in T1DM. Herein, the short- and long-term effects of a single injection of pregabalin on the acquisition of a fear extinction memory and parameters of anxiety in induced-T1DM animals were investigated. For that, we used the contextual fear conditioning (CFC) and elevated plus maze paradigms, respectively. A putative antioxidant activity was also evaluated. Our findings demonstrated that induced-T1DM animals presented greater expression of fear memory, difficulty in extinguishing this fear memory, associated with a more pronounced anxiety-like response. Pregabalin was able to induce a short and long-lasting effect by facilitating the acquisition of the fear extinction memory and inducing a later anxiolytic-like effect. Also, the increased lipid peroxidation levels in the hippocampus and prefrontal cortex of induced-T1DM rats were reduced after pregabalin injection, while the decreased levels of reduced glutathione were increased in the hippocampus. Despite the need for more studies to understand the mechanism of action of pregabalin under these conditions, our data demonstrate for the first time that a single injection of pregabalin in a specific time window was able to improve behavioral parameters in addition to inducing neuroprotective effect. Thus, pregabalin has potential worth exploring for the treatment of PTSD and/or Anxiety associated with T1DM.
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Affiliation(s)
| | - Debora Rasec Radulski
- Department of Pharmacology, Biological Science Sector, Federal University of Paraná, Curitiba, Paraná, Brazil
| | - Gabriela Saidel Pereira
- Department of Pharmacology, Biological Science Sector, Federal University of Paraná, Curitiba, Paraná, Brazil
| | - Alexandra Acco
- Department of Pharmacology, Biological Science Sector, Federal University of Paraná, Curitiba, Paraná, Brazil
| | - Janaina Menezes Zanoveli
- Department of Pharmacology, Biological Science Sector, Federal University of Paraná, Curitiba, Paraná, Brazil.
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Hanna R, Bensadoun RJ, Beken SV, Burton P, Carroll J, Benedicenti S. Outpatient Oral Neuropathic Pain Management with Photobiomodulation Therapy: A Prospective Analgesic Pharmacotherapy-Paralleled Feasibility Trial. Antioxidants (Basel) 2022; 11:533. [PMID: 35326183 PMCID: PMC8944471 DOI: 10.3390/antiox11030533] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Revised: 03/04/2022] [Accepted: 03/07/2022] [Indexed: 12/15/2022] Open
Abstract
Neuropathic pain (NP) can be challenging to treat effectively as analgesic pharmacotherapy (MED) can reduce pain, but the majority of patients do not experience complete pain relief. Our pilot approach is to assess the feasibility and efficacy of an evidence-based photobiomodulation (PBM) intervention protocol. This would be as an alternative to paralleled standard analgesic MED for modulating NP intensity-related physical function and quality of life (QoL) prospectively in a mixed neurological primary burning mouth syndrome and oral iatrogenic neuropathy study population (n = 28). The study group assignments and outcome evaluation strategy/location depended on the individual patient preferences and convenience rather than on randomisation. Our prospective parallel study aimed to evaluate the possible pre/post-benefit of PBM and to allow for a first qualitative comparison with MED, various patient-reported outcome measures (PROMs) based on Initiative on Methods, Measurement, and Pain Assessment in Clinical Trials (IMMPACT-II) were used for up to a nine-month follow-up period in both intervention groups (PBM and MED). The PBM protocol applied to the PBM group was as follows: λ810 nm, 200 mW, 0.088 cm2, 30 s/point, 9 trigger and affected points, twice a week for five consecutive weeks, whereas the MED protocol followed the National Institute of Clinical Excellence (NICE) guidelines. Our results showed that despite the severe and persistent nature of the symptoms of 57.50 ± 47.93 months at baseline in the PBM group, a notably rapid reduction in PISmax on VAS from 7.6 at baseline (T0) to 3.9 at one-month post-treatment (T3) could be achieved. On the other hand, mean PISmax was only reduced from 8.2 at baseline to 6.8 at T3 in the MED group. Our positive PBM findings furthermore support more patients' benefits in improving QoL and functional activities, which were considerably impaired by NP such as: eating, drinking and tasting, whereas the analgesic medication regimens did not. No adverse events were observed in both groups. To the best knowledge of the authors, our study is the first to investigate PBM efficacy as a monotherapy compared to the gold standard analgesic pharmacotherapy. Our positive data proves statistically significant improvements in patient self-reported NP, functionality, psychological profile and QoL at mid- and end-treatment, as well as throughout the follow-up time points (one, three, six and nine months) and sustained up to nine months in the PBM group, compared to the MED group. Our study, for the first time, proves the efficacy and safety of PBM as a potent analgesic in oral NP and as a valid alternative to the gold standard pharmacotherapy approach. Furthermore, we observed long-term pain relief and functional benefits that indicate that PBM modulates NP pathology in a pro-regenerative manner, presumably via antioxidant mechanisms.
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Affiliation(s)
- Reem Hanna
- Department of Oral Surgery, Dental Institute, King’s College Hospital NHS Foundation Trust, London SE5 9RS, UK
- Department of Surgical Sciences and Integrated Diagnostics, Laser Therapy Centre, University of Genoa, Viale Benedetto XV,6, 16132 Genoa, Italy;
| | - René Jean Bensadoun
- Department of Radiology Oncology, Centre De Haute Energie, 10 Boulevard Pasteur, 06000 Nice, France;
| | - Seppe Vander Beken
- Bredent Medical GmbH & Co., Gewerbegebiet Gartenäcker, Weißenhorner Str. 2, 89250 Senden, Germany;
| | - Patricia Burton
- Thor Photomedicine Ltd., Water Meadow, Chesham HP5 1LF, UK; (P.B.); (J.C.)
| | - James Carroll
- Thor Photomedicine Ltd., Water Meadow, Chesham HP5 1LF, UK; (P.B.); (J.C.)
