Glossopharyngeal neuralgia responding to pregabalin

The author reports the use of pregabalin in a patient with glossopharyngeal neuralgia. The patient achieved complete pain relief and tolerated the medication. This is the first published report of the use of this medicine for glossopharyngeal neuralgia.     

糖尿病合并顽固性结节性痒疹患者的护理

总结3例2型糖尿病合并顽固性结节性痒疹的护理,经严格控制血糖、使用有效抗生素、进行糖皮质类固醇激素治疗,配合病变皮肤清洗止痒及小剂量紫外线照射治疗,严格控制感染,做好创面处理、饮食护理及病情观察,3例患者均治愈出院。     

术前口服普瑞巴林对气管插管引起的血流动力学变化的影响

目的:评估麻醉诱导前口服普瑞巴林胶囊抑制全麻诱导后气管插管所致血流动力学变化的效果。方法:2016年9月至12月连续纳入53例受试者,随机分为对照组和术前1h口服150mg普瑞巴林组(普瑞巴林组),其中对照组26例、普瑞巴林组27例。在服药前及服药后1h进行镇静程度评分(Ramsay评分);分别在服药前,气管插管前,气管插管后0、1、3、5、7、10min记录心率(heart rate,HR)、收缩压(systolic blood pressure,SBP)、舒张压(diastolic blood pressure,DBP),同时记录围手术期药物不良反应。结果:普瑞巴林组SBP、DBP在气管插管后1、3、5min均小于对照组(P0.05);普瑞巴林组HR在气管插管后1min小于对照组(P0.05)。普瑞巴林组Ramsay评分在服药后1h高于对照组(P0.001)。两组患者围手术期不良反应的发生率差异无统计学意义。结论:术前口服150mg普瑞巴林可有效稳定气管插管后的血流动力学波动,降低术前焦虑程度,且不增加不良反应的发生。     

普瑞巴林治疗枕神经痛的临床疗效观察

目的观察普瑞巴林治疗枕神经痛的疗效及安全性。方法将80例枕神经痛患者,随机分为治疗组（n=40）和对照组（n=40）。对照组常规予以非甾体类消炎镇痛药、活血化瘀及B族维生素等治疗,治疗组在此基础上加用普瑞巴林75~150 mg,2次/d。2组均观察3周,分别于治疗前及治疗后的1、2、3周进行自评、医评分值评价和临床疗效评价,判断普瑞巴林的疗效及安全性。结果 2组治疗前自评和医评分值比较。差异无统计学意义（P〉0.05）;2组治疗后1、2、3周,治疗组与对照组自评和医评分值比较,差异有统计学意义（P〈0.05）;临床疗效：治疗组有效率92.5%;对照组有效率52.5%,2组比较差异有统计学意义（P〈0.05）。两组均未发现严重副作用。结论普瑞巴林能有效改善枕神经痛患者的临床症状,副作用小,值得临床推广应用。     

Actinic prurigo of the lip: Two case reports

Actinic prurigo is a photodermatosis that can affect the skin, conjunctiva and lips. It is caused by an abnormal reaction to sunlight and is more common in high-altitude living people, mainly in indigenous descendants. The diagnosis of actinic prurigo can be challenging, mainly when lip lesions are the only manifestation, which is not a common clinical presentation. The aim of this article is to report two cases of actinic prurigo showing only lip lesions. The patients were Afro-American and were unaware of possible Indian ancestry. Clinical exam, photographs, videoroscopy examination and biopsy were performed, and the diagnosis of actinic prurigo was established. Topical corticosteroid and lip balm with ultraviolet protection were prescribed with excellent results. The relevance of this report is to show that although some patients may not demonstrate the classical clinical presentation of actinic prurigo, the associated clinical and histological exams are determinants for the correct diagnosis and successful treatment of this disease.     

