Gabapentin for the Symptomatic Treatment of Painful Neuropathy in Patients With Diabetes Mellitus: a Randomized Controlled Trial

Bačkonja, Miroslav; Beydoun, Ahmad; Edwards, Keith R.; Schwartz, Sherwyn; Fonseca, Vivian; Hes, Marykay; Moreaux, Linda La; Garofalo, Elizabeth

doi:10.1097/00132586-199908000-00055

Cited by 498 publications

(685 citation statements)

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“…1,2,37 This fact is Clin J Pain Volume 00, Number 00, '' [40][41][42] Even for treating neuropathic pain in general, only a recent study associating GBP and morphine applied to patients with diabetic neuropathy and postherpetic neuralgia is worth mentioning owing to the significant reduction of daily pain intensity measured by the VAS scale and McGill Pain Questionnaire. 40 Complementary mechanisms associated with the local analgesic action of ROP and GBP may be at the basis for the strong pain reduction resulting from the association of both therapies in Protocol III.…”

Section: Potential Mechanisms Mediating Gbp+rop Therapeutic Associationmentioning

confidence: 99%

Gabapentin Supplemented With Ropivacain Block of Trigger Points Improves Pain Control and Quality of Life in Trigeminal Neuralgia Patients When Compared With Gabapentin Alone

Lemos¹,

Flores²,

Oliveira

et al. 2008

The Clinical Journal of Pain

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Objective: Pain control in trigeminal neuralgia (TN) is achieved using anticonvulsivants, mainly carbamazepine. When this drug cannot be used, other drugs like gabapentin (GBP) have been used to provide adequate pain control. To improve the therapeutic effect of GBP, we evaluated the clinical efficacy of associating GBP with ropivacain (ROP) analgesic block of facial trigger points in TN patients.Design: Thirty-six TN patients were randomly assigned during 4 weeks to 1 of the following protocols: Protocol I-daily oral GBP administered in a titrated dose; Protocol II-ROP applied as analgesic block to TN trigger points once a week; Protocol III-daily oral GBP plus ROP once a week. Protocol II had to be discontinued in 7/12 patients owing to insufficient pain control. Pain intensity was evaluated by the Visual Analog Scale (VAS) and disability was assessed by Sickness Impact Profile.Results: When compared with Protocol I, Protocol III (GBP+ROP) patients showed (1) a reduction of VAS score after 7 and 28 days of treatment, an effect that was still present 6 and 12 months later; (2) a faster reduction of VAS score using a significantly lower dose of GBP; (3) a smaller total and daily GBP dose at the end of the treatment, which resulted in a total absence of adverse side effects; and (4) an improvement of the functional well-being measured by the Sickness Impact Profile. The number needed to treat (NNT) (GBP+ROP vs. GBP protocols) to obtain 1 GBP+ROP-treated patient with at least 50% pain relief was 1.71 (day 7) and 2.40 (day 28). Conclusions:The association of GBP and ROP is safe, without side effects and results in an important clinical benefit associated to an improvement of the functional health status of TN patients when compared with GBP alone. This may constitute a therapeutic alternative for pain control in TN patients who cannot be treated with carbamazepine.

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Section: Potential Mechanisms Mediating Gbp+rop Therapeutic Associationmentioning

confidence: 99%

Gabapentin Supplemented With Ropivacain Block of Trigger Points Improves Pain Control and Quality of Life in Trigeminal Neuralgia Patients When Compared With Gabapentin Alone

Lemos¹,

Flores²,

Oliveira

et al. 2008

The Clinical Journal of Pain

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“…91 Evidence also supports use of gabapentin in painful diabetic neuropathy, complex regional pain syndrome, migraine headache, spinal cord injury, phantom limb, and other neuropathic pain syndromes. [92][93][94][95] The efficacy and safety of this medication for various neuropathic pain states has led to its widespread use in a number of non-neuropathic pain states as well; however, in general gabapentin has not been as effective in these disorders. For example, a single dose of gabapentin (1200 mg) or placebo was administered to individuals before mastectomy surgery.…”

Section: Gabapentinmentioning

confidence: 99%

Use of Antiepileptic Drugs for Nonepileptic Conditions: Psychiatric Disorders and Chronic Pain

2007

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Summary: Antiepileptic drugs (AEDs) are commonly utilized for nonepileptic conditions, including various psychiatric disorders and pain syndromes. Evidence for their benefit in these nonepileptic conditions varies widely among different drugs, but there is, in general, a paucity of published multicenter randomized double-blind trials. Variable levels of evidence suggest that lamotrigine and the vagal nerve stimulator have antidepressant properties. Carbamazepine, valproate, lamotrigine, and oxcarbazepine appear to have mood stabilizing properties while gabapentin, pregabalin, and tiagabine have anxiolytic benefits. Barbiturates, topiramate, and possibly phenytoin may precipitate or exacerbate depression. Underlying depression and anxiety symptoms may be exacerbated by levetiracetam, while psychotic symptoms have rarely been reported with topiramate, levetiracetam, and zonisamide. Pregabalin, gabapentin, carbamazepine, and oxcarbazepine have been used to treat neuropathic pain such as postherpetic neuralgia, and diabetic polyneuropathy. Topiramate and divalproex sodium have utility in the prophylaxis or acute treatment of migraine. Further rigorous studies are needed to clarify the utility of AEDs in nonepileptic conditions.

