A Review of Pregabalin for the Treatment of Peripheral and Central Neuropathic Pain and Its Place in the Treatment of Chronic Pain

Abstract

Pregabalin is an α2-δ ligand indicated for the treatment of peripheral and central neuropathic pain. In this article, we will review the pharmacodynamics, pharmacokinetics, randomized clinical trials supporting its efficacy for a wide array of neuropathic painful conditions, and the tolerability of this medication. We will comment the main differences with gabapentin, its parent compound, both from the pharmacological and clinical perspective. Our experience in the clinical practice setting with pregabalin, its use in patients with refractory neuropathic pain and its rational use in combination regimens will also be reviewed. With all this information in mind, the place of pregabalin in the pharmacotherapy of neuropathic pain is explored, mainly through the review of recent clinical guidelines which, in fact, place pregabalin among the first-line treatments for the management of most neuropathic painful conditions.

Add-On Treatment with Pregabalin for Patients with Uncontrolled Neuropathic Pain Who Have Been Referred to Pain Clinics

“…Relevant improvements in anxiety, depression, subjective sleep quality, and quality of life were observed after treatment with add-on pregabalin. This improvement in other dimensions of neuropathic pain is consistent with what it is known from randomized clinical trials in patients with neuropathic pain [9] and from previous studies on patients with refractory neuropathic pain [12, 14, 17, 40]. …”

“…Whether this higher score reflects a worse clinical condition or a greater neuropathic component of the pain is impossible to answer. Pregabalin has consistently been demonstrated, in several randomized clinical trials, to be effective for the treatment of painful diabetic neuropathy, and in fact is considered a first-line option for the treatment of this condition in most clinical guidelines [9]. Central neuropathic pain is very disabling and difficult to treat, and only a few drugs in a few studies have shown positive results for this condition [9].…”

“…Pregabalin has consistently been demonstrated, in several randomized clinical trials, to be effective for the treatment of painful diabetic neuropathy, and in fact is considered a first-line option for the treatment of this condition in most clinical guidelines [9]. Central neuropathic pain is very disabling and difficult to treat, and only a few drugs in a few studies have shown positive results for this condition [9]. Pregabalin has been shown to be significantly more effective than placebo in three of the four studies carried out in patients with central neuropathic pain [9], including a recent trial in patients with neuropathic pain secondary to spinal cord injury [41].…”

“…Central neuropathic pain is very disabling and difficult to treat, and only a few drugs in a few studies have shown positive results for this condition [9]. Pregabalin has been shown to be significantly more effective than placebo in three of the four studies carried out in patients with central neuropathic pain [9], including a recent trial in patients with neuropathic pain secondary to spinal cord injury [41]. However, whereas the response rates in these studies were 22 % and 35%, the response rates in randomized trials of pregabalin in painful diabetic neuropathy were usually over 45 % [9].…”

“…Pregabalin is an α2-δ ligand that, in randomized controlled trials, has been demonstrated to be effective for the treatment of several peripheral or central neuropathic painful conditions such as diabetic neuropathy, postherpetic neuralgia, trigeminal neuralgia, and the central neuropathic pain associated with spinal cord injury, among others [9]. Several non-randomized studies have evaluated the impact of pregabalin for the treatment of refractory neuropathic pain [10–18]; however, these studies were carried out in a primary care setting [10, 11, 13, 14], were focused on specific clinical entities [10, 12, 17], specifically evaluated patients refractory to gabapentin [13, 14], and/or used an economic model for the evaluation [15, 16].…”