Pregabalin provides good pain relief in postherpetic neuralgia and painful diabetic neuropathy

  • Derry S & al.
  • Cochrane Database Syst Rev
  • 23 Jan 2019

  • curated by Sarfaroj Khan
  • UK Clinical Digest
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Takeaway

  • Pregabalin (dose, 300-600 mg) provides good pain relief in postherpetic neuralgia and painful diabetic neuropathy.
  • Pregabalin shows no benefit in HIV-associated painful peripheral neuropathy; limited evidence was observed for other types of neuropathic pain.

Why this matters

  • This is an update of 2009 review.

Study design

  • Meta-analysis of 45 randomised controlled studies including 11,906 participants who received pregabalin or placebo.
  • Funding: National Institute for Health Research.

Key results

  • Postherpetic neuralgia:
    • Pregabalin 300 mg showed higher number of patients with ≥30% pain intensity reduction (50 vs 25%; risk ratio [RR], 2.1; 95% CI, 1.6-2.6) and ≥50% pain intensity reduction (32 vs 13%; RR, 2.5; 95% CI, 1.9-3.4) vs placebo.
    • Pregabalin 600 mg showed higher number of patients with ≥30% pain intensity reduction (62 vs 24%; RR, 2.5; 95% CI, 2.0-3.2) and ≥50% pain intensity reduction (41 vs 15%; RR, 2.7; 95% CI, 2.0-3.5) vs placebo.
  • Painful diabetic neuropathy:
    • Pregabalin 300 mg showed higher number of patients with ≥30% pain intensity reduction (RR, 1.1; 95% CI, 1.0-1.2) and ≥50% pain intensity reduction (RR, 1.3; 95% CI 1.2-1.53).
    • Pregabalin 600 mg showed higher number of patients with ≥30% pain intensity reduction (RR, 1.2; 95% CI 1.04-1.4) and ≥50% pain intensity reduction (RR, 1.4; 95% CI, 1.2-1.7).
  • Mixed or unclassified post-traumatic neuropathic pain:
    • Pregabalin 600 mg showed higher number of patients with ≥30% pain intensity reduction (RR, 1.2; 95% CI, 1.1-1.4) and ≥50% pain intensity reduction (RR, 1.5; 95% CI, 1.2-1.9).
  • Central neuropathic pain:
    • Pregabalin 600 mg showed higher number of patients with ≥30% pain intensity reduction (RR, 1.6; 95% CI, 1.3-2.0) and ≥50% pain intensity reduction (RR, 1.7; 95% CI, 1.2-2.3).
  • Other neuropathic pain conditions: No benefit was seen in HIV neuropathy; Evidence was limited for neuropathic back pain or sciatica, neuropathic cancer pain or polyneuropathy.
  • Somnolence and dizziness were more common with pregabalin.

Limitations

  • Study duration varied from 2 to 16 weeks.