Comparative study of safety and efficacy of pregabalin and gabapentin in management of neuropathic pain associated with chronic lumbar radiculopathy

Huzaif Shaikh; Maaz H. Syed; Imran N. Khan; Faheem Mubeen

doi:10.18203/2319-2003.ijbcp20194788

Authors

Huzaif Shaikh Department of Pharmacology, Indian Institute of Medical Science and Research, Jalna, Maharashtra
Maaz H. Syed Department of Pharmacology, Indian Institute of Medical Science and Research, Jalna, Maharashtra
Imran N. Khan Department of Pharmacology, Indian Institute of Medical Science and Research, Jalna, Maharashtra
Faheem Mubeen Department of Pharmacology, Indian Institute of Medical Science and Research, Jalna, Maharashtra

DOI:

https://doi.org/10.18203/2319-2003.ijbcp20194788

Keywords:

Lumbar radiculopathy, Pregabalin, Gabapentin

Abstract

Background: Chronic lumbar radiculopathy a clinical condition in which there is back and leg pain associated with sensory, reflex, or motor deficits in the area of nerve root distribution lasting for more than 12 weeks. The prevalence of lumbar radiculopathy has been reported to be 5.3% in men and 3.7% in women. Pregabalin and gabapentin, which fit in to a new category of drugs called as alpha-2-delta (α2δ) modulators, have been discovered to be effective in the treatment of neuropathic pain related with multiple conditions. So this study was done to compare safety and efficacy of pregabalin and gabapentin in management of pain associated with chronic lumbar radiculopathy.

Methods: This was a randomized two arm comparative prospective study. Total 160 patients were enrolled and randomized equally into 2 groups. Group A patients were given capsule pregabalin 75 mg two times a day orally, Group B patients were given tablet gabapentin 300 mg two times a day. Pain intensity was assessed at the start of study i.e. at baseline (0 week), at 6 weeks and at 12 weeks of starting the treatment using numeric pain rating scale.

Results: There was significant reduction in pain at the end of 12 weeks in both the groups (p<0.0001), but there was no significant difference between these two groups. The incidence of adverse effects was also more in group A.

Conclusions: Both the drugs are having comparable efficacy but gabapentin is more tolerable in such cases.

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Author Biography

Huzaif Shaikh, Department of Pharmacology, Indian Institute of Medical Science and Research, Jalna, Maharashtra

Assistant Professor, Department of Pharmacology

References

Dumitru D, Amato AA, Zwarts M. Electrodiagnostic medicine. 2nd ed. Philadelphia, PA; Hanley and Belfus Inc.; 2002.

Price C, Arden N, Coglan L, Rogers P. Cost-effectiveness and safety of epidural steroids in the management of sciatica. Health Technol Assess. 2005;9:1-58.

Waddell G. The back pain revolution. 2nd ed. Churchill Livingstone, 2004.

Fairbank JC. Sciatica: an archaic term. BMJ. 2007;335:112.

Koes BW, van Tulder MW, Peul WC. Diagnosis and treatment of sciatica. BMJ. 2007;334:1313-7.

Konstantinou K, Dunn KM. Sciatica: review of epidemiological studies and prevalence estimates. Spine. 2008;33:2464-72.

Karppinen J, Ohinmaa A, Malmivaara A, Kurunlahti M, Kyllönen E, Pienimäki T, et al. Cost effectiveness of peri-radicular infiltration for sciatica: subgroup analysis of a randomized controlled trial. Spine. 2001;26:2587-95.

Anderson PA, McCormick PC, Angevine PD. Randomized controlled trials of the treatment of lumbar disk herniation: 1983-2007. J Am Acad Orthop Surg. 2008;16:566-73.

Atlas SJ, Keller RB, Wu YA, Deyo RA, Singer DE. Long-term outcomes of surgical and nonsurgical management of sciatica secondary to a lumbar disc herniation: 10 year results from the Maine Lumbar Spine Study. Spine. 2005;30:927-35.

Bono CM, Wisneski R, Garfin SR. Lumbar disc herniations. In: Herkowitz HN, Garfin SR, Eismont FJ, Bell GR, Balderston RA, editors. The Spine. 5th ed. Philadelphia, PA: Saunders; 2006.

Buttermann GR. Treatment of lumbar disc herniation: Epidural steroid injection compared with discectomy. J Bone Joint Surg Am. 2004;86:670-9.

Carragee E. Surgical treatment of disk disorders. JAMA. 2006; 296:2485-2487.

Guilfoyle MR, Ganesan D, Seeley H, Laing RJ. Prospective study of outcomes in lumbar discectomy. Br J Neurosurg. 2007;21:389-95.

Majlesi J, Togay H, Unalan H, Toprak S. The sensitivity and specificity of the slump and the straight leg raising tests in patients with lumbar disc herniation. J Clin Rheumatol. 2008;14:87-91.

Peul WC, van Houwelingen HC, van den Hout WB, Brand R, Eekhof JA, Tans JT, et al. Surgery versus prolonged conservative treatment for sciatica. N Engl J Med. 2007;356:2245-56.