| | - Stefano Benedicenti
- Department of Surgical Sciences and Integrated Diagnostics, Laser Therapy Centre, University of Genoa, Viale Benedetto XV,6, 16132 Genoa, Italy;
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The Effects of Prenatal Exposure to Pregabalin on the Development of Ventral Midbrain Dopaminergic Neurons. Cells 2022; 11:cells11050852. [PMID: 35269474 PMCID: PMC8909856 DOI: 10.3390/cells11050852] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 02/21/2022] [Accepted: 02/26/2022] [Indexed: 12/04/2022] Open
Abstract
Pregabalin is widely used as a treatment for multiple neurological disorders; however, it has been reported to have the potential for misuse. Due to a lack of safety studies in pregnancy, pregabalin is considered the last treatment option for various neurological diseases, such as neuropathic pain. Therefore, pregabalin abuse in pregnant women, even at therapeutic doses, may impair fetal development. We used primary mouse embryonic neurons to investigate whether exposure to pregabalin can impair the morphogenesis and differentiation of ventral midbrain neurons. This study focused on ventral midbrain dopaminergic neurons, as they are responsible for cognition, movement, and behavior. The results showed that pregabalin exposure during early brain development induced upregulation of the dopaminergic progenitor genes Lmx1a and Nurr1 and the mature dopaminergic gene Pitx3. Interestingly, pregabalin had different effects on the morphogenesis of non-dopaminergic ventral midbrain neurons. Importantly, our findings illustrated that a therapeutic dose of pregabalin (10 μM) did not affect the viability of neurons. However, it caused a decrease in ATP release in ventral midbrain neurons. We demonstrated that exposure to pregabalin during early brain development could interfere with the neurogenesis and morphogenesis of ventral midbrain dopaminergic neurons. These findings are crucial for clinical consideration of the use of pregabalin during pregnancy.
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Saxena AK, Singh A, Chilkoti GT, Sharma T, Banerjee BD, Das S, Singhal A. Modulation of signal transduction gene expression following pulsed radiofrequency in dorsal root ganglia and pregabalin therapy. Pain Manag 2021; 12:347-356. [PMID: 34786952 DOI: 10.2217/pmt-2021-0057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Introduction: A randomized controlled study was conducted to assess modulation of signal transduction genes (PKA, PKC and ERK) following integrated multimodal approach encompassing pulsed radiofrequency treatment (PRF) of dorsal root ganglion and pregabalin in thoracic postherpetic neuralgia (PHN). Clinical variables such as pain intensity and quality of life were also explored. Material & methods: A total of 40 Patients of PHN were recruited. 20 patients randomly assigned to each of the two groups, group PP administered PRF with pregabalin and group SP administered pregabalin alone. Results: Significant downregulation of PKA and ERK observed in group PP at end of 10th week (p < 0.05). A significantly positive correlation demonstrated between Visual analog scale scores and signal transduction genes expression in PHN patients. Conclusion: Downregulation of all three signal transduction genes was observed following the integrated multimodal approach; however, significant downregulation was observed with PKA and ERK only. A positive correlation observed between signal transduction gene expression and visual analog scale scores signify their role in the pathogenesis of PHN.
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Affiliation(s)
- Ashok Kumar Saxena
- Department of Anaesthesiology, Critical care & Pain Medicine, University College of Medical Sciences & Guru Tegh Bahadaur Hospital, Delhi, 110095, India
| | - Anshul Singh
- Department of Anaesthesiology, Critical care & Pain Medicine, University College of Medical Sciences & Guru Tegh Bahadaur Hospital, Delhi, 110095, India
| | - Geetanjali T Chilkoti
- Department of Anaesthesiology, Critical care & Pain Medicine, University College of Medical Sciences & Guru Tegh Bahadaur Hospital, Delhi, 110095, India
| | - Tusha Sharma
- Department of Environmental Biochemistry & Molecular Biology, University College of Medical Sciences & Guru Tegh Bahadur Hospital, Dilshad garden, Delhi, 110095, India
| | - Basu Dev Banerjee
- Department of Environmental Biochemistry & Molecular Biology, University College of Medical Sciences & Guru Tegh Bahadur Hospital, Dilshad garden, Delhi, 110095, India
| | - Swati Das
- Department of Anaesthesiology, Critical care & Pain Medicine, University College of Medical Sciences & Guru Tegh Bahadaur Hospital, Delhi, 110095, India
| | - Archana Singhal
- Department of Dermatology, University College of Medical Sciences & G.T.B. Hospital, Dilshad Garden, Delhi, 110095, India
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Jingxuan L, Litian M, Jianfang F. Different Drugs for the Treatment of Painful Diabetic Peripheral Neuropathy: A Meta-Analysis. Front Neurol 2021; 12:682244. [PMID: 34777192 PMCID: PMC8585758 DOI: 10.3389/fneur.2021.682244] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Accepted: 10/04/2021] [Indexed: 01/16/2023] Open
Abstract
Objective: To systematically evaluate the effects of different drugs for the treatment of painful diabetic peripheral neuropathy. Methods: All literature from PubMed, Embase, and Cochrane Central Register of Controlled Trials published over the past 12 years (from January 1, 2008 to June 1, 2020) was searched, and two reviewers independently assessed study eligibility, continuous data extraction, independent assessment of bias risk, and graded strength of evidence. The pain score was used as the main result, and 30 and 50% pain reduction and adverse events were used as secondary results. Results: A total of 37 studies were included. Pregabalin, duloxetine, tapentadol, lacosamide, mirogabalin, and capsaicin were all more effective than placebo in alleviating the pain associated with diabetic peripheral neuropathy, while ABT-894 and gabapentin showed no significant effect. In addition, the efficacy of buprenorphine, tanezumab, fulranumab and others could not be concluded due to insufficient studies. Conclusion: Pregabalin and duloxetine showed good therapeutic effects on painful DPN, but adverse events were also significant. The analgesic effects of ABT-894 and gabapentin need to be further studied with longer and larger RCTs. As an opioid drug, tapentadol has a good analgesic effect, but due to its addiction, it needs to be very cautious in clinical use. Although lacosamide, mirogabalin, and capsaicin are more effective than placebo, the therapeutic effect is weaker than pregabalin. For the results of our meta-analysis, long-term studies are still needed to verify their efficacy and safety in the future. Systematic Review Registration: PROSPERO, identifier: CRD42020197397.
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Affiliation(s)
- Lian Jingxuan
- Department of Endocrinology, Xijing Hospital of Air Force Medical University, Xi'an, China
| | - Ma Litian
- Department of Gastroenterology, Xijing Hospital of Air Force Medical University, Xi'an, China
| | - Fu Jianfang
- Department of Endocrinology, Xijing Hospital of Air Force Medical University, Xi'an, China
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Giménez-Campos MS, Pimenta-Fermisson-Ramos P, Díaz-Cambronero JI, Carbonell-Sanchís R, López-Briz E, Ruíz-García V. A systematic review and meta-analysis of the effectiveness and adverse events of gabapentin and pregabalin for sciatica pain. Aten Primaria 2021; 54:102144. [PMID: 34637958 PMCID: PMC8515246 DOI: 10.1016/j.aprim.2021.102144] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 05/06/2021] [Accepted: 05/31/2021] [Indexed: 11/26/2022] Open
Abstract
Aim This SR aims to assess the effectiveness of pregabalin and gabapentin on pain and disability caused by acute sciatica and the adverse events associated with their clinical use. Design Systematic review. Databases Electronic databases of Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, and Clinical Trials.gov were searched from their inception until March 1st of 2021. Selection criteria Randomized trials (RCT) with adults > 18 years old with acute sciatica for a minimum of 1 week and a maximum of 1 year (at least moderate pain). Data treatment The outcomes were pain, disability and adverse events. Data was summarized using odds ratio and mean difference. GRADE was used to calculate the level of evidence. Results Eight RCT involving 747 participants were included. The effect of pregabalin was assessed in 3 RCT and in one three-arm trial (pregabalin vs limaprost vs a combination of limaprost and pregabalin). Two trials assessed the effect of gabapentin compared with placebo and one compared with tramadol. One study assessed the effect of gabapentin vs pregabalin in a crossover head-to-head trial. A statistically significant improvement on leg pain at 2 weeks and leg pain with movement at 3 and 4 months was found in a RCT comparing gabapentin with placebo. There were no statistically differences on the remaining time periods assessed for leg pain, low back pain and functional disability. Conclusions This SR provides clear evidence for lack of effectiveness of pregabalin and gabapentin for sciatica pain management. In view of this, its routine clinical use cannot be supported.
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Abstract
This review summarizes current evidence on the abuse and misuse of the gabapentinoids pregabalin and gabapentin. Pharmacovigilance studies, register-based studies, surveys, clinical toxicology studies, and forensic toxicology studies were identified and scrutinized with the goal to define the problem, identify risk factors, and discuss possible methods to reduce the potential for abuse and misuse. Studies found that gabapentinoids are abused and misused and that individuals with a history of psychiatric disorders or substance use disorder seem to be at high risk. Moreover, some evidence supports the notion that patients with opioid use disorders may be at an increased risk of abusing gabapentinoids. Available evidence also suggests that abuse and misuse are more frequent in users of pregabalin compared with users of gabapentin. Health professionals and prescribers should be aware of the risk for misuse of pregabalin and gabapentin, which eventually could lead to abuse, substance dependence, and intoxications. Prescribing to patients belonging to risk populations such as those with psychiatric disorders or substance use disorder should be avoided if possible and, if prescribed, signs of misuse and abuse should be monitored.
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Affiliation(s)
- Staffan Hägg
- Futurum, Jönköping, Region Jönköping County and Department of Biomedicine and Clinical Sciences, Faculty of Medicine and Health Sciences, Linköping University, Futurum, Hus B4, Ryhov Hospital, S-551 85, Jönköping, Sweden.
| | - Anna K Jönsson
- Division of Drug Research, Department of Biomedicine and Clinical Sciences, Faculty of Medicine and Health Sciences, Linköping University, Linköping, Sweden
- Department of Forensic Genetics and Forensic Chemistry, National Board of Forensic Medicine, Linköping, Sweden
| | - Johan Ahlner
- Division of Drug Research, Department of Biomedicine and Clinical Sciences, Faculty of Medicine and Health Sciences, Linköping University, Linköping, Sweden
- Department of Forensic Genetics and Forensic Chemistry, National Board of Forensic Medicine, Linköping, Sweden
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35
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Cheng DK, Lai KSP, Pico-Espinosa OJ, Rice DB, Chung C, Modarresi G, Sud A. Interventions for Depressive Symptoms in People Living with Chronic Pain: A Systematic Review of Meta-Analyses. PAIN MEDICINE 2021; 23:934-954. [PMID: 34373915 PMCID: PMC9071227 DOI: 10.1093/pm/pnab248] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE This review investigated the effectiveness of clinical interventions on depressive symptoms in people with all types of chronic pain. METHODS We searched seven electronic databases and reference lists on September 15, 2020, and included English-language, systematic reviews and meta-analyses of trials that examined the effects of clinical interventions on depressive outcomes in chronic pain. Two independent reviewers screened, extracted, and assessed the risk of bias. PROSPERO registration: CRD42019131871. RESULTS Eighty-three reviews were selected and included 182 meta-analyses. Data were summarized visually and narratively using standardized mean differences with 95% confidence intervals as the primary outcome of interest. A large proportion of meta-analyses investigated fibromyalgia or mixed chronic pain, and psychological interventions were most commonly evaluated. Acceptance and commitment therapy for general chronic pain, and fluoxetine and web-based psychotherapy for fibromyalgia showed the most robust effects and can be prioritized for implementation in clinical practice. Exercise for arthritis, pharmacotherapy for neuropathic pain, self-regulatory psychotherapy for axial pain, and music therapy for general chronic pain showed large, significant effects, but estimates were derived from low- or critically low-quality reviews. CONCLUSIONS No single intervention type demonstrated substantial superiority across multiple pain populations. Other dimensions beyond efficacy, such as accessibility, safety, cost, patient preference, and efficacy for non-depressive outcomes should also be weighed when considering treatment options. Further effectiveness research is required for common pain types such as arthritis and axial pain, and common interventions such as opioids, anti-inflammatories and acupuncture.
