Gabapentin for Chronic Neuropathic Pain

Moore, Andrew; Derry, Sheena; Wiffen, Philip J

doi:10.1001/jama.2017.21547

Cited by 65 publications

(35 citation statements)

References 8 publications

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“…The higher rates of side-effects observed with gabapentin compared with placebo (eg, dizziness, drowsiness, and visual disturbances) in the trial are consistent with other published studies. A 2018 meta-analysis of all trials for postherpetic neuralgia and painful diabetic neuropathy 28 showed that, compared with placebo, gabapentin was associated with more drowsiness (gabapentin 14% vs placebo 5%; p<0·001) and dizziness (gabapentin 19% vs placebo 7%; p<0·001). Nevertheless, the rates of side-effects in our trial are lower than in these other studies, despite only measuring these in women.…”

Section: Discussionmentioning

confidence: 99%

Gabapentin for chronic pelvic pain in women (GaPP2): a multicentre, randomised, double-blind, placebo-controlled trial

et al. 2020

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Background Chronic pelvic pain affects 2-24% of women worldwide and evidence for medical treatments is scarce. Gabapentin is effective in treating some chronic pain conditions. We aimed to measure the efficacy and safety of gabapentin in women with chronic pelvic pain and no obvious pelvic pathology. Methods We performed a multicentre, randomised, double-blind, placebo-controlled randomised trial in 39 UK hospital centres. Eligible participants were women with chronic pelvic pain (with or without dysmenorrhoea or dyspareunia) of at least 3 months duration. Inclusion criteria were 18-50 years of age, use or willingness to use contraception to avoid pregnancy, and no obvious pelvic pathology at laparoscopy, which must have taken place at least 2 weeks before consent but less than 36 months previously. Participants were randomly assigned in a 1:1 ratio to receive gabapentin (titrated to a maximum dose of 2700 mg daily) or matching placebo for 16 weeks. The online randomisation system minimised allocations by presence or absence of dysmenorrhoea, psychological distress, current use of hormonal contraceptives, and hospital centre. The appearance, route, and administration of the assigned intervention were identical in both groups. Patients, clinicians, and research staff were unaware of the trial group assignments throughout the trial. Participants were unmasked once they had provided all outcome data at week 16-17, or sooner if a serious adverse event requiring knowledge of the study drug occurred. The dual primary outcome measures were worst and average pain scores assessed separately on a numerical rating scale in weeks 13-16 after randomisation, in the intention-to-treat population. Self-reported adverse events were assessed according to intention-to-treat principles. This trial is registered with the ISRCTN registry, ISCRTN77451762. Findings Participants were screened between Nov 30, 2015, and March 6, 2019, and 306 were randomly assigned (153 to gabapentin and 153 to placebo). There were no significant between-group differences in both worst and average numerical rating scale (NRS) pain scores at 13-16 weeks after randomisation. The mean worst NRS pain score was 7•1 (standard deviation [SD] 2•6) in the gabapentin group and 7•4 (SD 2•2) in the placebo group. Mean change from baseline was-1•4 (SD 2•3) in the gabapentin group and-1•2 (SD 2•1) in the placebo group (adjusted mean difference-0•20 [97•5% CI-0•81 to 0•42]; p=0•47). The mean average NRS pain score was 4•3 (SD 2•3) in the gabapentin group and 4•5 (SD 2•2) in the placebo group. Mean change from baseline was-1•1 (SD 2•0) in the gabapentin group and-0•9 (SD 1•8) in the placebo group (adjusted mean difference-0•18 [97•5% CI-0•71 to 0•35]; p=0•45). More women had a serious adverse event in the gabapentin group than in the placebo group (10 [7%] of 153 in the gabapentin group compared with 3 [2%] of 153 in the placebo group; p=0•04). Dizziness, drowsiness, and visual disturbances were more common in the gabapentin group. Interpretation This study was adequately...

