Gabapentin for the Symptomatic Treatment of Chronic Neuropathic Pain in Patients with Late-Stage Lyme Borreliosis: A Pilot Study

Abstract

Background: Chronic neuropathic pain occurs in 10–15% of patients with neuroborreliosis and is difficult to treat. Objective: We evaluated the effect of gabapentin monotherapy on residual pain in patients with neuroborreliosis after intravenous ceftriaxone treatment. Methods: Ten patients with neuroborreliosis and a long-lasting history of neurologic symptoms were treated with gabapentin, starting with 300 mg/day. Doses were raised over a period of 4–12 weeks to the individually effective and tolerated maximum dose (500–1,200 mg). Treatment was maintained until pain disappeared and then gradually reduced in dose over weeks. If symptoms recurred, the doses were raised again. Therapy was maintained over an average of 1–2 years. Results: Pain quality and pain quantity were evaluated using the McGill pain questionnaire and a visual analogue scale. There was an improvement of ‘crawling’ and ‘burning’ pain sensations, neck and radiating lumbar pain in 9/10 (90%) patients as well as a positive effect on mood, general feeling of health and quality of sleep in 5/10 (50%) patients. The average dose leading to a clear-cut pain reduction was 700 mg. Conclusions: In an open pilot study (10 patients), gabapentin monotherapy which has to our knowledge not been published as treatment of chronic neuropathic pain in patients with late Lyme borreliosis is efficacious in treating pain associated with neuroborreliosis and can thus improve quality of life in these patients.

Comparison of a Two- or Three-Week Regimen and a Review of Treatment of Erythema Migrans with Phenoxymethylpenicillin

“…But what about the late complaints that we want to treat? Klempner et al[ 31] showed that frequency and type of complaints reported by patients after EM are indistinguishable from those occurring in healthy individuals, and these complaints need a different type of treatment [35]. A 3-month course of antimicrobials (1 month of ceftriaxone followed by 2 months of doxycycline) was no more effective than placebo in alleviating symptoms.…”

Mechanisms of the Antinociceptive Action of Gabapentin

“…Clinically, gabapentin has been reported to be effective in the following pain status, including reflex sympathetic dystrophy (33), trigeminal neuralgia (34), postherpetic neuralgia (35,36), diabetic neuropathy (36,37), migraine (38), acute pain in herpes zoster infection (39), and other neuropathic pain status (40,41) (Table 2). Gabapentin is also effective in the postoperative pain management in different surgeries such as breast (42,43), hysterectomy (44,45), cholecystectomy (46), spinal (47), and knee (48) surgeries (Table 2).…”

Chronic Lyme disease: the controversies and the science

“…These include antidepressants, pregabalin and gabapentin, analgesics, biofeedback and complementary and alternative medicine. To date, the only published study is a small open-label trial that found that gabapentin reduced pain in 9/10 and improved quality of life in 5/10 patients with chronic post-Lyme neuropathic pain [124]. Until the medical community has better explanations and therapies for the millions who suffer unexplained chronic symptoms, some patients looking for answers will still come to blame Lyme disease for their illness.…”