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Affiliation(s)
- Darren K Cheng
- Bridgepoint Collaboratory for Research and Innovation, Lunenfeld-Tanenbaum Research Institute, Sinai Health
| | | | | | | | | | - Golale Modarresi
- Bridgepoint Collaboratory for Research and Innovation, Lunenfeld-Tanenbaum Research Institute, Sinai Health
| | - Abhimanyu Sud
- Department of Family and Community Medicine, University of Toronto
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36
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Poppen H, Oehlke K, Van Klompenburg E. Weight Gain in Veterans Taking Duloxetine, Pregabalin, or Both for the Treatment of Neuropathy. Fed Pract 2021; 38:238-242. [PMID: 34177234 DOI: 10.12788/fp.0111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Introduction Peripheral neuropathy is a common condition with an estimated incidence of 3 million cases in the United States per year, with manifestations including weakness, numbness, burning or tingling sensations, and lingering pain. The burden of neuropathy may be greater among veterans due to the higher prevalence of type 2 diabetes mellitus (T2DM) and an aging population. Among the medications used to treat neuropathy are duloxetine and pregabalin. It has been observed at the Sioux Falls Veterans Affairs Health Care System (SFVAHCS) that veterans who are treated for neuropathy with duloxetine, pregabalin, or both, may experience significant weight gain after starting therapy. The purpose of this study was to evaluate the association of weight gain in veterans taking duloxetine, pregabalin, or both, for the treatment of neuropathy. Methods This was a retrospective, chart review study conducted at the SFVAHCS. The primary end point of this study was the change in body weight, expressed in pounds, after 12 to 18 months of treatment. The secondary end points of this study were the percent change in body weight; duration effect; dose effect, which evaluated weight gain at doses of duloxetine > 60 mg/d and pregabalin at doses > 300 mg/d; change in hemoglobin A1c in patients with prediabetes and T2DM, and involvement in the Managing Overweight Veterans Everywhere (MOVE!) weight management program. Results The change in body weight after 12 to 18 months of treatment was -0.8 lb in the duloxetine group, +2.9 lb in the pregabalin group, and +5.5 lb in the pregabalin plus duloxetine group (P = .12). The change in body weight after > 12 months of treatment was -0.88 lb in the duloxetine group, +3.6 lb in the pregabalin group, and +8.5 lb in the duloxetine plus pregabalin group (P = .046). The change in body weight in patients who received increased doses of the study agents was -2.8 lb in the duloxetine group and +6.5 lb in the pregabalin group (P = .047). Conclusions There was no significant difference in weight in veterans who took duloxetine, pregabalin, or both, for treatment of neuropathy after 12 to 18 months of therapy. However, there was a difference in weight gain among the 3 groups when therapy lasted > 12 months. The combination therapy of pregabalin and duloxetine was associated with the most amount of weight gain, followed by pregabalin alone. Monotherapy of duloxetine had minimal association with weight gain. In veterans who took increased doses of duloxetine or pregabalin, there was a difference in weight between the monotherapy groups, with pregabalin associated with weight gain and duloxetine associated with weight loss.
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Affiliation(s)
- Hannah Poppen
- was a PGY1 Pharmacy Resident at the time the article was written; is Associate Chief of Pharmacy, both at Sioux Falls VA Health Care System in South Dakota. is an Assistant Professor at South Dakota State University College of Pharmacy and Allied Health Professions in Sioux Falls
| | - Kelley Oehlke
- was a PGY1 Pharmacy Resident at the time the article was written; is Associate Chief of Pharmacy, both at Sioux Falls VA Health Care System in South Dakota. is an Assistant Professor at South Dakota State University College of Pharmacy and Allied Health Professions in Sioux Falls
| | - Emily Van Klompenburg
- was a PGY1 Pharmacy Resident at the time the article was written; is Associate Chief of Pharmacy, both at Sioux Falls VA Health Care System in South Dakota. is an Assistant Professor at South Dakota State University College of Pharmacy and Allied Health Professions in Sioux Falls
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Pedowitz EJ, Abrams RMC, Simpson DM. Management of Neuropathic Pain in the Geriatric Population. Clin Geriatr Med 2021; 37:361-376. [PMID: 33858616 DOI: 10.1016/j.cger.2021.01.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Neuropathic pain is common in the geriatric population. Diagnosis requires a thorough history and physical examination to differentiate it from other types of pain. Once diagnosed, further workup is required to elucidate the cause, including potential reversible causes of neuropathy. When treating neuropathic pain in the elderly, it is important to consider patients' comorbidities and other medications to avoid drug-drug interactions and iatrogenic effects given the physiologic changes of drug metabolism in the elderly. Nonsystemic therapies and topical medications should be considered. Systemic medications should be started at low dose and titrated up slowly with frequent monitoring for adverse effects.
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Affiliation(s)
- Elizabeth J Pedowitz
- Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, 1468 Madison Avenue, Annenberg, 10th Floor, New York, NY 10029, USA.
| | - Rory M C Abrams
- Department of Neurology, Division of Neuromuscular Diseases and Clinical Neurophysiology Laboratories, Icahn School of Medicine at Mount Sinai, 1000 Tenth Avenue, 10th Floor Suite 10C, New York, NY 10019, USA
| | - David M Simpson
- Department of Neurology Division of Neuromuscular Diseases and Clinical Neurophysiology Laboratories, Icahn School of Medicine at Mount Sinai, 1468 Madison Avenue, Annenberg, 2nd Floor, Box 1052, New York, NY 10029, USA
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Ni J, Jiang J, Mao S, Sun RF. Pregabalin does not decrease acute pain or postoperative nausea and vomiting after hysterectomy: a meta-analysis. J Int Med Res 2021; 48:300060520954720. [PMID: 33334230 PMCID: PMC7750779 DOI: 10.1177/0300060520954720] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE Hysterectomy is associated with severe postoperative pain. The relative efficacy of pregabalin compared with other treatments for post-hysterectomy pain is unclear. METHODS We searched the PubMed, Cochrane Library, and Web of Science databases for studies that compared the use of pregabalin and placebo for reducing pain in patients undergoing hysterectomy. RESULTS This meta-analysis showed that pregabalin had limited pain-relieving effects at 2, 6, 24, and 48 hours after hysterectomy compared with placebo. Pregabalin significantly reduced postoperative nausea and vomiting. However, there was no significant difference in postoperative sedation or visual disturbances between patients treated with pregabalin and placebo. CONCLUSIONS Pregabalin is not clinically superior to placebo in terms of reducing pain intensity and morphine consumption in patients undergoing hysterectomy. However, the limitations of this meta-analysis mean that more high-quality randomized controlled trials are necessary to verify our pooled results.
