Patient Compliance With SSRIs and Gabapentin in Painful Diabetic Neuropathy

Giannopoulos, Sotirios; Kosmidou, Maria; Sarmas, Ioannis; Markoula, Sofia; Pelidou, Sygkliti-Henrietta; Lagos, Georgios; Kyritsis, Athanassios P.

doi:10.1097/ajp.0b013e31802fc14a

Cited by 28 publications

(30 citation statements)

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“…Future research should therefore investigate determinants of underuse and overuse non-adherence separately. Overuse of medication was not taken into account in the study of Giannopoulos et al (2007). Our own research (Broekmans et al, unpublished results) showed that irrespective of pain diagnosis, these two types of non adherence are present.…”

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confidence: 99%

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Medication adherence in patients with chronic non‐malignant pain: Is there a problem?

Broekmans

Dobbels

Milisen

et al. 2009

European Journal of Pain

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Kosmidou and colleagues made a constructive contribution to our review (Broekmans et al., 2009). They added three additional issues to consider, when studying adherence with analgesic treatment. First, how do we define adherence and compliance to treatment? Second, are adherence and compliance numeric or qualitative factors? And finally, there are no studies focusing on neuropathic pain, a common cause of chronic non-malignant pain.The authors underline once more an important gap in the adherence literature: how much adherence is needed in patients suffering chronic non-malignant pain? Until now, no evidence is available to support a specific cut off percentage of adherence. There are no studies on how adherent patients have to be to ensure positive outcomes. Giannopoulos et al. (2007) used a cut off of 75% to define adherence: patients taking less than 75% of their medication were considered non-adherent. However, the authors did not report on outcome differences between adherent and non-adherent patients. Hence, evidence supporting the choice of this cutoff is currently lacking. Prospective studies are needed to provide evidence on the relationship between adherence and clinical outcome. At the moment, there is no evidence in a chronic pain population supporting the cut off of 75%. In other populations, where adherence is of the utmost importance (e.g. patients prescribed antiretroviral therapy) a 75% cut off would be regarded as excessively low.A second major finding of our review was that in patients with chronic non-malignant pain, two different types of medication non-adherence emerge: underuse and overuse. It can be expected that underusers and overusers do have a different profile. Future research should therefore investigate determinants of underuse and overuse non-adherence separately. Overuse of medication was not taken into account in the study of Giannopoulos et al. (2007). Our own research (Broekmans et al., unpublished results) showed that irrespective of pain diagnosis, these two types of non adherence are present. Among patients suffering from neuropathic pain, 31-48% is underusing their pain medication; 4-20% of these patients are overusing pain medication. These percentages do not differ significantly from the under-or overuse prevalence in other chronic pain diagnoses (e.g. low back pain, fibromyalgia). We agree with Giannopoulos et al. that adherence in chronic pain patients should take into account the type of pain (e.g., neuropathic versus nociceptive) and the type of pain medication (e.g. typical versus atypical analgesics).In conclusion, there is need for prospective adherence research in chronic non-malignant pain populations to determine an adequate level of adherence with regard to outcome. Both overuse and underuse of pain medication should be assessed, as well as different types of chronic pain and pain medications.

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confidence: 99%

“…There are no studies on how adherent patients have to be to ensure positive outcomes. Giannopoulos et al (2007) used a cut off of 75% to define adherence: patients taking less than 75% of their medication were considered non-adherent. However, the authors did not report on outcome differences between adherent and non-adherent patients.…”

mentioning

confidence: 99%

Medication adherence in patients with chronic non‐malignant pain: Is there a problem?

Broekmans

Dobbels

Milisen

et al. 2009

European Journal of Pain

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“…(51). Similarmente, tantos as DAE tradicionais como as de nova geração têm sido utilizadas na neuropatia diabética, que atinge de 40% a 50% dos pacientes com diabetes melito em algum momento da evolução da doença (51)(52)(53). Nos quadros sintomáticos, as DAE constituem uma boa opção terapêutica, frequentemente associadas aos antidepressivos tricíclicos, que são as drogas de primeira linha na abordagem da neuropatia diabética.…”

Section: Dae E Função Tireoideanaunclassified

“…Ela é geralmente bem tolerada e apresenta bons resultados, os quais podem ser aumentados quando em associação com a amitriptilina (51)(52)(53)56). Inicia-se o tratamento com a dose de 300 mg/dia e aumenta-se semanalmente até atingir uma dosagem entre 900 e 1800 mg, fracionada em três administrações.…”

Section: Dae E Função Tireoideanaunclassified

Efeitos endócrinos e metabólicos das drogas antiepilépticas

Bortolini

Kulak

Borba

et al. 2009

Arq Bras Endocrinol Metab

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RESUMOAs drogas antiepilépticas (DAE) são utilizadas por um enorme contingente de pessoas em todo o mundo -tanto no tratamento das epilepsias como para outros fins -frequentemente por um longo tempo. Por essas razões, torna-se fundamental o conhecimento sobre os potenciais efeitos adversos desses medicamentos, muitos deles envolvendo vários aspectos hormonais e metabólicos que devem ser do conhecimento do endocrinologista. Nesta revisão, foi abordada a relação das DAE com anormalidades no metabolismo mineral ósseo, balanço energético e peso corporal, eixo gonadal e função tireoideana, além de ter sido revisado o papel terapêutico dessas medicações no tratamento da neuropatia diabética. Arq Bras Endocrinol Metab. 2009;53(7):795-803.Descritores Drogas antiepilépticas; epilepsia; metabolismo mineral ósseo; obesidade; disfunção gonadal; disfunção tireoideana. ABSTRACTThe antiepileptic drugs (AED) have been widely used for a great deal of people -in the treatment of epilepsy and other diseases -throughout the world. Continuous and prolonged use of AED may be associated with adverse effects in different systems, including a variety of endocrine and metabolic abnormalities. In this review, the relationship of AED with alterations in bone mineral metabolism, energy balance and body weight, gonadal function and thyroid metabolism was revised, as well as their clinical utility in the treatment of diabetic neuropathy. INTRODUÇÃO A s drogas antiepilépticas (DAE) são utilizadas no tratamento da epilepsia desde 1857, quando Locock usou sal de brometo com resultados positivos em mulheres com epilepsia catamenial (1). Desde então, inúmeros medicamentos foram introduzidos na prática clínica para o tratamento dos mais diversos tipos de epilepsia, uma doença crônica comum que atinge homens e mulheres em todas as faixas etárias, com incidência anual de 43 casos por 100 mil habitantes em países indus trializados e o dobro em países em desenvolvimento (2). No Brasil, a prevalência encontrada tem variado de 0,4% a 0,8% da população (3). Além do clássico uso para tratamento da epilepsia, as várias ações das DAE resultaram em uma ampliação de seu uso terapêutico e, hoje, elas são empregadas tanto no controle de desordens psiquiátricas, como ansiedade, esquizofrenia e transtorno bipolar, como em distúrbios neurológicos diversos, incluin do tremor essencial, cefaleia e dores neuropáticas (4). Em caráter experimental, as DAE têm sido testadas em pacientes com câncer e infecção por HIV, no tratamento para o abuso de drogas e álcool e, também, como agentes neuroprotetores (4).Os principais mecanismos de ação das DAE mais utilizadas incluem bloqueio dos canais de sódio ou de cálcio dependentes de voltagem, aumento da inibição mediada por GABA e bloqueio ao glutamato (5). A fenitoína, o fenobarbital e a carbamazepina são metabolizados por via hepática por meio do citocromo P450 ("drogas indutoras hepáticas"), ao passo que a enzima hepática uridina difosfato glucuronosil transferase (UGP) é responsável pela metabolização do valproato

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“…Several studies have shown that Selective Serotonin Reuptake Inhibitors (SSRIs) also have potential analgesic effects, but this effect is lower than that of the TCAs (Giannopoulos et al, 2007;Varia et al, 2000). Because they are associated with fewer side effects however, they have recently started to replace TCAs in the treatment of chronic pain (Miller and Rabe-Jablonska, 2005).…”

Section: Introductionmentioning

confidence: 99%

Mirtazapine in Veterinary Medicine a Pharmacological Rationale for its Application in Chronic Pain

Saleh¹

2012

American Journal of Animal and Veterinary Sciences

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Problem statement:Many recent studies have shown that antidepressant agents have analgesic effects in addition to their intended primary actions. The Tricyclic Antidepressants (TCAs) have been recognized as an effective first-line treatment of human neuropathic pain but unfortunately they display a wide range of side effects. Recent studies have shown that Selective Serotonin Reuptake Inhibitors (SSRI) also have potential analgesic effects, albeit of a lower potency compared with the TCAs. Despite this, there is a trend for their increased use, in place of TCAs, in the treatment of chronic pain. Mirtazapine, a SSRI has been recently investigated in the context of veterinary medicine. It has shown favourable pharmacokinetic profiles. Despite the fact that it has mainly been used for anorexia and as an antiemetic for veterinary patients thus far, it could be potentially useful for the treatment of a wide range of anxiety-related conditions and as an analgesic in chronic and cancerassociated pain, due to its effects on both the noradrenergic and serotonic system. Rationale for the use of mirtazapine in veterinary medicine is reviewed in light of previously published literature. Conclusion/Recommendations: Mirtazapine is proposed as a potential analgesic for use in a multidrug analgesic regime in the context of veterinary medicine. Further studies need to be performed before it is implemented in clinical practice however.

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Patient Compliance With SSRIs and Gabapentin in Painful Diabetic Neuropathy

Abstract: The lack of negative effects on quality of life, the better compliance, and the comparable efficiency of SSRIs suggest that these drugs may be considered as alternative to gabapentin in painful diabetic neuropathy.

Cited by 28 publications

References 13 publications

Medication adherence in patients with chronic non‐malignant pain: Is there a problem?

Medication adherence in patients with chronic non‐malignant pain: Is there a problem?

Efeitos endócrinos e metabólicos das drogas antiepilépticas

Mirtazapine in Veterinary Medicine a Pharmacological Rationale for its Application in Chronic Pain

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