普瑞巴林联合塞来昔布治疗腰椎间盘突出症患者术后疼痛的效果

目的研究普瑞巴林联合塞来昔布治疗腰椎间盘突出症(LDH)患者术后疼痛的效果。方法纳入2018年1月至2018年12月我院收治的LDH术后疼痛患者90例,按照随机数字表法将其分为对照组和观察组,各45例。对照组于术前3 d至术后14 d给予塞来昔布治疗,观察组在对照组基础上于术前3 d至术后14 d给予普瑞巴林治疗。比较两组术后3个月的治疗优良率,术前及术后1、3个月的VAS和腰痛ODI评分。结果术后3个月,观察组的治疗优良率明显高于对照组,差异具有统计学意义(P<0.05)。术前及术后3个月,两组患者的VAS评分比较,差异无统计学意义(P>0.05);术后1个月,观察组的VAS评分明显低于对照组,差异具有统计学意义(P<0.05)。术前,两组患者ODI评分比较,差异无统计学意义(P>0.05);术后1、3个月,观察组ODI评分明显低于对照组,差异具有统计学意义(P<0.05)。两组不良反应总发生率比较,差异无统计学意义(P>0.05)。结论普瑞巴林联合塞来昔布能够有效降低LDH患者术后疼痛评分及ODI评分,安全性好,有利于促进患者的早期康复,值得临床推广应用。     

脉冲射频刺激联合普瑞巴林治疗带状疱疹后遗三叉神经痛的临床效果

目的探讨脉冲射频刺激联合普瑞巴林治疗带状疱疹后遗三叉神经痛的临床效果,为临床治疗该病提供参考依据。方法选取我科室于2017年2月至2020年2月收治的358例带状疱疹后遗三叉神经疼痛者为研究对象,以随机数字表法将其分为对照组和观察组,各179例。对照组给予普瑞巴林治疗,观察组给予脉冲射频刺激联合普瑞巴林治疗。比较两组的疼痛程度、机体神经肽水平、生活质量及治疗过程中的不良反应发生情况。结果治疗后1、2、3、4周,观察组的VAS评分均明显低于对照组,差异具有统计学意义(P<0.05)。治疗后,观察组的SP、CGRP水平明显低于对照组,β-EP水平明显高于对照组,差异具有统计学意义(P<0.05)。治疗后,两组的生理机能、生理职能、躯体疼痛、一般健康状况、精力、社会功能、情感职能、精神健康评分均较治疗前明显升高,且观察组高于对照组,差异具有统计学意义(P<0.05)。两组患者治疗过程中的不良反应总发生率比较,差异无统计学意义(P>0.05)。结论脉冲射频刺激联合普瑞巴林应用于带状疱疹后遗三叉神经痛的治疗中,可改善患者体内的神经肽水平,迅速缓解疼痛,提升生活质量,且不增加不良反应,安全性好,值得推广。     

Efficacy and safety of pregabalin in alcohol dependence

INTRODUCTION: Pregabalin is a new anxiolytic that selectively binds to the alpha2-delta subunit of voltage-gated calcium channels, inhibiting release of excessive levels of excitatory neurotransmitters. In this open-label trial we aimed to investigate the efficacy of pregabalin on alcoholism indices in detoxified alcohol-dependent subjects. Reduction of cravings, psychiatric symptom improvements, and the evaluation of safety parameters were the secondary endpoints. METHODS: Thirty-one alcohol-dependent patients were consecutively recruited and screened for the study. Twenty detoxified patients received pregabalin starting at 50 mg/day (orally) in the first week, gradually increasing to a flexible dose of 150-450 mg/day. Subjects were assessed at the beginning of the treatment, and after 2, 8 and 16 weeks. Craving (visual analogue scale, Obsessive and Compulsive Drinking Scale [OCDS]) and withdrawal (Clinical Institute Withdrawal Assessment for Alcohol [CIWA-Ar]) rating scales were applied; psychiatric symptoms were evaluated through the Symptom Check List-90-Revised (SCL-90-R). RESULTS: Out of the twenty patients who received the study drug, 15 completed the study procedures: 10 remained totally alcohol-free for the duration of the study, five relapsed. An additional four patients dropped out during the study, and one stopped taking medication due to adverse events. A significant progressive reduction of both craving and withdrawal symptomatology were observed. Safety parameters did not show any significant variation during treatment. CONCLUSION: Pregabalin shows promise as a treatment for alcohol dependence. Although limited by a low number of participants and by the open design, this is the first study concerning the efficacy and safety of pregabalin in current alcoholics. In these patients pregabalin was effective and well tolerated. Additional research is needed to explore the clinical relevance of these findings.     