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Affiliation(s)
- Jie Ni
- Department of Gynecology, Jingjiang People's Hospital, Taizhou, Jiangsu Province, China
| | - Juan Jiang
- Department of Gynecology, Jingjiang People's Hospital, Taizhou, Jiangsu Province, China
| | - Shiqin Mao
- Department of Gynecology, Jingjiang People's Hospital, Taizhou, Jiangsu Province, China
| | - Rui-Fang Sun
- Department of Gynecology, Jingjiang People's Hospital, Taizhou, Jiangsu Province, China
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Nutt DJ, Phillips LD, Barnes MP, Brander B, Curran HV, Fayaz A, Finn DP, Horsted T, Moltke J, Sakal C, Sharon H, O'Sullivan SE, Williams T, Zorn G, Schlag AK. A Multicriteria Decision Analysis Comparing Pharmacotherapy for Chronic Neuropathic Pain, Including Cannabinoids and Cannabis-Based Medical Products. Cannabis Cannabinoid Res 2021; 7:482-500. [PMID: 33998895 PMCID: PMC9418467 DOI: 10.1089/can.2020.0129] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Background: Pharmacological management of chronic neuropathic pain (CNP) still represents a major clinical challenge. Collective harnessing of both the scientific evidence base and clinical experience (of clinicians and patients) can play a key role in informing treatment pathways and contribute to the debate on specific treatments (e.g., cannabinoids). A group of expert clinicians (pain specialists and psychiatrists), scientists, and patient representatives convened to assess the relative benefit–safety balance of 12 pharmacological treatments, including orally administered cannabinoids/cannabis-based medicinal products, for the treatment of CNP in adults. Methods: A decision conference provided the process of creating a multicriteria decision analysis (MCDA) model, in which the group collectively scored the drugs on 17 effect criteria relevant to benefits and safety and then weighted the criteria for their clinical relevance. Findings: Cannabis-based medicinal products consisting of tetrahydrocannabinol/cannabidiol (THC/CBD), in a 1:1 ratio, achieved the highest overall score, 79 (out of 100), followed by CBD dominant at 75, then THC dominant at 72. Duloxetine and the gabapentinoids scored in the 60s, amitriptyline, tramadol, and ibuprofen in the 50s, methadone and oxycodone in the 40s, and morphine and fentanyl in the 30s. Sensitivity analyses showed that even if the pain reduction and quality-of-life scores for THC/CBD and THC are halved, their benefit–safety balances remain better than those of the noncannabinoid drugs. Interpretation: The benefit–safety profiles for cannabinoids were higher than for other commonly used medications for CNP largely because they contribute more to quality of life and have a more favorable side effect profile. The results also reflect the shortcomings of alternative pharmacological treatments with respect to safety and mitigation of neuropathic pain symptoms. Further high-quality clinical trials and systematic comprehensive capture of clinical experience with cannabinoids is warranted. These results demonstrate once again the complexity and multimodal mechanisms underlying the clinical experience and impact of chronic pain.
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Affiliation(s)
- David J Nutt
- Department of Brain Sciences, Faculty of Medicine, Imperial College London, London, United Kingdom
| | - Lawrence D Phillips
- Department of Management, Emeritus Professor of Decision Science, London School of Economics and Political Science, London, United Kingdom
| | | | | | | | - Alan Fayaz
- University College London, London, United Kingdom
| | | | | | | | | | | | | | - Tim Williams
- AWP Mental Health NHS Trust, Bristol, United Kingdom
| | - Gregor Zorn
- European Cannabinoid Therapy Association, Worcester, United Kingdom
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Tu J, Vargas Castillo J, Das A, Diwan AD. Degenerative Cervical Myelopathy: Insights into Its Pathobiology and Molecular Mechanisms. J Clin Med 2021; 10:jcm10061214. [PMID: 33804008 PMCID: PMC8001572 DOI: 10.3390/jcm10061214] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 03/07/2021] [Accepted: 03/09/2021] [Indexed: 12/12/2022] Open
Abstract
Degenerative cervical myelopathy (DCM), earlier referred to as cervical spondylotic myelopathy (CSM), is the most common and serious neurological disorder in the elderly population caused by chronic progressive compression or irritation of the spinal cord in the neck. The clinical features of DCM include localised neck pain and functional impairment of motor function in the arms, fingers and hands. If left untreated, this can lead to significant and permanent nerve damage including paralysis and death. Despite recent advancements in understanding the DCM pathology, prognosis remains poor and little is known about the molecular mechanisms underlying its pathogenesis. Moreover, there is scant evidence for the best treatment suitable for DCM patients. Decompressive surgery remains the most effective long-term treatment for this pathology, although the decision of when to perform such a procedure remains challenging. Given the fact that the aged population in the world is continuously increasing, DCM is posing a formidable challenge that needs urgent attention. Here, in this comprehensive review, we discuss the current knowledge of DCM pathology, including epidemiology, diagnosis, natural history, pathophysiology, risk factors, molecular features and treatment options. In addition to describing different scoring and classification systems used by clinicians in diagnosing DCM, we also highlight how advanced imaging techniques are being used to study the disease process. Last but not the least, we discuss several molecular underpinnings of DCM aetiology, including the cells involved and the pathways and molecules that are hallmarks of this disease.
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Affiliation(s)
- Ji Tu
- Spine Labs, St. George and Sutherland Clinical School, University of New South Wales, Kogarah, NSW 2217, Australia; (J.T.); (A.D.D.)
| | | | - Abhirup Das
- Spine Labs, St. George and Sutherland Clinical School, University of New South Wales, Kogarah, NSW 2217, Australia; (J.T.); (A.D.D.)
- Spine Service, St. George Hospital, Kogarah, NSW 2217, Australia;
- Correspondence:
| | - Ashish D. Diwan
- Spine Labs, St. George and Sutherland Clinical School, University of New South Wales, Kogarah, NSW 2217, Australia; (J.T.); (A.D.D.)
- Spine Service, St. George Hospital, Kogarah, NSW 2217, Australia;
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Sadik A, Jelley M, Ward R. Depression with psychosis following pregabalin discontinuation. PROGRESS IN NEUROLOGY AND PSYCHIATRY 2021. [DOI: 10.1002/pnp.693] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Aws Sadik
- Dr Sadik is Core Psychiatry Trainee at Avon and Wiltshire Mental Health Partnership NHS Trust
| | - Matthew Jelley
- Dr Jelley is Consultant Liaison Psychiatrist for Older People at Bath and North East Somerset Acute & Royal United Hospital A&E Acute Liaison Team, Avon and Wiltshire Mental Health Partnership NHS
| | - Rosalind Ward
- Dr Ward is Consultant Old Age Psychiatrist and Training Programme Director at Avon and Wiltshire Mental Health Partnership NHS Trust and Severn Postgraduate Medical Education School of Psychiatry
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Evaluating the impact of gabapentinoids on sleep health in patients with chronic neuropathic pain: a systematic review and meta-analysis. Pain 2021; 161:476-490. [PMID: 31693543 DOI: 10.1097/j.pain.0000000000001743] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Chronic neuropathic pain (NP) is debilitating and impacts sleep health and quality of life. Treatment with gabapentinoids (GBs) has been shown to reduce pain, but its effects on sleep health have not been systematically evaluated. The objective of this systematic review and meta-analysis was to assess the relationship between GB therapy dose and duration on sleep quality, daytime somnolence, and intensity of pain in patients with NP. Subgroup comparisons were planned for high- vs low-dose GBs, where 300 mg per day or more of pregabalin was used to classify high-dose therapy. Trial data were segregated by duration less than 6 weeks and 6 weeks or greater. Twenty randomized controlled trials were included. Primary outcome measures included pain-related sleep interference and incidence of daytime somnolence. Secondary outcomes included daily pain scores (numerical rating scale 0-10) and patient global impression of change. Significant improvement in sleep quality was observed after 6 weeks of GB treatment when compared with placebo (standardized mean difference 0.39, 95% confidence interval 0.32-0.46 P < 0.001). Increased daytime somnolence was observed among all GB-treated groups when compared with placebo. Treated patients were also more likely to report improvement of patient global impression of change scores. Pain scores decreased significantly in patients both after 6 weeks of treatment (P < 0.001) and in trials less than 6 weeks (P = 0.017) when compared with placebo. Our data demonstrate that GBs have a positive impact on sleep health, quality of life, and pain in patients with NP syndromes. However, these benefits come at the expense of daytime somnolence.
