The effect of gabapentin in earlier stage of reflex sympathetic dystrophy

Abstract

The objective of this paper is to investigate the effect of gabapentin in the earlier stage of reflex sympathetic dystrophy syndrome (RSD). Twenty-two patients diagnosed with RSD were enrolled. Initial gabapentin dosage was 600 mg/day. This dosage is increased gradually until a satisfactory pain level was reached. After this level, this dosage was maintained throughout the study. An exercise program was also applied to the patients. Provoked and static pain scores of the patients were obtained initially, at 3-day intervals for maintenance dosage determining, and at 6 weeks after the discharge. Functional improvement parameters were volumetric measurement; dynamometric measurement and third finger pulp-distal palmar crease distance measurement for hands; and metric circumferential measurement and range of motion for elbow, knee, and foot initially, at baseline, on the tenth day, upon discharge, and 6 weeks after the discharge. The mean maintenance dose of gabapentin was 1,145.46+/-377.6 mg/day (range, 900-1,800 mg/day). Improvements in spontaneous and provoked pain intensities were statistically significant. No statistically significant difference was obtained in functional improvement parameters. Dizziness in three patients, headache in two patients, and mild burning feeling in the tongue in one patient were the reported side effects. These symptoms resolved spontaneously in few days. Gabapentin cannot be recommended as the drug of choice, but it may be considered as one of the therapeutic alternatives in the management of pain due to RSD. We suggest that it is effective only for the pain and not for other symptoms of RSD. Serious side effects that will cause the patient to stop using the drug are rare.

Complex regional pain syndrome: a recent update

“…Studies investigating the efficacy of gabapentin in CRPS type I have reported marked improvements in pain reduction and long-term sensory deficits, thereby supporting the utility of this form of therapy [66, 67]. Although gabapentin has a good safety profile, it is important to be aware of the rare but severe side effects including mood disorders and suicide ideation [68].…”

Evidence based guidelines for complex regional pain syndrome type 1

“…These articles comprised one retrospective chart review [121], one prospective cohort [120], six case series [117,125,127,128,132,133], 14 clinical trials [109,111,112,119,122,123,126,131,135,138,140,146,147,150], two controlled clinical trials [130,136], 16 RCT's [108,113,114,116,124,129,134,137,139,141,143,145,146,148,149,152], four systematic reviews/meta analyses [110,115,142,144], and one treatment guideline [118]. Interventions evaluated therein were piroxicam [114], gabapentin [126], intrathecal baclofen [146], sympathetic blockade (lumbar, stellate ganglion and intravenous) (n = 5) [122,123,134,143,149], corticosteroids (n = 3) [114,119,135], calcium regulating medication (bisphosphonates, calcitonin) (n = 4) [110,116,138,142], NMDA antagonists (magnesium sulphate, ketamine, memantine) (n = 9) [111,121,125,131,140,146-148,152], free radical scavengers (mannitol, vitamin C) (n = 3) [129,135.137], nitric oxide regulating medication (n = 3) [133,141,151], spinal cord stimulation (n = 5) [112,115,120,128,132], regional anaesthesia (n = 2) [113,117], physiotherapy and rehabilitation medicine (physiotherapy, ...…”

Gabapentin for complex regional pain syndrome in Machado-Joseph disease: a case report

“…Most of the pharmacologic rationales for CRPS (such as topical agents, anti-epileptic drugs, tricyclic anti-depressants, and opioids) were applied by the treatment of other neuropathic pain syndromes, which are strongly related to gabapentin [11]. It has been reported that gabapentin at daily doses of 900 to 2400 mg [12,13] could be considered to control CRPS, but the effects seemed to be limited. We suppose that, since the neurodegeneration in MJD is multi-systemic (involving the somatosensory cortex), gabapentin might play a role in central neuromodulation via the alpha-2-delta subunit of the voltage-gated calcium channels [14].…”