Neuropathic pain: clinically important aspects of pregabalin in questions and illustrated answers | Український Медичний Часопис

Neuropathic pain is a common feature of various diseases; NSAIDs are not able to relieve it. Gabapentinoids, in particular pregabalin, are the first line of treatment for neuropathic pain. Pregabalin has an extensive evidence base of efficacy and safety in the treatment of neuropathic pain of various genesis; pregabalin is recommended for use by leading international societies with a stepwise increase in dosage from the initiating dose (150 mg/day) to reaching maintenance doses (300 or 600 mg/day). The likelihood of developing serious side effects with pregabalin does not differ from that of placebo. Pregabalin is a highly effective drug for the treatment of neuropathic pain, which has some potential side effects, the likelihood of which increases significantly in case of self-medication, abuse, and overdose; which requires mandatory prescription of the drug and careful prescription to persons at risk.

References

1. Becerra-Bolaños Á., Armas-Domínguez A., Valencia L. et al. (2023) Pain Prevalence and Satisfaction with Pain Management in Inpatients: A Cross-Sectional Study. Healthcare (Basel), 11(24): 3191. doi: 10.3390/healthcare11243191.
2. www.iasp-pain.org/terminology?navItemNumber=576.
3. Rugnath R., Orzechowicz C., Newell C. et al. (2024) A Literature Review: The Mechanisms and Treatment of Neuropathic Pain-A Brief Discussion. Biomedicines, 12(1): 204.
4. Vieira W.F., Coelho D., Litwiler S. et al. (2024) Neuropathic Pain, Mood, and Stress-Related Disorders: A Literature Review of Comorbidity and Co-Pathogenesis. Neurosci. Biobehav. Rev., 105673. doi: 10.1016/j.neubiorev.2024.105673.
5. Baskozos G., Hébert H.L., Pascal M. et al. (2023) Epidemiology of neuropathic pain: an analysis of prevalence and associated factors in UK Biobank. Pain Rep., 8(2): e1066.
6. Doneddu P.E., Pensato U., Iorfida A. et al. (2023) Neuropathic Pain in the Emergency Setting: Diagnosis and Management. J. Clin. Med., 12(18): 6028.
7. Price R., Smith D., Franklin G. et al. (2022) Oral and topical treatment of painful diabetic polyneuropathy: practice guideline update summary: report of the AAN Guideline Subcommittee. Neurology, 98(1): 31–43.
8. Pop-Busui R., Ang L., Boulton A. et al. (2022) Diagnosis and Treatment of Painful Diabetic Peripheral Neuropathy. Arlington (VA): American Diabetes Association.
9. Blonde L., Umpierrez G.E., Reddy S.S. et al. (2022) American Association of Clinical Endocrinology Clinical Practice Guideline: developing a Diabetes Mellitus Comprehensive Care Plan-2022 Update. Endocr. Pract., 28(10): 923–1049.
10. www.ncbi.nlm.nih.gov/books/NBK552848/.
11. Mu A., Weinberg E., Moulin D. et al. (2017) Pharmacologic management of chronic neuropathic pain: Review of the Canadian Pain Society consensus statement. Can. Fam. Physician, 63(11): 844–852.
12. Finnerup N.B., Attal N., Haroutounian S. et al. (2015) Pharmacotherapy for neuropathic pain in adults: Systematic review, meta-analysis and updated NeuPSig recommendations. Lancet Neurol., 14: 162–173. doi: 10.1016/S1474-4422(14)70251-0.
13. Derry S., Bell R.F., Straube S. et al. (2019) Cochrane Database Syst. Rev., 1(1): CD007076.
14. Національні настанови з керування хронічного болю (2023) http://www.dec.gov.ua/wp-content/uploads/2023/04/kn-2023-hb-u-doroslyh.pdf.
15. Yeh Y.C., Cappelleri J.C., Marston X. et al. (2021) Effects of dose titration on adherence and treatment duration of pregabalin among patients with neuropathic pain: A MarketScan database study. PLoS One, 16(1): e0242467.
16. Alexander J.Jr., Edwards R.A., Manca L. et al. (2018) Dose Titration of Pregabalin in Patients with Painful Diabetic Peripheral Neuropathy: Simulation Based on Observational Study Patients Enriched with Data from Randomized Studies. Adv. Ther., 35(3): 382–394.
17. Mallick-Searle T., Adler J.A. (2024) Update on Treating Painful Diabetic Peripheral Neuropathy: A Review of Current US Guidelines with a Focus on the Most Recently Approved Management Options. J. Pain Res., 17: 1005–1028.
18. Evoy K.E., Covvey J.R., Peckham A. et al. (2019) Reports of gabapentin and pregabalin abuse, misuse, dependence, or overdose: An analysis of the Food And Drug Administration Adverse Events Reporting System (FAERS). Res. Social Adm. Pharm., 15(8): 953–958.
19. Evoy K.E., Sadrameli S., Contreras J. et al. (2021) Abuse and Misuse of Pregabalin and Gabapentin: A Systematic Review Update. Drugs, 81(1): 125–156.
20. Kiliç Z., Aydin Özaslan E. (2023) Abuse and addiction in gabapentinoid drug users for neuropathic pain. Eur. Rev. Med. Pharmacol. Sci., 27(12): 5378–5389.
21. Pickering G., Marcoux M., Chapiro S. et al. (2016) An Algorithm for Neuropathic Pain Management in Older People. Drugs Aging., 33(8): 575–583.
22. Semel D., Murphy T., Zlateva G. et al. (2010) Evaluation of the safety and efficacy of pregabalin in older patients with neuropathic pain: results from a pooled analysis of 11 clinical studies. BMC Fam. Pract., 11: 85.
23. Akazawa M., Igarashi A., Ebata N. et al. (2019) A Cost-Effectiveness Analysis Of Pregabalin For The Treatment Of Patients With Chronic Cervical Pain With A Neuropathic Component In Japan. J. Pain Res., 12: 2785–2797. doi: 10.2147/JPR.S203712.
24. Zeng F., Wang M., Zhang D. (2021) Cost-effectiveness analysis of 5% lidocaine-medicated plaster compared with pregabalin for the treatment of post-herpetic neuralgia in China. Ann. Palliat. Med., 10(4): 4493–4501.