综合康复治疗肩周炎的疗效观察

目的：观察口服普瑞巴林联合经皮电刺激治疗腹部带状疱疹后遗神经痛（PHN）的临床效果。方法：腹部PHN患者52例,随机分为2组各26例。对照组口服普瑞巴林300mg,每天2次;观察组在此基础上给予患处经皮神经电刺激（TENS）治疗。用视觉模拟疼痛评分（VAS）和睡眠质量评分（QS）评价效果,并观察治疗后的不良反应。结果：治疗1、2、3及4周后,2组VAS和QS评分均显著下降（均P〈0．05）,观察组降低较对照组更明显（均P〈0．05）。2组不良反应比较差异无统计学意义。结论：口服普瑞巴林300mg联合TENS治疗可有效缓解腹部PHN,改善睡眠质量。且无明显不良反应。     

普瑞巴林联合神经阻滞治疗老年带状疱疹后三叉神经痛的疗效

目的观察普瑞巴林联合神经阻滞治疗老年带状疱疹后三叉神经痛的效果。方法 45例带状疱疹后三叉神经痛患者随机分为观察组和对照组,对照组采用口服普瑞巴林胶囊,观察组在对照组的基础上加用神经阻滞法。治疗4周后采用视觉模拟评分(VAS)和睡眠质量评分(PSQI)评价临床疗效。结果 2组患者治疗前及治疗1周后VAS评分和PSQI评分均无显著差异(P0.05),但治疗第2、3、4周,2组患者VAS评分和PSQI评分均显著降低,且观察组较对照组降低更为显著,差异有统计学意义(P0.05)。结论普瑞巴林联合神经阻滞治疗老年带状疱疹后三叉神经痛效果好,操作简单,值得临床应用。     

Efficacy of pregabalin in the treatment of trigeminal neuralgia

This prospective, open-label study aimed to evaluate the efficacy of pregabalin treatment in patients suffering from trigeminal neuralgia with and without concomitant facial pain. Fifty-three patients with trigeminal neuralgia (14 with concomitant chronic facial pain) received pregabalin (PGB) 150–600 mg daily and were prospectively followed for 1 year. The primary outcome was number of patients pain free or with reduction of pain intensity by > 50% and of attack frequency by > 50% after 8 weeks. Secondary outcome was sustained pain relief after 1 year. Thirty-nine patients (74%) improved after 8 weeks with a mean dose of 269.8 mg/day (range 150–600 mg/day) PGB: 13 (25%) experienced complete pain relief and 26 (49%) reported pain reduction > 50%, whereas 14 (26%) did not improve. Patients without concomitant facial pain showed better response rates (32 of 39, 82%) compared with patients with concomitant chronic facial pain (7 of 14, 50%, P  = 0.020). Concomitant chronic facial pain appears to be a clinical predictor of poor treatment outcome. PGB appears to be effective in the treatment of trigeminal neuralgia.     

普瑞巴林术前给药对肛肠病患者术后疼痛的影响

目的探讨普瑞巴林术前给药对肛肠病患者术后疼痛及睡眠质量的影响。方法选择肛肠病手术患者60例,随机分为P组(普瑞巴林)、S组(塞来昔布)和C组为(安慰剂)。比较3组术后4、8、12、24、48 h的VAS评分、血流动力学指标及并发症情况。结果与S组和C组相比,P组在术后24 h内各个时点创口VAS评分均显著较低(P0.01)。S组和C组术后24 h内各时点血压、心率均显著升高(P0.05);S组和C组在术后8、12和24 h血压、心率均显著高于P组(P0.05)。P组夜间睡眠障碍发生情况显著优于S组和C组。结论普瑞巴林超前镇痛可有效缓解肛肠病患者术后疼痛,减少应激反应,提高患者生活质量。     

