Pregabalin vs placebo to prevent chronic pain after whiplash injury in at-risk individuals: results of a feasibility study for a large randomised controlled trial

Abstract

Supplemental Digital Content is Available in the Text.A future definitive trial of pregabalin for acute WAD may be feasible with protocol modifications. Pregabalin may be more effective than placebo at 3 months for neck pain intensity. Results will inform the design and logistics of a definitive multisite trial.

Recruitment and retention for chronic pain clinical trials: a narrative review

“…51,53 Although not unique to pain studies, an important consideration in designing a pain trial is the extent to which those patients with a strong treatment preference exhibit reluctance or refusal to participate or to continue participating. 56,64,93,100 To overcome this reluctance, rescue medications (eg, acetaminophen, aspirin, or other nonsteroidal anti-inflammatory drugs, or weak opioids such as codeine, tramadol, dihydrocodeine, or dextropropoxyphene) can be tried. 55 A balancing act exists, however, between providing sufficient rescue relief to retain participants in a study, but not so much that data noise invalidates the treatment effect estimate 55 or contributes to falsenegative results.…”

Nerve pathology and neuropathic pain after whiplash injury: a systematic review and meta-analysis

“…13,68 Our findings suggest that this may need to be considered for a subset of patients. There are currently several efforts underway to examine the benefit of targeted neuropathic treatments for patients with WAD, 69,70 and results from preliminary studies may be promising. 70 Such studies are required to determine whether interventions targeting neuropathic pain and nerve pathology may be beneficial in a subset of patients.…”

“…Additionally, clinical questionnaires have identified some patients reporting neuropathic pain characteristics after whiplash injury [ 89 ; 106 ]. In line with these findings, a recent feasibility trial using a first-line neuropathic pain medication (pregabalin) for patients after acute whiplash injury showed short-term improvements in neck pain intensity when compared to placebo [ 70 ].…”

“…89,106 In line with these findings, a recent feasibility trial using a first-line neuropathic pain medication (pregabalin) for patients after acute whiplash injury showed short-term improvements in neck pain intensity when compared with placebo. 70 The presence of nerve pathology would have important implications for the management of patients with WAD. Compared with other chronic pain conditions, people with neuropathic pain experience greater impairments to quality of life and emotional wellbeing.…”

Systematic Review on Nonopioid Pharmacologic Treatments for Chronic Pain: Surveillance Report 2

“…The addition of one trial of duloxetine (n=236) 9 to an updated meta-analysis did not change prior conclusions of no effect of serotonin-norepinephrine reuptake inhibitors (SNRIs) on the risk of serious adverse events (SAEs) (20 RCTs, N=9,059, 1.6% vs. 2.6%, RR 0.92, 95% CI, 0.65 to 1.29, I 2 =0%) 9,[23][24][25][26][29][30][31][32][33][34][35][36][37][38][39][40][41][42][43] and a moderate risk of withdrawals due to adverse events (WAEs) (25 RCTs, N=10,207, 15.2% vs. 7.4%, RR 2.00, 95% CI, 1.72 to 2.35, I 2 =18%). 9,[23][24][25][26][27][29][30][31][32][33][34][35][36][37][38][39][40][41][42][43][44][45][46][47]…”