Toth, C. (2010). Substitution of gabapentin therapy with pregabalin therapy in neuropathic pain due to peripheral neuropathy. Pain Medicine, 11, 456–465.

DOI Link

Study Purpose

The goal of the study was to determine utility of substitution of pregabalin for gabapentin therapy in relief of neuropathic pain.

Intervention Characteristics/Basic Study Process

All patients starting on gabapentin and all patients already using gabapentin as monotherapy were offered the choice of replacing their gabapentin with pregabalin. Comparison was made between the groups switched to pregabalin and a cohort group of patients with peripheral neuropathy and pain receiving only gabapentin without a switch to pregabalin.

Sample Characteristics

  • The total sample consisted of 40 participants (68% female, 32% male).
  • The mean age of those classified as gabapentin responders was 57.3 years (SD = 9.2).
  • The mean age of those classified as nonresponders was 54.5 years (SD = 9.8).
  • The mean age of those in the gabapentin cohort was 58.4 years (SD = 11.1).
  • 38 patients were diabetic, 11 had MGUS, 6 had vitamin B12 deficiency, 34 had idiopathic peripheral neuropathy, 2 had autoimmune conditions, and 2 had multiple myeloma.

Setting

The study was conducted at a single site in Canada.

Study Design

Cohort study

Measurement Instruments/Methods

  • Toronto Clinical Scoring System (TCSS) was used to measure diabetic peripheral neuropathy.
  • EQ-5D: European Quality of Life–5 domains
  • EQ-5D VAS: European Quality of Life–Pain Visual Analog Scale

Results

Both gabapentin responder and nonresponders groups had additional pain relief of about 25% following substitution of pregabalin after 6 and 12 months. The percentage of improvement on the EQ-5D VAS was significant (p < 0.025).

Conclusions

Findings show that pregabalin may provide pain relief in this patient population.

Limitations

  • These patients had diabetic and/or five other possible causes of peripheral neuropathy.
  • No blinding in the study sample.
  • Small sample.
  • Few patients had cancer.

Nursing Implications

The findings support that notion that both pregabalin and gabapentin may provide pain relief in some patients with peripheral neuropathy. The majority of cases were patients with diabetes. Application to patients with cancer is unclear.