Gabapentin for chronic neuropathic pain in adults

Gabapentin at doses of 1200 mg or more is reasonably effective for some people with painful neuropathic pain conditions.

Comment: The strength of recommendation is downgraded by unknown balance of benefit and harm, and lack of information on comparative effectiveness with other drugs for neuropathic pain.

Summary

A Cochrane review included 37 studies with a total of 5633 subjects. Gabapentin was studied at daily doses of 1200 mg or more in 12 chronic pain conditions; 84% of participants were in studies of postherpetic neuralgia (PHN), painful diabetic neuropathy (PDN) or mixed neuropathic pain (mostly PHN, PDN and complex regional pain syndrome CRPS).

In postherpetic neuralgia (PHN),a substantial (at least 50% pain intensity reduction) occurred in 34% of patients given gabapentin and 21% of those given placebo by the end of the study, In painful diabethic neuropathy (PDN), at least 50% pain intensity reduction occurred in 38% of patients given gabapentin and 21% of those given placebo. Numbers needed to treat to benefit (NNTs) were between 5 and 12 for substantial improvement in PHN and PDN. Results were consistent across the major neuropathic pain conditions tested, though gabapentin was tested only in small numbers in uncommon neuropathic pain conditions and fibromyalgia. See Table .

Seventeen studies with 4002 participants reported on participants experiencing at least one adverse event, which occurred in 62% of participants on gabapentin and in 50% on placebo. Somnolence, drowsiness, or sedation occurred in 14% vs. 5% on placebo. Dizziness occurred in 19% vs. 6.1% on placebo. Other reported adverse effects were peripheral oedema and ataxia or gait disturbance. Serious adverse events were no more common with gabapentin than placebo,

Ədəbiyyat

1. Moore RA, Wiffen PJ, Derry S et al. Gabapentin for chronic neuropathic pain and fibromyalgia in adults. Cochrane Database Syst Rev 2014;4():CD007938.