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Section: Discussionmentioning

confidence: 99%

Gabapentin for chronic pelvic pain in women (GaPP2): a multicentre, randomised, double-blind, placebo-controlled trial

et al. 2020

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“…In our experiment, treatment with Noxiall ® elicited a marked enhancement of the withdrawal threshold in response to a mechanical stimulus applied to the ligated paw suggesting an ability of this treatment to attenuate allodynia. In parallel to treatment with Noxiall ® , a separate group of mice was treated with gabapentin, an anti-epileptic agent that is a first-line treatment for NP in the clinic (Wiffen et al, 2017; Moore et al, 2018). The dose of gabapentin used was chosen based on previous studies in which its efficacy in rodent CCI models was demonstrated (Kusunose et al, 2010; Corona-Ramos et al, 2016; Hewitt et al, 2016).…”

Section: Discussionmentioning

confidence: 99%

Efficacy of a Combination of N-Palmitoylethanolamide, Beta-Caryophyllene, Carnosic Acid, and Myrrh Extract on Chronic Neuropathic Pain: A Preclinical Study

et al. 2019

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Neuropathic pain (NP) is a common public health problem that poses a major challenge to basic scientists and health-care providers. NP is a complex problem with an unclear etiology and an often-inadequate response to current medications. Despite the high number of drugs available, their limited pharmacological efficacy and side effects hamper their chronic use. Thus, the search for novel treatments is a priority. In addition to pharmaceuticals, natural extracts and food supplements are often used to help treating patients with NP. One such supplement is Noxiall ® , a commercially available combination of N-Palmitoylethanolamide (PEA), beta-caryophyllene; carnosic acid and myrrh. Here, we compare the efficacy of Noxiall ® to that of the medications gabapentin and pregabalin in the NP model of chronic constriction injury (CCI) using sciatic nerve ligation in mouse. Following CCI, mice developed a significant increase in mechanical allodynia and thermal hyperalgesia. Results showed that administration of either Noxiall ® , pregabalin, or gabapentin significantly attenuated mechanical allodynia. The magnitude of the Noxiall ® effect was comparable to that of gabapentin or pregabalin. In addition, co-administration of non-effective doses of pregabalin and Noxiall ® resulted in a significant decrease in NP, suggesting an additive efficacy. Noxiall ® was efficacious also in reducing CCI-induced thermal hyperalgesia. These findings support the rationale of using natural remedies in conjunction with classical pharmacological agents to treat chronic NP.

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“…85 Gabapentin is associated with pain reduction in patients with moderate or severe neuropathic pain from post-herpetic neuralgia or painful diabetic neuropathy. 87 Both gabapentin and pregabalin have been used in several pediatric studies of vincristine-induced neuropathy, but their efficacy has not been unequivocally established. 80,88…”

Section: Management Of Neuropathymentioning

confidence: 99%

Peripheral neuropathy in children and adolescents treated for cancer

Bjornard

Gilchrist

Inaba

et al. 2018

The Lancet Child & Adolescent Health

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Peripheral neuropathy is a well recognised treatment-related toxicity in children with cancer, associated with exposure to neurotoxic chemotherapy agents. Acute damage can occur in sensory, motor, or autonomic neurons, with symptoms that are rarely life threatening, but often severe enough to interfere with function during therapy and after treatment ends. The type of neuropathy and specific symptoms are associated with multiple factors including age at time of therapy, genetic predisposition, chemotherapy type and cumulative dose, and exposure to other agents during therapy. In this Review, we describe the peripheral neuropathy phenotype in children during cancer therapy and among survivors who have completed therapy, to summarise genetic and treatment-related risk factors for neuropathy, and to outline strategies to monitor and detect neuropathy during and after therapy. Additionally, we outline strategies for medical management of neuropathy during treatment and potential rehabilitation interventions to prevent or remediate functional loss.

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Gabapentin for Chronic Neuropathic Pain

Abstract: Oral gabapentin (1200-3600 mg/d for 4-12 weeks) for patients with moderate or severe neuropathic pain from postherpetic neuralgia (PHN) or painful diabetic neuropathy (PDN) is associated with pain reduction of at least 50% in 14% to 17% more patients than placebo.

Cited by 65 publications

References 8 publications

Gabapentin for chronic pelvic pain in women (GaPP2): a multicentre, randomised, double-blind, placebo-controlled trial

Gabapentin for chronic pelvic pain in women (GaPP2): a multicentre, randomised, double-blind, placebo-controlled trial

Efficacy of a Combination of N-Palmitoylethanolamide, Beta-Caryophyllene, Carnosic Acid, and Myrrh Extract on Chronic Neuropathic Pain: A Preclinical Study

Peripheral neuropathy in children and adolescents treated for cancer

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