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Nielsen S, Gisev N, Leung J, Clare P, Bruno R, Lintzeris N, Larance B, Blyth F, Hall W, Cohen M, Degenhardt L, Farrell M, Campbell G. Clinical correlates and outcomes associated with pregabalin use among people prescribed opioids for chronic non-cancer pain: A five-year prospective cohort study. Br J Clin Pharmacol 2021; 87:3092-3104. [PMID: 33368473 DOI: 10.1111/bcp.14715] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 11/23/2020] [Accepted: 12/06/2020] [Indexed: 12/16/2022] Open
Abstract
AIMS Pregabalin has become widely used as an alternative to opioids in treating certain types of chronic non-cancer pain, but few studies have examined its clinical efficacy outside trials. We address this gap by examining the utilization, correlates and clinical outcomes of pregabalin use among an Australian community-based cohort of people prescribed opioids for chronic non-cancer pain. METHODS Through a five-year prospective cohort study (n = 1514) we examined associations between pregabalin use and pain severity and interference, mental health, opioid dose and past month use of ambulance and emergency department services. We used fixed-effects regression models to examine within-participant differences, and random-effects regression models to examine within- and between-participant differences in clinical outcomes. RESULTS In an analysis of cases with complete data over five-years (n = 896), the prevalence of pregabalin use ranged from 16% at cohort entry to 29% at 36- and 48-months, and 46% reported pregabalin use at any time during the five years. Pregabalin use was associated with greater pain severity and interference and greater use of high-risk opioid doses (>90 oral morphine equivalents/day). Pregabalin use was not associated with changes in mental health symptoms, ambulance or emergency department attendance in the fixed or random effects models. CONCLUSIONS Pregabalin use was common, but for most people use was not associated with clinically meaningful improvements in pain or functioning.
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Affiliation(s)
- Suzanne Nielsen
- National Drug and Alcohol Research Centre, UNSW, Sydney, Australia.,Monash Addiction Research Centre, Monash University, Melbourne, Australia
| | - Natasa Gisev
- National Drug and Alcohol Research Centre, UNSW, Sydney, Australia
| | - Janni Leung
- National Drug and Alcohol Research Centre, UNSW, Sydney, Australia.,School of Psychology, University of Queensland, Brisbane, Australia.,Centre for Education and Research on Ageing, University of Sydney, Concord Hospital, Sydney, Australia
| | - Philip Clare
- National Drug and Alcohol Research Centre, UNSW, Sydney, Australia
| | - Raimondo Bruno
- National Drug and Alcohol Research Centre, UNSW, Sydney, Australia.,School of Medicine, University of Tasmania, Australia
| | - Nicholas Lintzeris
- The Langton Centre, South East Sydney Local Health District (SESLHD) Drug and Alcohol Services, Sydney, Australia.,Discipline of Addiction Medicine, University of Sydney, Sydney, Australia
| | - Briony Larance
- National Drug and Alcohol Research Centre, UNSW, Sydney, Australia.,School of Psychology, University of Wollongong, Wollongong, Australia.,Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, Australia
| | - Fiona Blyth
- Centre for Education and Research on Ageing, University of Sydney, Concord Hospital, Sydney, Australia
| | - Wayne Hall
- Centre for Youth Substance Abuse Research, University of Queensland, Brisbane, Australia
| | - Milton Cohen
- St Vincent's Clinical School, Faculty of Medicine, UNSW, Sydney, Australia
| | | | - Michael Farrell
- National Drug and Alcohol Research Centre, UNSW, Sydney, Australia
| | - Gabrielle Campbell
- National Drug and Alcohol Research Centre, UNSW, Sydney, Australia.,School of Health and Sport Sciences, University of the Sunshine Coast, Sunshine Coast, Australia
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Efficacy and Safety of the Controlled-release Pregabalin Tablet (GLA5PR GLARS-NF1) and Immediate-release Pregabalin Capsule for Peripheral Neuropathic Pain: A Multicenter, Randomized, Double-blind, Parallel-group, Active-controlled, Phase III Clinical Trial. Clin Ther 2020; 42:2266-2279. [PMID: 33272643 DOI: 10.1016/j.clinthera.2020.10.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 10/15/2020] [Accepted: 10/21/2020] [Indexed: 01/10/2023]
Abstract
PURPOSE This study compared the efficacy and safety of controlled-release pregabalin (GLA5PR GLARS-NF1 tablets) with those of an immediate-release pregabalin capsule after 12 weeks' administration to patients with peripheral neuropathic pain. METHODS In this multicenter, randomized, double-blind, active-controlled, parallel-group, Phase III study, the primary outcome was to confirm that a single treatment with the study drug (after the evening meal) is clinically noninferior to the control drug (BID regimen) at improving the mean Daily Pain Rating Scale score for treating peripheral neuropathic pain. Secondary outcomes were the Daily Sleep Interference Scale, Medical Outcomes Study Sleep Scale, Hospital Anxiety and Depression scale, and frequency of rescue medication use. The safety and tolerability of GLA5PR GLARS-NF1 tablets were also evaluated. The total daily dose of pregabalin is 150-600 mg. FINDINGS Of the 352 randomized subjects, 261 (n = 130, study group; n = 131, control group) were analyzed. The difference in adjusted mean Daily Pain Rating Scale scores between the groups was -0.11 (95% confidence interval, -0.05 to 0.30), indicating that the study group is noninferior to the control group. There was no statistically significant difference in Daily Sleep Interference Scale, Medical Outcomes Study Sleep Scale, and Hospital Anxiety and Depression scale scores between the groups at treatment termination. Logistic regression analysis revealed no significant difference in the use of rescue medication between the groups (P = 0.217). The overall adverse event profile of the groups was similar, and no serious adverse drug reactions were observed. IMPLICATIONS GLA5PR GLARS-NF1 tablets can be effectively and safely administered to patients with peripheral neuropathic pain. Furthermore, we found that sleep, anxiety, and depression were improved with pain control. Owing to the once-daily administration, treatment effects can be maximized by improved treatment compliance. ClinicalTrials.gov identifier: NCT03221907.