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“…Recent preclinical studies suggest a role for the ␣ 2 ␦ subunit in neuropathic pain processing. Gabapentin, an anticonvulsant drug found to be effective against clinical neuropathic pain states (Mellick et al, 1995;Rosner et al, 1996;Mellick and Mellick, 1997;Rosenberg et al, 1997;Backonja et al, 1998;Rowbotham et al, 1998), also exerts a spinal action in preclinical neuropathic pain models (Hwang and Yaksh, 1997;Abdi et al, 1998) and yet lacks general analgesic properties (Field et al, 1997). Gabapentin binds with high affinity to the ␣ 2 ␦ subunit in vitro (Gee et al, 1996).…”

mentioning

confidence: 99%

Upregulation of Dorsal Root Ganglion α₂δ Calcium Channel Subunit and Its Correlation with Allodynia in Spinal Nerve-Injured Rats

et al. 2001

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Peripheral nerve injury can lead to a persistent neuropathic pain state in which innocuous tactile stimulation elicits pain behavior (tactile allodynia). Spinal administration of the anticonvulsant gabapentin suppresses allodynia by an unknown mechanism. In vitro studies indicate that gabapentin binds to the ␣ 2 ␦-1 (hereafter referred to as ␣ 2 ␦) subunit of voltage-gated calcium channels. We hypothesized that nerve injury may result in altered ␣ 2 ␦ subunit expression in spinal cord and dorsal root ganglia (DRGs) and that this change may play a role in neuropathic pain processing. Using a rat neuropathic pain model in which gabapentin-sensitive tactile allodynia develops after tight ligation of the left fifth and sixth lumbar spinal nerves, we found a Ͼ17-fold, time-dependent increase in ␣ 2 ␦ subunit expression in DRGs ipsilateral to the nerve injury. Marked ␣ 2 ␦ subunit upregulation was also evident in rats with unilateral sciatic nerve crush, but not dorsal rhizotomy, indicating a peripheral origin of the expression regulation. The increased ␣ 2 ␦ subunit expression preceded the allodynia onset and diminished in rats recovering from tactile allodynia. RNase protection experiments indicated that the DRG ␣ 2 ␦ regulation was at the mRNA level. In contrast, calcium channel ␣ 1B and ␤ 3 subunit expression was not co-upregulated with the ␣ 2 ␦ subunit after nerve injury. These data suggest that DRG ␣ 2 ␦ regulation may play an unique role in neuroplasticity after peripheral nerve injury that may contribute to allodynia development. Key words: ␣ 2 ␦ calcium channel subunit; peripheral nerve injury; rhizotomy; allodynia; dorsal root ganglia; spinal cord; sensory neuronsPeripheral nerve injury may lead to neuropathic syndromes characterized by both spontaneous and evoked painful sensations. Allodynia, or an exaggerated response to otherwise innocuous tactile stimuli, is considered both a hallmark and the most troublesome of these syndromes (Price et al., 1989;Wahren and Torebjork, 1992;Koltzenburg et al., 1994). The molecular mechanisms of neuropathic pain states are not clear. It has been hypothesized that disordered sensory processing arises from long-term changes in the function of sensory afferents and the organization of sensory input into the dorsal horn (Coderre et al., 1993;Woolf and Doubell, 1994).Pharmacological evidence suggests that spinal N-type voltagegated calcium channels (N-VGCCs) play a role in neuropathic pain transduction. Intrathecal delivery of N-type ( -conopeptides), but not L-or P-type, VGCC antagonists suppresses allodynia in neuropathic rat models (Chaplan et al., 1994b;Calcutt and Chaplan, 1997). Autoradiographic studies showed the highest density of conopeptide-binding sites in the spinal dorsal horn (lamina I and II) where primary afferents terminate (Kerr et al., 1988;Takemura et al., 1989). N-VGCCs are also found in dorsal root ganglion (DRG) neurons where they are differentially modulated after sciatic nerve damage (Abdulla and Smith, 1997).High-threshold neuronal VGCCs contain thr...

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Gabapentin for the Symptomatic Treatment of Painful Neuropathy in Patients With Diabetes Mellitus: a Randomized Controlled Trial

Cited by 498 publications

References 0 publications

Gabapentin Supplemented With Ropivacain Block of Trigger Points Improves Pain Control and Quality of Life in Trigeminal Neuralgia Patients When Compared With Gabapentin Alone

Gabapentin Supplemented With Ropivacain Block of Trigger Points Improves Pain Control and Quality of Life in Trigeminal Neuralgia Patients When Compared With Gabapentin Alone

Use of Antiepileptic Drugs for Nonepileptic Conditions: Psychiatric Disorders and Chronic Pain

Upregulation of Dorsal Root Ganglion α₂δ Calcium Channel Subunit and Its Correlation with Allodynia in Spinal Nerve-Injured Rats

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Gabapentin for the Symptomatic Treatment of Painful Neuropathy in Patients With Diabetes Mellitus: a Randomized Controlled Trial

Cited by 498 publications

References 0 publications

Gabapentin Supplemented With Ropivacain Block of Trigger Points Improves Pain Control and Quality of Life in Trigeminal Neuralgia Patients When Compared With Gabapentin Alone

Gabapentin Supplemented With Ropivacain Block of Trigger Points Improves Pain Control and Quality of Life in Trigeminal Neuralgia Patients When Compared With Gabapentin Alone

Use of Antiepileptic Drugs for Nonepileptic Conditions: Psychiatric Disorders and Chronic Pain

Upregulation of Dorsal Root Ganglion α2δ Calcium Channel Subunit and Its Correlation with Allodynia in Spinal Nerve-Injured Rats

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Upregulation of Dorsal Root Ganglion α₂δ Calcium Channel Subunit and Its Correlation with Allodynia in Spinal Nerve-Injured Rats