Abstract
Among patients with cervical myelopathy who were diagnosed with neuropathic pain (NP) by the LANSS test, the study participants were randomly assigned to one of the two study groups. The participants in one study group received opioids only, while those in the other group received opioids and pregabalin. Thirty-nine patients were analyzed in the study (20 patients in the opioid-only group and 19 in the pregabalin add-on group). The LANSS, neck pain, and arm pain scores in the pregabalin add-on group improved significantly compared with those in the opioid-only group after the first 4 weeks (p = 0.005, 0.001 and 0.035, respectively), but there was no significant difference between the two groups during the next 4 weeks (p = 0.615, 0.377 and 0.716, respectively). There was no significant difference in the neck disability index and EuroQol-5Dimension scores after four weeks and eight weeks of follow-up. Adverse events were reported by four patients (20.0%) in the opioid-only group and five patients (26.3%) in the pregabalin add-on group (p = 0.716). However, over time, the occurrence of side effects and dropouts increased in the pregabalin add-on group. This exploratory pilot study suggests that pregabalin add-on treatment is more efficient than the use of opioids alone at the beginning of NP treatment in cervical myelopathy patients. However, prescribing pregabalin add-on treatment for more than four weeks should be done cautiously.
Highlights
Among patients with cervical myelopathy who were diagnosed with neuropathic pain (NP) by the LANSS test, the study participants were randomly assigned to one of the two study groups
Some medications are available for NP, including opioids, tramadol, antidepressants, and different antiepileptic drugs (AEDs), a systematic review suggests that considering the balance between efficacy and tolerability, pregabalin may be recommended as a first-line treatment for NP3–5
It is frequently used for the treatment of several NP syndromes, and it has been approved by the Food and Drug Administration for the treatment of post-herpetic neuralgia, fibromyalgia, diabetic peripheral neuropathy, and spinal cord injury[7,8,9,10,11]
Summary
Among patients with cervical myelopathy who were diagnosed with neuropathic pain (NP) by the LANSS test, the study participants were randomly assigned to one of the two study groups. Over time, the occurrence of side effects and dropouts increased in the pregabalin add-on group This exploratory pilot study suggests that pregabalin add-on treatment is more efficient than the use of opioids alone at the beginning of NP treatment in cervical myelopathy patients. In central NP associated with spinal cord injury, the mean endpoint pain score was found to be lower in the pregabalin group than in the placebo group[8]. Unacceptable side effects such as dizziness, somnolence, ataxia, cognitive impairment, edema, and myalgia anxiety, and more patients reported global improvement at the endpoint in the pregabalin group. The current clinical trial was developed to provide pilot data regarding the efficacy of pregabalin add-on treatment for NP in cervical myelopathic patients and to provide enough positive data to support the conduct of a subsequent large definitive randomized placebo-controlled trial
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