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45
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Pharmacotherapy for Small Fiber Neuropathy. Curr Treat Options Neurol 2020. [DOI: 10.1007/s11940-020-00652-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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46
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Huygen F, Kern KU, Pérez C. Expert Opinion: Exploring the Effectiveness and Tolerability of Capsaicin 179 mg Cutaneous Patch and Pregabalin in the Treatment of Peripheral Neuropathic Pain. J Pain Res 2020; 13:2585-2597. [PMID: 33116801 PMCID: PMC7569173 DOI: 10.2147/jpr.s263054] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Accepted: 07/31/2020] [Indexed: 11/23/2022] Open
Abstract
Background and Objective Treatment of peripheral neuropathic pain (PNP) remains a challenge. In the absence of clear predictors of response, clinical decision-making involves trial and error. While many classes of pharmacological agent are used and have shown efficacy, one of the most commonly used first-line treatments is pregabalin. However, in the 60% of PNP cases in which the pain is localized, a local treatment may be more suitable. This article will summarize the evidence for the relative effectiveness and tolerability of the capsaicin 179 mg patch and pregabalin in the treatment of PNP and highlight the expert opinion of the authors based on their own clinical experiences. Results When compared in a head-to-head trial in patients with PNP, capsaicin 179 mg patch provided non-inferior pain relief compared with an optimized dose of pregabalin, as well as a reduction in dynamic mechanical allodynia, faster onset of action, fewer systemic side effects, and greater treatment satisfaction. Adverse events associated with capsaicin patch are mainly application site reactions, compared with systemic and central nervous system effects with pregabalin. Studies indicate that capsaicin 179 mg patch is associated with a lower burden of therapy than pregabalin in terms of improved tolerability, lack of a daily pill burden, lack of drug-drug interactions, and increased regimen flexibility. Conclusion In localized neuropathic pain, evidence supports a pragmatic approach of using a local treatment before considering a systemic treatment. For treatment selection, the patient profile (eg, concomitant medication use, age) and the treatments' efficacy and tolerability profiles should be considered.
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Affiliation(s)
- Frank Huygen
- Department of Anesthesiology, Erasmus University Medical Centre, Rotterdam, the Netherlands
| | - Kai-Uwe Kern
- Institute for Pain Medicine/Pain Practice Wiesbaden, Wiesbaden, Germany
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Zhu C, Liu N, Tian M, Ma L, Yang J, Lan X, Ma H, Niu J, Yu J. Effects of alkaloids on peripheral neuropathic pain: a review. Chin Med 2020; 15:106. [PMID: 33024448 PMCID: PMC7532100 DOI: 10.1186/s13020-020-00387-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Accepted: 09/20/2020] [Indexed: 12/16/2022] Open
Abstract
Neuropathic pain is a debilitating pathological pain condition with a great therapeutic challenge in clinical practice. Currently used analgesics produce deleterious side effects. Therefore, it is necessary to investigate alternative medicines for neuropathic pain. Chinese herbal medicines have been widely used in treating intractable pain. Compelling evidence revealed that the bioactive alkaloids of Chinese herbal medicines stand out in developing novel drugs for neuropathic pain due to multiple targets and satisfactory efficacy. In this review, we summarize the recent progress in the research of analgesic effects of 20 alkaloids components for peripheral neuropathic pain and highlight the potential underlying molecular mechanisms. We also point out the opportunities and challenges of the current studies and shed light on further in-depth pharmacological and toxicological studies of these bioactive alkaloids. In conclusion, the alkaloids hold broad prospects and have the potentials to be novel drugs for treating neuropathic pain. This review provides a theoretical basis for further applying some alkaloids in clinical trials and developing new drugs of neuropathic pain.
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Affiliation(s)
- Chunhao Zhu
- Department of Pharmacology, College of Pharmacy, Ningxia Medical University, No. 1160 Shengli Street, Yinchuan, 750004 Ningxia China
| | - Ning Liu
- Department of Pharmacology, College of Pharmacy, Ningxia Medical University, No. 1160 Shengli Street, Yinchuan, 750004 Ningxia China.,Ningxia Collaborative Innovation Center of Regional Characteristic Traditional Chinese Medicine, Ningxia Medical University, No. 692 Shengli Street, Yinchuan, 750004 Ningxia China
| | - Miaomiao Tian
- Department of Pharmacology, College of Pharmacy, Ningxia Medical University, No. 1160 Shengli Street, Yinchuan, 750004 Ningxia China
| | - Lin Ma
- Ningxia Key Laboratory of Craniocerebral Diseases of Ningxia Hui Autonomous Region, Ningxia Medical University, No. 1160 Shengli Street, Yinchuan, 750004 Ningxia China
| | - Jiamei Yang
- Department of Pharmacology, College of Pharmacy, Ningxia Medical University, No. 1160 Shengli Street, Yinchuan, 750004 Ningxia China.,Ningxia Collaborative Innovation Center of Regional Characteristic Traditional Chinese Medicine, Ningxia Medical University, No. 692 Shengli Street, Yinchuan, 750004 Ningxia China
| | - Xiaobing Lan
- Department of Pharmacology, College of Pharmacy, Ningxia Medical University, No. 1160 Shengli Street, Yinchuan, 750004 Ningxia China.,Ningxia Collaborative Innovation Center of Regional Characteristic Traditional Chinese Medicine, Ningxia Medical University, No. 692 Shengli Street, Yinchuan, 750004 Ningxia China
| | - Hanxiang Ma
- Department of Anesthesiology, General Hospital of Ningxia Medical University, No. 804 Shengli Street, Yinchuan, Ningxia Hui Autonomous Region, 750004 Ningxia China
| | - Jianguo Niu
- Ningxia Key Laboratory of Craniocerebral Diseases of Ningxia Hui Autonomous Region, Ningxia Medical University, No. 1160 Shengli Street, Yinchuan, 750004 Ningxia China
| | - Jianqiang Yu
- Department of Pharmacology, College of Pharmacy, Ningxia Medical University, No. 1160 Shengli Street, Yinchuan, 750004 Ningxia China.,Ningxia Collaborative Innovation Center of Regional Characteristic Traditional Chinese Medicine, Ningxia Medical University, No. 692 Shengli Street, Yinchuan, 750004 Ningxia China.,Ningxia Key Laboratory of Craniocerebral Diseases of Ningxia Hui Autonomous Region, Ningxia Medical University, No. 1160 Shengli Street, Yinchuan, 750004 Ningxia China
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Chye A, Lin CWC, Hancock MJ, Harris I, Latimer J, Maher CG, McLachlan AJ, Mathieson S, Koes B, Day RO, Billot L, Jan S, Angell B. Healthcare expenditure and its predictors in a cohort of Australians living with sciatica. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2020; 30:878-885. [PMID: 32970236 DOI: 10.1007/s00586-020-06605-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Revised: 09/03/2020] [Accepted: 09/12/2020] [Indexed: 11/25/2022]
Abstract
PURPOSE To estimate the healthcare resource utilisation of an Australian cohort of people with sciatica and explore individual-level factors associated with expenditure. METHODS Healthcare utilisation (services and medication) data from a randomised, double-blind, placebo-controlled trial of pregabalin in patients with sciatica (n = 185) were analysed to estimate healthcare expenditure of participants over 12 months. Associations between key baseline socio-economic, pain and quality of life characteristics and healthcare expenditure were examined using generalised linear imputation models. RESULTS On average, participants accessed AUD$1,134 of healthcare over the year, predominantly made up of $114 of medication and $914 of health services, which included $418 of physiotherapy services. Participants randomised to receive pregabalin incurred higher expenditure ($1,263 compared to $1,001 for placebo), which was largely driven by pregabalin ($158) and greater health services ($107). Healthcare expenditure was significantly higher for participants prescribed pregabalin, earning greater than $1,700 per week ($88,400 per year) and reporting poorer quality of life (physical and mental). CONCLUSION Our results suggest inefficiency in the use of healthcare resources due to increased healthcare resource utilisation in people with sciatica treated with pregabalin, compared to placebo. Costs of treating sciatica varied based on individual quality of life and socio-economic characteristics.
