Pregabalin and Gabapentin in Patients with Spinal Cord Injury-Related Neuropathic Pain: A Network Meta-Analysis

Abstract

Introduction: This study was performed to explore the efficacy and safety of pregabalin and gabapentin in patients with spinal cord injury (SCI)-induced neuropathic pain to determine which treatment is most suitable for such patients. Methods: We searched the PubMed, MEDLINE, Embase, and Cochrane Library databases from database inception to August 31, 2020. The quality of the included studies was assessed. We selected the average pain intensity after treatment and the proportion of patients who discontinued treatment because of adverse effects as the outcome indicators for efficacy and safety, respectively. Statistical analyses were performed using Stata, v16.0, and RevMan, v5.3, software. Results: We included eight randomized controlled trials that examined four interventions (pregabalin, gabapentin, carbamazepine, and amitriptyline). Based on the average pain intensity after treatment, the efficacy order from highest to lowest was pregabalin, gabapentin, amitriptyline, carbamazepine, and placebo. Based on the proportion of patients who discontinued treatment because of adverse effects, the order from highest to lowest was pregabalin, amitriptyline, carbamazepine, gabapentin, and placebo. In addition, five studies reported the overall incidence of treatment-related adverse effects for two interventions (pregabalin and gabapentin). According to the pooled analysis of these studies, the order for the overall incidence of treatment-related adverse effects from highest to lowest was pregabalin, gabapentin, and placebo. Conclusions: This study revealed that for patients with SCI-related neuropathic pain, pregabalin was the most effective for relieving pain, whereas gabapentin performed better in aspects associated with drug therapy-related safety.

Is pregabalin better than gabapentin in treatment of neuropathic pain? An observation-based study at tertiary care centre of North India

“…Tong et al had completed a network meta-analysis which shows eight randomized controlled trials that examined four interventions (pregabalin, gabapentin, carbamazepine, and amitriptyline). 33 Based on the average pain intensity after treatment, the efficacy order from highest to lowest was pregabalin, gabapentin, amitriptyline, carbamazepine, and placebo in patients with spinal cord injury-related neuropathic pain.…”

Spinal Cord Injury Provoked Neuropathic Pain and Spasticity, and Their GABAergic Connection

“…82 They are known to act by binding α2δ calcium channel subtype, thus reducing spinal excitatory glutamate and substance P release, without showing any serious side effects. 26,83 Other favorable mechanisms include promoting the descending inhibitory pathway, a decrease in glial activation and proinflammatory cytokine release. They also promote axonal regeneration and are found to be neuroprotective in several animal models of neurotrauma.…”

“…84 A recent meta-analysis report suggested that compared to the other drugs used, pregabalin was found to be more effective, and gabapentin safer for CNP post-SCI. 83 Gait instability, sedation, and dizziness are some of their common reported adverse effects. Gabapentin may cause cognitive dysfunction.…”

“…Their efficacy and tolerability are demonstrated in phase 3 randomized trials of SCI-NP patients ( Table 2 ) [ 82 ]. They are known to act by binding α2δ calcium channel subtype, thus reducing spinal excitatory glutamate and substance P release, without showing any serious side effects [ 26 , 83 ]. Other favorable mechanisms include promoting the descending inhibitory pathway, a decrease in glial activation and proinflammatory cytokine release.…”

“…When administered in the acute phase of the injury, they carry the potential to prevent the CNP development [ 84 ]. A recent meta-analysis report suggested that compared to the other drugs used, pregabalin was found to be more effective, and gabapentin safer for CNP post-SCI [ 83 ]. Gait instability, sedation, and dizziness are some of their common reported adverse effects.…”