普瑞巴林联合神经妥乐平治疗脊髓损伤患者神经病理性疼痛的疗效观察

目的:探讨神经妥乐平对于脊髓损伤后神经病理性疼痛的临床疗效,同时比较单独使用神经妥乐平与联合使用普瑞巴林和神经妥乐平对神经病理性疼痛的缓解程度、对患者情绪以及睡眠状况的改善情况。方法:选取符合入组标准的脊髓损伤伴神经病理性疼痛患者62例,电脑随机分2组,分别为神经妥乐平组、普瑞巴林联合神经妥乐平组,神经妥乐平组起始剂量为4U bid,普瑞巴林联合神经妥乐平组起始剂量为普瑞巴林75mg bid+神经妥乐平4U bid,间隔3d调整药物剂量,疗程为4周。采用视觉模拟评分量表(visual analogue scale,VAS)、医院焦虑抑郁量表(hospital anxiety and depression scale,HAD)、匹茨堡睡眠质量指数量表(Pittsburgh sleep quality index,PSQI)对患者进行疼痛、情绪和睡眠质量的评估。由专业的康复治疗师对患者服药前和疗程结束后的疗效分别进行评估。结果:单独使用神经妥乐平可以缓解脊髓损伤患者神经病理性疼痛,同时改善患者睡眠质量,治疗前后比较差异有显著性意义(P0.05);而联合使用普瑞巴林和神经妥乐平治疗后,患者的VAS和HAD评分均较神经妥乐平组明显降低,差异有显著性意义(P0.05)。结论:神经妥乐平可以缓解脊髓损伤患者的疼痛症状,联合使用普瑞巴林和神经妥乐平不仅明显缓解脊髓损伤神经病理性疼痛患者的疼痛症状,同时显著改善了患者的焦虑抑郁情绪,提高患者睡眠质量,进而提升患者生存质量,是一种有效的临床治疗方法。     

Cost of treatment of peripheral neuropathic pain with pregabalin or gabapentin in routine clinical practice: impact of their loss of exclusivity

To analyze the effect of loss of exclusivity of data on the cost of treatment of peripheral neuropathic pain (PNP) with pregabalin or gabapentin in routine clinical practice. A retrospective observational study, with electronic medical records for patients enrolled at primary care centers managed by the health care provider Badalona Serveis Assistencials, who initiated treatment of PNP with pregabalin or gabapentin. The analysis used drugs and resources prices for year 2015. The 1163 electronic medical records (pregabalin; N = 764, gabapentin; N = 399) for patients (62.2% women) with a mean (standard deviation) age of 59.2 (14.7) years were analyzed. Treatment duration was slightly shorter with pregabalin than with gabapentin (5.2 vs 5.5 months; P = 0.124), with mean doses of 227.4 (178.6) mg and 900.0 (443.4) mg, respectively. The average study drug cost per patient was higher for pregabalin than for gabapentin; €214.6 (206.3) vs €157.4 (181.9), P < 0.001, although the cost of concomitant analgesic medication was lower; €176.5 (271.8) vs €306.7 (529.2), P < 0.001. The adjusted average total cost per patient was lower in those treated with pregabalin than in those treated with gabapentin; €2,413 (2119‐2708) vs €3201 (2806–3.597); P = 0.002, owing to significantly lower health care costs; €1307 (1247‐1367) vs €1538 (1458‐1618), P < 0.001, and also non‐health care costs; €1106 (819‐1393) vs €1663 (1279‐2048), P = 0.023, that was caused by a significantly lower use of concomitant medication, fewer medical visits to primary care, and fewer days of sick leave. After loss of exclusivity of both drugs, pregabalin continued to show lower health care and non‐health care costs than gabapentin in the treatment of PNP in routine clinical practice.     

Gabapentin and pregabalin in the treatment of fibromyalgia: a systematic review and a meta-analysis

WHAT IS KNOWN AND OBJECTIVES: Fibromyalgia (FBM) is a common chronic pain disorder affecting up to 2% of the general population. Current treatment options are mostly symptom-based and limited both in efficacy and number. Two promising alternatives are gabapentin (GP) and pregabalin (PB). We aimed to estimate the efficacy and safety/tolerability of the two compounds in FBM through a systematic review and a meta-analysis of relevant randomized double-blind placebo-controlled (RCT) were performed. DATA SOURCES, EXTRACTION AND ANALYSIS: A literature search was conducted through MEDLINE, EMBASE, Cochrane CENTRAL and the reference lists of relevant studies. Responders to treatment (>30% reduction in mean pain score) and dropouts due to lack of efficacy were used as primary outcome measures. Dropout rates and incidence of common adverse outcomes were also investigated. Four RCTs, reporting data on 2040 patients, were reviewed and three of them using PG were included in the meta-analysis. RESULTS: Pregabalin at a dose of 600, 450 and 300 mg per day is effective in FBM compared to placebo (NNT: 7, upper 95% CI: 12, 450 mg). A number of adverse events (AE), such as dizziness, somnolence, dry mouth, weight gain, peripheral oedema, is consistently associated with treatment at any dose and could lead one out of four patients to quit treatment (NNH: 6, lower 95% CI: 4, 600 mg). Indirect comparison meta-analysis suggests that PB at a dose of 450 mg per day could result in more responders than at 300 mg, but this result needs to be interpreted with caution as there were no significant differences between 600 and 300 mg or between 600 and 450 mg. Data on GP is limited. WHAT IS NEW AND CONCLUSIONS: The analysis indicates that PB at a dose of 450 mg per day is most likely effective in treating FBM, although AE are not negligible. Further evidence is necessary for more conclusive inferences.     