Peul WC, van den Hout WB, Brand R, Thomeer RT, Koes BW; Leiden-The Hague Spine Intervention Prognostic Study Group. Prolonged conservative care versus early surgery in patients with sciatica caused by lumbar disc herniation: Two year results of a randomised controlled trial. BMJ. 2008;336:1355-8.

Weinstein JN, Lurie JD, Tosteson TD, Tosteson AN, Blood EA, Abdu WA, et al. Surgical versus nonoperative treatment for lumbar disc herniation: Four year results for the Spine Patient Outcomes Research Trial (SPORT). Spine. 2008;33:2789-800.

Finnerup NB, Otto M, McQuay HJ, Jensen TS, Sindrup SH. Algorithm for neuropathic pain treatment: an evidence based proposal. Pain. 2005;118(3):289-305.

Harden N, Cohen M. Unmet needs in the management of neuropathic pain. J Pain Symptom Manage. 2003;25(5 Suppl):S12-S17.

Tolle T, Xu X, Sadosky AB. Painful diabetic neuropathy: a cross-sectional survey of health state impairment and treatment patterns. J Diabetes Complications. 2006;20(1):26-33.

Tolle T, Dukes E, Sadosky A. Patient burden of trigeminal neuralgia: results from a cross-sectional survey of health state impairment and treatment patterns in six European countries. Pain Pract. 2006;6(3):153-60.

Seventer R, Sadosky A, Lucero M, Dukes E. A cross-sectional survey of health state impairment and treatment patterns in patients with postherpetic neuralgia. Age Ageing. 2006;35(2):132-7.

Lesser H, Sharma U, LaMoreaux L, Poole RM. Pregabalin relieves symptoms of painful diabetic neuropathy: A randomized controlled trial. Neurology. 2004;63:2104-10.

Rosenstock J, Tuchman M, LaMoreaux L, Sharma U. Pregabalin for the treatment of painful diabetic peripheral neuropathy: A double-blind, placebo-controlled trial. Pain. 2004;110:628-38.

Richter RW, Portenoy R, Sharma U, LaMoreaux L, Bockbrader H, Knapp LE. Relief of painful diabetic peripheral neuropathy with pregabalin: A randomized, placebo-controlled trial. J Pain. 2005;6:253.

Freynhagen R, Strojek K, Griesing T, Whalen E, Balkenohl M. Efficacy of pregabalin in neuropathic pain evaluated in a 12-week, randomised, double-blind, multicentre, placebo-controlled trial of flexible- and fixed-dose regimens. Pain. 2005;115:254-63.

Dworkin RH, Corbin AE, Young JP, Jr, Sharma U, LaMoreaux L, Bockbrader H, et al. Pregabalin for the treatment of postherpetic neuralgia: A randomized, placebo-controlled trial. Neurology. 2003;60:1274-83.

Sabatowski R, Gálvez R, Cherry DA, Jacquot F, Vincent E, Maisonobe P, et al. Pregabalin reduces pain and improves sleep and mood disturbances in patients with post-herpetic neuralgia: Results of a randomised, placebo-controlled clinical trial. Pain. 2004;109:26-35.

Van Seventer R, Feister HA, Young JP, Jr, Stoker M, Versavel M, Rigaudy L. Efficacy and tolerability of twice-daily pregabalin for treating pain and related sleep interference in postherpetic neuralgia: A 13-week, randomized trial. Curr Med Res Opin. 2006;22:375-84.

Siddal P, Cousins M, Otte A, Phillips K, Griesing T. Pregabalin safely and efficaciously treats chronic central neuropathic pain after spinal cord injury. J Pain. 2005;6:S25.

Caraceni A, Zecca E, Bonezzi C, Arcuri E, Tur R, Maltoni M, et al. Gabapentin for neuropathic cancer pain: A randomized controlled trial from gabapentin cancer pain study group. J Clin Oncol. 2004;22:2909-17.

Tassone DM, Boyce E, Guyer J, Nuzum D. Pregabalin: a novel gamma-aminobutyric acid analogue in the treatment of neuropathic pain, partial-onset seizures, and anxiety disorders. Clin Ther. 2007;29(1):26-48.

Baron R, Freynhagen R, Tolle TR, Cloutier C, Leon T, Murphy TK, et al. The efficacy and safety of pregabalin in the treatment of neuropathic pain associated with chronic lumbosacral radiculopathy. Pain. 2010;150(3):420-7.

Kasimcan O, Kaptan H. Efficacy of gabapentin for radiculopathy caused by lumbar spinal stenosis and lumbar disk hernia. Neurologia medico-chirurgica. 2010;50(12):1070-3.

Tzellos TG, Papazisis G, Amaniti E, Kouvelas D. Efficacy of pregabalin and gabapentin for neuropathic pain in spinal-cord injury: an evidence-based evaluation of the literature. Eur J Clin Pharmacol. 2008;64(9):851-8.