Pharmacological management of chronic low back pain in older patients: a randomized controlled trial of the effect of pregabalin and opioid administration
- 1.5k Downloads
Pregabalin and opioids are used to treat chronic low back pain (LBP). No previous investigations have compared the efficacy of pregabalin and that of opioids for chronic LBP.
We performed a randomized controlled trial of pregabalin and opioids in 65 consecutive patients aged 65 years or older who had chronic LBP. Each agent was administered randomly in different phases. Pain and activities of daily living (ADL) were evaluated after 4 weeks of treatment using the visual analog scale, Japanese Orthopaedic Association score, Roland Morris Disability Questionnaire, short-form McGill Pain Questionnaire, EuroQol quality-of-life scale, and geriatric depression scale. Neuropathic pain was evaluated using a neuropathic pain screening questionnaire.
The effectiveness rate was 73.3 % for pregabalin and 83.3 % for opioid, showing no significant difference. The mean durations until the onset of effect were 10.2 and 6.1 days, respectively, albeit without significant difference. Pregabalin was effective for LBP with neuropathic pain, whereas opioids were effective for non-neuropathic pain. The improvement of ADL was greater with opioids than with pregabalin. Pregabalin was effective for LBP in patients with lower limb symptoms, whereas opioids were effective for those without lower limb symptoms.
Aside from screening tests, consideration of neuropathic pain and lower extremity symptoms may be an integral component in the selection of the appropriate medication for chronic LBP. Moreover, the therapeutic objectives, including pain relief and/or improvement of ADL, should be specified.
KeywordsChronic low back pain Pregabalin Opioid Randomized controlled trial Pharmacological intervention
- 3.Ruoff GE, Rosenthal N, Jordan D, Karim R, Kamin M (2003) Protocol CAPSS-112 Study Groups. Tramadol/acetaminophen combination tablets for the treatment of chronic low back pain: a multicenter, randomized, double-blind, placebo-controlled outpatient study. Clin Ther 25:1123–1141CrossRefPubMedGoogle Scholar
- 4.Peloso PM, Fortin L, Beailieu A, Kamin M, Rosenthal N (2004) Protocol TRP-CAN-1 Study Group. Analgesic efficacy and safety of tramadol/acetaminophen combination tablets (Ultracet) in treatment of chronic low back pain: a multicenter, outpatient, randomized, double-blind, placebo controlled trial. J Rheumatol 31:2454–2463PubMedGoogle Scholar
- 7.Freynhagen R, Baron R, Tölle T, Stemmler E, Gockel U, Stevens M, Majer C (2006) Screening of neuropathic pain components in patients with chronic low back pain associated with nerve root compression: a prospective observational pilot study (MIPORT). Curr Med Res Opin 22:529–537CrossRefPubMedGoogle Scholar
- 11.Ogawa S (2010) Development of new screening questionnaire to identify neuropathic components in Japanese patients with chronic pain. [In Japanese]. Pain Clinic 31:1187–1194Google Scholar
- 18.Lee JH, Lee CS, the Ultracet ER Study Group (2013) A randomized, double-blind, placebo-controlled, parallel-group study to evaluate the efficacy and safety of the extended-release tramadol hydrochloride/acetaminophen fixed-dose combination tablet for the treatment of chronic low back pain. Clin Ther 35:1830–1840CrossRefGoogle Scholar
- 24.Choi CB, Song JS, Kang YM, Suh CH, Lee J, Choe JY, Lee CK, Shim SC, Chung WT, Song GG, Kim HA, Ji JD, Nam EJ, Park SH, Hong YH, Sheen DH, Lim MK, Seo YI, Sung YK, Kim TH, Lee JT, Bae SC (2007) A 2-week, multicenter, randomized, double-blind, double-dummy, add-on study of the effects of titration on tolerability of tramadol/acetaminophen combination tablet in Korean adults with knee osteoarthritis pain. Clin Ther 29:1381–1389CrossRefPubMedGoogle Scholar