Abstract
BackgroundPostherpetic neuralgia (PHN) interferes with patients’ quality of life, and disturbed sleep is a prevalent complaint. Pain-associated sleep interference in turn enhances pain and/or reduces pain tolerance. Therefore, reducing sleep interference by pain, in addition to pain control, may improve patient care. To address this notion, we characterized relationships among changes in pain intensity, sleep interference, and overall impression of improvement in PHN patients treated with gastroretentive gabapentin (G-GR).MethodsPatients with PHN (n = 556) received G-GR 1800 mg once-daily in two phase 3 and one phase 4 study. Visual Analog Scale (VAS) and Brief Pain Inventory (BPI) were completed at baseline and the end of study. Patients’ Global Impression of Change (PGIC) was completed at the end of study. Regression analyses examined relationships between VAS, BPI sleep interference by pain, and PGIC.ResultsAt the end of treatment, 53.7 and 63.2 % of patients reported a ≥30 % reduction in VAS and BPI pain-associated sleep interference (BPISI) respectively; 46.3 % reported feeling “Much” or “Very Much” improved on the PGIC. There were positive correlations between the percent reductions in VAS and BPISI; both correlated with PGIC improvements. Percent changes in VAS and BPISI were significant (p < 0.0001 and p = 0.0082, respectively), and were independent predictors of feeling “Much” or “Very Much” improved on the PGIC.ConclusionsReductions in pain intensity and in BPISI were correlated, and both also correlated with overall impression of improvement for patients with PHN treated with G-GR. Both pain relief and improvement BPISI independently predicted improvement in PGIC. For optimal patient care, clinicians should consider reducing the impact of pain on quality of sleep as well as overall pain reduction.Trial registrationClinicalTrials.gov numbers, NCT00335933, NCT00636636, NCT01426230.
Highlights
Postherpetic neuralgia (PHN) interferes with patients’ quality of life, and disturbed sleep is a prevalent complaint
Postherpetic neuralgia (PHN) is a chronic neuropathic pain syndrome resulting from nerve damage caused by the varicella zoster virus that is reactivated during acute herpes zoster (HZ, shingles) [1]
Sleep disturbance may in turn lead to additional comorbid conditions such as anxiety or depression [5, 8,9,10], and some studies suggest that shortened or disturbed sleep may lead to reduced pain tolerance [11, 12]
Summary
Postherpetic neuralgia (PHN) interferes with patients’ quality of life, and disturbed sleep is a prevalent complaint. Pain-associated sleep interference in turn enhances pain and/or reduces pain tolerance. Reducing sleep interference by pain, in addition to pain control, may improve patient care. To address this notion, we characterized relationships among changes in pain intensity, sleep interference, and overall impression of improvement in PHN patients treated with gastroretentive gabapentin (G-GR). PHN, which occurs in up to 20 % of HZ patients, can be debilitating and interferes with patients’ physical function and their quality of life [2,3,4,5,6]. It is expected that improvement in sleep quality, in addition to control of neuropathic pain, may improve patients’ overall quality of life [14]
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