Gabapentin and pregabalin suppress tactile allodynia and potentiate spinal cord stimulation in a model of neuropathy.

Spinal cord stimulation (SCS) is an effective tool in alleviating neuropathic pain. However, a number of well-selected patients fail to obtain satisfactory pain relief. Previous studies have demonstrated that i.t. baclofen and/or adenosine can enhance the SCS effect, but this combined therapy has been shown to be useful in less than half of the cases and more effective substances are therefore needed. The aim of this experimental study in rats was to examine whether gabapentin or pregabalin attenuates tactile allodynia following partial sciatic nerve injury and whether subeffective doses of these drugs can potentiate the effects of SCS in rats which do not respond to SCS. Mononeuropathy was produced by a photochemically induced ischaemic lesion of the sciatic nerve. Tactile withdrawal thresholds were assessed with von Frey filaments. Effects of increasing doses of gabapentin and pregabalin (i.t. and i.v.) on the withdrawal thresholds were analysed. These drugs were found to reduce tactile allodynia in a dose-dependent manner. In SCS non-responding rats, i.e. where stimulation per se failed to suppress allodynia, a combination of SCS and subeffective doses of the drugs markedly attenuated allodynia. In subsequent acute experiments, extracellular recordings from wide dynamic range neurones in the dorsal horn showed prominent hyperexcitability. The combination of SCS and gabapentin, at the same subeffective dose, clearly enhanced suppression of this hyperexcitability. In conclusion, electrical therapy and pharmacological therapy in neuropathic pain can, when they are inefficient individually, become effective when combined.     

Costs and health resources utilization following switching to pregabalin in individuals with gabapentin-refractory neuropathic pain: a post hoc analysis

Purpose: To analyze the changes in pain severity and associated costs resulting from resource utilization and reduced productivity in patients with gabapentin‐refractory peripheral neuropathic pain who switched to pregabalin therapy in primary care settings in Spain. Patients and Methods: This is a post hoc analysis of a 12‐week, multicentre, noninterventional cost‐of‐illness study. Patients were included in the study if they were over 18 years of age and had a diagnosis of chronic, treatment‐refractory peripheral neuropathic pain. The analysis included all pregabalin‐naïve patients who had previously shown an inadequate response to gabapentin and switched to pregabalin. Severity of pain before and after treatment with pregabalin, alone or as an add‐on therapy, was assessed using the Short‐Form McGill Pain Questionnaire (SF‐MPQ) and its related visual analogue scale (VA). Healthcare resource utilization, productivity (including lost‐workday equivalents [LWDE]), and related costs were assessed at baseline and after pregabalin treatment. Results: A total of 174 patients switched to pregabalin had significant and clinically relevant reductions in pain severity (mean [SD] change on SF‐MPQ VA scale, ?31.9 [22.1]; P < 0.05 vs. baseline; effect size, 1.87). Reduction in pain was similar with both pregabalin monotherapy and add‐on therapy. Significant reductions in healthcare resource utilization (concomitant drug use [in pregabalin add‐on group], ancillary tests, and unscheduled medical visits) were observed at the end of trial. Additionally, there were substantial improvements in productivity, including a reduction in the number of LWDE following pregabalin treatment (?18.9 [26.0]; P < 0.0001). These changes correlated with substantial reductions in both direct (?652.9 ± 1622.4 €; P < 0.0001) and indirect healthcare costs (?851.6 [1259.6] €; P < 0.0001). Conclusions: The cost of care in patients with gabapentin‐refractory peripheral neuropathic pain appeared to be significantly reduced after switching to pregabalin treatment, alone or in combination with other analgesic drugs, in a real‐life setting.