Pregabalin, the lidocaine plaster and duloxetine in patients with refractory neuropathic pain: a systematic review

Abstract

BackgroundPatients frequently fail to receive adequate pain relief from, or are intolerant of, first-line therapies prescribed for neuropathic pain (NeP). This refractory chronic pain causes psychological distress and impacts patient quality of life. Published literature for treatment in refractory patients is sparse and often published as conference abstracts only. The aim of this study was to identify published data for three pharmacological treatments: pregabalin, lidocaine plaster, and duloxetine, which are typically used at 2nd line or later in UK patients with neuropathic pain.MethodsA systematic review of the literature databases MEDLINE, EMBASE and CCTR was carried out and supplemented with extensive conference and grey literature searching. Studies of any design (except single patient case studies) that enrolled adult patients with refractory NeP were included in the review and qualitatively assessed.ResultsSeventeen studies were included in the review: nine of pregabalin, seven of the lidocaine plaster, and one of duloxetine. No head-to-head studies of these treatments were identified. Only six studies included treatments within UK licensed indications and dose ranges. Reported efficacy outcomes were not consistent between studies. Pain scores were most commonly assessed in studies including pregabalin; trials of pregabalin and the lidocaine plaster reported the proportion of responders. Significant improvements in the total, sensory and affective scores of the Short-form McGill Pain Questionnaire, and in function interference, sleep interference and pain associated distress, were associated with pregabalin treatment; limited or no quality of life data were available for the other two interventions. Limitations to the review are the small number of included studies, which are generally small, of poor quality and heterogeneous in patient population and study design.ConclusionsLittle evidence is available relevant to the treatment of refractory neuropathic pain despite the clinical need. There is a notable lack of high-quality comparative studies. It is evident that there is a need for future, high quality trials, particularly "gold-standard" RCTs in this refractory patient population.

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]. …”

Effectiveness of Pregabalin as Monotherapy or Combination Therapy for Neuropathic Pain in Patients Unresponsive to Previous Treatments in a Spanish Primary Care Setting

“…Furthermore, pregabalin has been successfully used in patients with refractory NP [41, 42], which may be the case in some patients in the current study, since they were symptomatic despite using a mean 2.4 drugs. Specifically, in the Spanish primary care setting, pregabalin was shown to be an effective therapy for the treatment of peripheral NP in patients refractory to at least one previous analgesic in routine clinical practice [43, 44].…”

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

“…According to the authors, significant pain reduction was reported in all 7 of the studies involving pregabalin, while only one study using lidocaine reported a significant reduction; there was only one study with duloxetine. 88 …”

“…85 Plested et al performed a systematic review of pregabalin, a lidocaine plaster and duloxetine in patients with refractory neuropathic pain. 88 It included four of the 5 studies with pregabalin mentioned above and 3 studies published only as abstracts. According to the authors, significant pain reduction was reported in all 7 of the studies involving pregabalin, while only one study using lidocaine reported a significant reduction; there was only one study with duloxetine.…”