The Possible Preventive Role of Pregabalin in Postmastectomy Pain Syndrome: A Double-Blinded Randomized Controlled Trial

Reyad, Raafat M.; Omran, Azza F.; Abbas, Dina N; Kamel, Mona M.; Shaker, Ehab; Tharwat, Jhon; Reyad, Ehab M.; Hashem, Tarek

doi:10.1016/j.jpainsymman.2018.10.496

Cited by 28 publications

(32 citation statements)

References 41 publications

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“…The appropriate treatment of acute pain is associated with the prevention of persistent pain after an axillary lymphadenectomy, as shown by a meta-analysis involving a total of 19,813 patients 12 . Similarly to Reyad et al 14 , we have observed that patients have frequently pain in the 2nd and 3rd week after surgery. During this period shoulder movement becomes very painful due to the fibrous scar that limits a successful physical therapy 11 .…”

Section: Discussionsupporting

confidence: 84%

Acute pain and side effects after tramadol in breast cancer patients: results of a prospective double-blind randomized study

Bešič

Smrekar

Strazisar

2020

Sci Rep

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The objective of this study was to evaluate the severity of acute pain and side effects in breast cancer patients postoperatively treated with two regimens of tramadol with paracetamol in a prospective double-blind study. Altogether 117 breast cancer patients who had axillary lymphadenectomy were randomized into two analgesic study groups and the analgesic treatment lasted 4 weeks. Stronger analgesia group received every 8 h 75/650 mg of tramadol with paracetamol, while weaker analgesia group received every 8 h 37.5/325 mg of tramadol with paracetamol. Patients with the higher dose of tramadol had less pain during the 1st and 4th week than patients with the lower dose. Frequency of nausea, vomiting, lymphedema or range of shoulder movement was not significantly different between the two groups of patients. Constipation was significantly more common in the group with stronger analgesia during the 2nd week in comparison to patients with weaker analgesia. The patients who were on 75/650 mg of tramadol with paracetamol had less pain in comparison to patients who were on 37.5/325 mg. Side effects were mild, but common in both groups of patients.

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Section: Discussionsupporting

confidence: 84%

Acute pain and side effects after tramadol in breast cancer patients: results of a prospective double-blind randomized study

Bešič

Smrekar

Strazisar

2020

Sci Rep

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“…For the years 1999 and 2019, a total of 46 reports containing 305 cases who developed MDs after the use of PGB from 17 different countries were reported [ Table 1 ]. [ 2 3 10 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 ] The origin was North American in 196, European in 68, Asian in 40, and South American in 1. The MDs associated with PGB found were as follows: 184 patients with ataxia, 61 with tremors, 39 with MCL, 8 with parkinsonism, 1 with restless legs syndrome, 1 with dystonia, 1 with dyskinesia, and 1 with akathisia.…”

Section: Resultsmentioning

confidence: 99%

“…In the subgroup of cases not clearly defined, there were 7 individuals with MCL, 1 with akathisia, and 1 with stuttering. Three articles did not report the number of patients, but they observed MCL[ 39 54 ] and parkinsonism. [ 49 ]…”

Section: Resultsmentioning

confidence: 99%

Pregabalin-associated movement disorders: A literature review

Rissardo

Caprara

2020

Brain Circ

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Central nervous system adverse effects are commonly reported with pregabalin (PGB). On the other hand, movement disorders (MDs) associated with this drug were rarely described. However, their occurrence could significantly affect the quality of life of PGB users. This literature review aims to evaluate the clinical epidemiological profile, pathological mechanisms, and management of PGB-associated MDs. Relevant reports in six databases were identified and assessed by two reviewers without language restriction. A total of 46 reports containing 305 cases from 17 countries were assessed. The MDs encountered were as follows: 184 individuals with ataxia, 61 with tremors, 39 with myoclonus, 8 with parkinsonism, 1 with restless legs syndrome, 1 with dystonia, 1 with dyskinesia, and 1 with akathisia. The mean age was 62 years (range: 23–94). The male sex was slightly predominant with 54.34%. The mean PGB dose when the MD occurred was 238 mg, and neuropathic pain was the most common indication of PGB. The time from PGB start to MD was < 1 month at 75%. The time from PGB withdrawal to recovery was < 1 week at 77%. All the individuals where the follow-up was reported had a full recovery. The most common management was PGB withdrawal. In the literature, the majority of the cases did not report information about timeline events, neurological examination details, or electrodiagnostic studies. The best management for all MDs is probably PGB withdrawal. If the patient is on dialysis program, perhaps an increased number of sessions will decrease recovery time. Furthermore, the addition of a benzodiazepine could accelerate recovery.