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Affiliation(s)
- Alexander Chye
- The George Institute for Global Health, University of New South Wales, Level 5, 1 King Street, Newtown, Sydney, 2041, Australia.
| | - Chung-Wei Christine Lin
- The Institute for Musculoskeletal Health, Sydney, Australia.,Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Mark J Hancock
- Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, Australia
| | - Ian Harris
- South Western Sydney Clinical School, University of New South Wales, Sydney, Australia
| | - Jane Latimer
- The Institute for Musculoskeletal Health, Sydney, Australia.,Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Christopher G Maher
- The Institute for Musculoskeletal Health, Sydney, Australia.,Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | | | - Stephanie Mathieson
- The Institute for Musculoskeletal Health, Sydney, Australia.,Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Bart Koes
- Department of General Practice, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands.,Center for Muscle and Joint Health, University of Southern Denmark, Odense, Denmark
| | - Richard O Day
- St Vincent's Clinical School, Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Laurent Billot
- The George Institute for Global Health, University of New South Wales, Level 5, 1 King Street, Newtown, Sydney, 2041, Australia
| | - Stephen Jan
- The George Institute for Global Health, University of New South Wales, Level 5, 1 King Street, Newtown, Sydney, 2041, Australia
| | - Blake Angell
- The George Institute for Global Health, University of New South Wales, Level 5, 1 King Street, Newtown, Sydney, 2041, Australia
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Kohli D, Katzmann G, Ananthan S. Glossopharyngeal neuropathy: A case report. J Am Dent Assoc 2020; 152:245-249. [PMID: 32900465 DOI: 10.1016/j.esmoop.2020.04.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Accepted: 04/15/2020] [Indexed: 11/19/2022]
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50
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Lund M, Poulsen G, Pasternak B, Worm Andersson N, Melbye M, Svanström H. Use of Pregabalin and Worsening Heart Failure: A Nationwide Cohort Study. Drug Saf 2020; 43:1035-1044. [PMID: 32651945 DOI: 10.1007/s40264-020-00969-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Concerns regarding the increased risk of worsening heart failure with pregabalin have been raised. We assessed the association between use of pregabalin and risk of worsening heart failure in routine clinical practice. METHODS We conducted a population-based cohort study in Denmark using data from nationwide registers, from 1 January 2008 to 31 December 2017. The study population consisted of patients 50 years of age or older with a diagnosis of heart failure who were new users of pregabalin or gabapentin (active comparator). We matched a total of 1395 new users of pregabalin to 1395 new users of gabapentin on a propensity score based on 55 covariates. Using proportional hazards regression, we estimated hazard ratios (HRs) for worsening heart failure (hospitalization with, or death from, heart failure) within 90 days of the start of treatment. RESULTS We observed 33 patients with worsening heart failure among users of pregabalin [incidence rate (IR) 105.7 per 1000 person-years] versus 43 patients among users of gabapentin (IR 133.8 per 1000 person-years), corresponding to an HR of 0.79 [95% confidence interval (CI) 0.50-1.23]. The corresponding absolute risk difference was - 28.6 (95% CI - 66.8 to 31.3) per 1000 person-years. In sensitivity analysis using duloxetine as an alternative active comparator, including 847 new users of pregabalin and 847 new users of duloxetine, the results were similar (HR 1.08, 95% CI 0.60-1.94). CONCLUSIONS The present study found no evidence to support an association between the use of pregabalin and increased risk of worsening heart failure, compared with gabapentin and duloxetine.
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Affiliation(s)
- Marie Lund
- Department of Epidemiology Research, Statens Serum Institut, Artillerivej 5, 2300, Copenhagen S, Denmark. .,Department of Clinical Pharmacology, Bispebjerg and Frederiksberg Hospitals, Copenhagen NV, Denmark.
| | - Gry Poulsen
- Department of Epidemiology Research, Statens Serum Institut, Artillerivej 5, 2300, Copenhagen S, Denmark
| | - Björn Pasternak
- Department of Epidemiology Research, Statens Serum Institut, Artillerivej 5, 2300, Copenhagen S, Denmark.,Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Niklas Worm Andersson
- Department of Epidemiology Research, Statens Serum Institut, Artillerivej 5, 2300, Copenhagen S, Denmark.,Department of Clinical Pharmacology, Bispebjerg and Frederiksberg Hospitals, Copenhagen NV, Denmark
| | - Mads Melbye
- Department of Epidemiology Research, Statens Serum Institut, Artillerivej 5, 2300, Copenhagen S, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen N, Denmark.,Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Henrik Svanström
- Department of Epidemiology Research, Statens Serum Institut, Artillerivej 5, 2300, Copenhagen S, Denmark.,Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
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