Cases: Anti-epileptic Medicines for Pain Management
Discussion: Tri-cyclic antidepressants (TCAs), serotonin-norepinephrine
reuptake inhibitors (SNRIs) and anti-epileptic drugs (AEDs) are the mainstays
of adjuvant therapy for neuropathic pain.
This Case of the Month will focus on oral anti-epileptic neuropathic
pain analgesics. Due to lack of head-to-head data, evidence is presented as
numbers needed to treat (NNT) and numbers needed to harm (NNH). For instance,
an NNT of 5 for 50% pain reduction means for every 5 patients treated with a
drug, only 1 of them would achieve a 50% reduction in pain. Gabapentin (Neurontin)
and pregabalin (Lyrica) are considered first-line anti-epileptics for the
treatment of neuropathic pain.
Gabapentin is effective in treating central and peripheral
neuropathic pain. According to a 2011 Cochrane review of the effect of
gabapentin on chronic neuropathic conditions (including post-herpetic
neuralgia, painful diabetic neuropathy, mixed neuropathic pain), the NNT is 5.8
(4.8-7.2) to achieve at least moderate benefit. This NNT is more conservative
than those previously published due to better definitions of efficacy outcomes
and an increased number of participants and studies evaluated.
Adverse effects are frequent and include drowsiness,
dizziness and edema. Typically, if the dose is increased slowly these side
effects are tolerable (1). Gabapentin should be dose adjusted for renal
dysfunction. It should be withdrawn gradually to avoid precipitating seizures
(2).
Pregabalin is ...
Source: Pallimed: A Hospice and Palliative Medicine Blog - Category: Palliative Carer Workers Authors: Christian Sinclair Source Type: blogs
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