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“…Harm reported included epidural spread of the local anaesthetic in two patients (Pusch et al, 1999), a pleural puncture in one (Terheggen et al, 2002), an intoxication due to local anaesthetics in one (Kairaluoma et al, 2004), vascular punctures without subsequent haematoma in two (Fallatah & Mousa, 2016), and one patient described pain at the site of injection for more than 1 month postoperatively (Fallatah & Mousa, 2016). Six trials (Dirks et al, 2002;Grover et al, 2009;Hetta et al, 2016;Kim et al, 2011;Mansor & Choy, 2015;Reyad et al, 2019) testing gabapentinoids reported on the incidence of dizziness (OR 1.7; 95% CI 1.0-2.8). One trial tested different doses of pregabalin and found dose-responsiveness (Hetta et al, 2016).…”

Section: Safety Datamentioning

confidence: 99%

Preventing pain after breast surgery: A systematic review with meta‐analyses and trial‐sequential analyses

Lepot

Elia

Tramèr

et al. 2020

European Journal of Pain

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Background and objective: The aim of this systematic review was to indirectly compare the efficacy of any intervention, administered perioperatively, on acute and persistent pain after breast surgery. Databases and data treatment: We searched for randomized trials comparing analgesic interventions with placebo or no treatment in patients undergoing breast surgery under general anaesthesia. Primary outcome was intensity of acute pain (up to 6 hr postoperatively). Secondary outcomes were cumulative 24-hr morphine consumption, incidence of postoperative nausea and vomiting (PONV), and chronic pain. We used an original three-step approach. First, meta-analyses were performed when data from at least three trials could be combined; secondly, trial sequential analyses were used to separate conclusive from unclear evidence. And thirdly, the quality of evidence was rated with GRADE. Results: Seventy-three trials (5,512 patients) tested loco-regional blocks (paravertebral, pectoralis), local anaesthetic infiltrations, oral gabapentinoids or intravenous administration of glucocorticoids, lidocaine, N-methyl-D-aspartate antagonists or alpha2 agonists. With paravertebral blocks, pectoralis blocks and glucocorticoids, there was conclusive evidence of a clinically relevant reduction in acute pain (visual analogue scale > 1.0 cm). With pectoralis blocks, and gabapentinoids, there was conclusive evidence of a reduction in the cumulative 24-hr morphine consumption (> 30%). With paravertebral blocks and glucocorticoids, there was conclusive evidence of a relative reduction in the incidence of PONV of 70%. For chronic pain, insufficient data were available. Conclusions: Mainly with loco-regional blocks, there is conclusive evidence of a reduction in acute pain intensity, morphine consumption and PONV incidence after breast surgery. For rational decision making, data on chronic pain are needed. Significance: This quantitative systematic review compares eight interventions, published across 73 trials, to prevent pain after breast surgery, and grades their degree of efficacy. The most efficient interventions are paravertebral blocks, pectoralis blocks and glucocorticoids, with moderate to low evidence for the blocks. Intravenous lidocaine and alpha2 agonists are efficacious to a lesser extent, but with a higher level of evidence. Data for chronic pain are lacking.

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The Possible Preventive Role of Pregabalin in Postmastectomy Pain Syndrome: A Double-Blinded Randomized Controlled Trial

Cited by 28 publications

References 41 publications

Acute pain and side effects after tramadol in breast cancer patients: results of a prospective double-blind randomized study

Acute pain and side effects after tramadol in breast cancer patients: results of a prospective double-blind randomized study

Pregabalin-associated movement disorders: A literature review

Preventing pain after breast surgery: A systematic review with meta‐analyses and trial‐sequential analyses

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