Modulation of mRNA Expression of IL-6 and mTORC1 and Efficacy and Feasibility of an Integrated Approach Encompassing Cognitive Behavioral Therapy Along with Pregabalin for Management of Neuropathic Pain in Postherpetic Neuralgia: A Pilot Study

Abstract

Objective This study was designed to explore the efficacy and feasibility of cognitive behavioural therapy(CBT) along with pregabalin and compare it with pregabalin monotherapy for the management of neuropathic pain in post-herpetic neuralgia (PHN) patients and to explore the modulation of mRNA expression of interleukin (IL)-6 and mammalian target of rapamycin-1 (mTORC1) genes in these patients. Design Randomized controlled pilot study Methods The patients aged >18 years of age with an established diagnosis of PHN with evident allodynia and hyperalgesia who had pain for at least 3 months after healing of rash with pain intensity ≥4/10 on NRS-Pain Scale were enrolled. The trial was registered with the Clinical Trials Registry-India (CTRI/2019/03/018014). A detailed baseline assessment regarding type and duration of pain and disability using pain-relevant self-report questionnaires was done. Two ml venous blood samples were collected for gene expression studies at base line and at end of 12 weeks of treatment. Patients were randomized into one of the two groups. Group PR received pregabalin and Group CP received CBT along with pregabalin. The pain intensity was measured using numeric rating scale (NRS)-Pain scale, neuropathic component of the pain by using Neuropathic Pain Symptom Inventory (NPSI) and Pain Detect Questionnaire (PDQ), sleep interference by NRS-Sleep, pain-related catastrophic thoughts by using Pain Catastrophizing Scale (PCS), depression and quality of life using Beck Depression Inventory-II (BDI-II) and Short Form-12 (SF-12), respectively. The research funding was supported by the intramural grant from the institution. Results A total of 40 patients with 20 in each group were included. Following integrated approach encompassing CBT and Pregabalin, group CP had significant downregulation of mRNA expression of IL-6; however, no such correlation was observed with mTOR expression. A significant decline in the intensity of pain, NPSI scoring for burning, allodynia, and pain-related catastrophizing were observed; also a significant improvement in depressive symptoms and quality of life were observed with the use of CBT. Conclusions A significant downregulation of mRNA expression of IL-6 was observed; however, no significant correlation was observed between NRS pain score and ΔCt values of mRNA expression of both mTORC1 gene and IL-6 gene at baseline and at the end of 12th week. In addition, we note a significant decrease in pain intensity, depressive symptoms, and pain-related catastrophizing while improving QOL was observed with the use of CBT as a clinical adjunct along with pregabalin in PHN patients.

Serum interleukin-6 levels are increased in post-herpetic neuralgia: a single-center retrospective study

“…The pain relief effect is remarkable, a significant downregulation of mRNA expression of IL-6 was observed. 24 Confirming consistent results in East Asian and West Asian populations, however, it is not shown that IL6 level is closely related to PHN prognosis. This study found that serum IL6 levels in patients with PHN in admission are correlated to the Likert scale score on the 14 th day after diagnosis.…”

Pain intensity and self‐perceived burden mediate the relationship between family functioning and pain catastrophizing in patients with neuropathic pain

“…Overall, our study provides information for family‐centered care in patients with NP. First, pain catastrophizing is one of the essential indicators for measuring pain management's effectiveness (Martinez‐Calderon et al, 2019; Saxena et al, 2021; Sisco‐Taylor et al, 2022). In our study, the significant total effect of good family functioning on reducing pain catastrophizing provides some support for family‐centered care.…”

Exploring Novel Therapeutic Targets in the Common Pathogenic Factors in Migraine and Neuropathic Pain

“…In group 1, PHN-related NP patients received pregabalin monotherapy alone, while Group 2 patients were treated with a combination of pregabalin together with cognitive behavioral therapy. The results showed that patients in Group 2 had significant downregulation of IL-6 mRNA expression [143].…”