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A comparative efficacy of amitriptyline, gabapentin, and pregabalin in neuropathic cancer pain: a prospective randomized double-blind placebo-controlled study.

Abstract

Neuropathic pain is difficult to diagnose and difficult to treat with certainty. So the aim of the study was to evaluate comparative clinical efficacy of pregabaline with amitriptyline and gabapentin in neuropathic cancer pain. A total of 120 patients with cancer having severe neuropathic cancer pain were enrolled in the study after taking approval from Institutional Ethics Committee and divided in to 4 groups: group AT-amitriptyline, group GB-gabapentin, group PG-pregabalin, and group PL-placebo. Oral morphine was used for rescue analgesic for continued pain. Pain score (Visual Analogue scale) and secondary outcome measures such as intensity of lancinating, dysesthesia, and burning on numerical rating scale, Global satisfaction score (GSS), Eastern Co-operative Oncology Group scoring (ECOG), and adverse effects were assessed. At the end of study there was significant decrease in pain score in group PG as compared to the other groups; group AT (P = .003), group GB (P = .042), and group PL (P = .024). Percentage of patients with lancinating pain and dysesthesia were significantly less in group PG as compared to groups GB and PL. All the patients in group PL needed rescue morphine. After 4 visits, maximum improvement in ECOG scoring and GSS scoring was observed in group PG patients. Our results suggested that all antineuropathic drugs are effective in relieving cancer-related neuropathic pain. There was statistically and clinically significant morphine sparing effect of pregabaline in relieving neuropathic cancer pain and neuropathic symptoms as compared to other antineuropathic drugs.

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  • Authors+Show Affiliations

    ,

    Unit of Anaesthesiology, Dr. B. R. Ambedkar, Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi. mseema17@yahoo.co.in

    , , ,

    Source

    MeSH

    Adult
    Amines
    Amitriptyline
    Analgesics
    Analysis of Variance
    Cyclohexanecarboxylic Acids
    Double-Blind Method
    Drug Therapy, Combination
    Female
    Gabapentin
    Humans
    Male
    Morphine
    Neoplasms
    Neuralgia
    Pain Measurement
    Pregabalin
    Prospective Studies
    gamma-Aminobutyric Acid

    Pub Type(s)

    Comparative Study
    Journal Article
    Randomized Controlled Trial
    Research Support, Non-U.S. Gov't

    Language

    eng

    PubMed ID

    21745832

    Citation

    Mishra, Seema, et al. "A Comparative Efficacy of Amitriptyline, Gabapentin, and Pregabalin in Neuropathic Cancer Pain: a Prospective Randomized Double-blind Placebo-controlled Study." The American Journal of Hospice & Palliative Care, vol. 29, no. 3, 2012, pp. 177-82.
    Mishra S, Bhatnagar S, Goyal GN, et al. A comparative efficacy of amitriptyline, gabapentin, and pregabalin in neuropathic cancer pain: a prospective randomized double-blind placebo-controlled study. Am J Hosp Palliat Care. 2012;29(3):177-82.
    Mishra, S., Bhatnagar, S., Goyal, G. N., Rana, S. P., & Upadhya, S. P. (2012). A comparative efficacy of amitriptyline, gabapentin, and pregabalin in neuropathic cancer pain: a prospective randomized double-blind placebo-controlled study. The American Journal of Hospice & Palliative Care, 29(3), pp. 177-82. doi:10.1177/1049909111412539.
    Mishra S, et al. A Comparative Efficacy of Amitriptyline, Gabapentin, and Pregabalin in Neuropathic Cancer Pain: a Prospective Randomized Double-blind Placebo-controlled Study. Am J Hosp Palliat Care. 2012;29(3):177-82. PubMed PMID: 21745832.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - A comparative efficacy of amitriptyline, gabapentin, and pregabalin in neuropathic cancer pain: a prospective randomized double-blind placebo-controlled study. AU - Mishra,Seema, AU - Bhatnagar,Sushma, AU - Goyal,Gaurav Nirvani, AU - Rana,Shiv Pratap Singh, AU - Upadhya,Surjya Prasad, Y1 - 2011/07/10/ PY - 2011/7/13/entrez PY - 2011/7/13/pubmed PY - 2012/8/29/medline SP - 177 EP - 82 JF - The American journal of hospice & palliative care JO - Am J Hosp Palliat Care VL - 29 IS - 3 N2 - Neuropathic pain is difficult to diagnose and difficult to treat with certainty. So the aim of the study was to evaluate comparative clinical efficacy of pregabaline with amitriptyline and gabapentin in neuropathic cancer pain. A total of 120 patients with cancer having severe neuropathic cancer pain were enrolled in the study after taking approval from Institutional Ethics Committee and divided in to 4 groups: group AT-amitriptyline, group GB-gabapentin, group PG-pregabalin, and group PL-placebo. Oral morphine was used for rescue analgesic for continued pain. Pain score (Visual Analogue scale) and secondary outcome measures such as intensity of lancinating, dysesthesia, and burning on numerical rating scale, Global satisfaction score (GSS), Eastern Co-operative Oncology Group scoring (ECOG), and adverse effects were assessed. At the end of study there was significant decrease in pain score in group PG as compared to the other groups; group AT (P = .003), group GB (P = .042), and group PL (P = .024). Percentage of patients with lancinating pain and dysesthesia were significantly less in group PG as compared to groups GB and PL. All the patients in group PL needed rescue morphine. After 4 visits, maximum improvement in ECOG scoring and GSS scoring was observed in group PG patients. Our results suggested that all antineuropathic drugs are effective in relieving cancer-related neuropathic pain. There was statistically and clinically significant morphine sparing effect of pregabaline in relieving neuropathic cancer pain and neuropathic symptoms as compared to other antineuropathic drugs. SN - 1938-2715 UR - https://www.unboundmedicine.com/medline/citation/21745832/A_comparative_efficacy_of_amitriptyline_gabapentin_and_pregabalin_in_neuropathic_cancer_pain:_a_prospective_randomized_double_blind_placebo_controlled_study_ L2 - http://journals.sagepub.com/doi/full/10.1177/1049909111412539?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -