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Low-dose gabapentin as useful adjuvant to opioids for neuropathic cancer pain when combined with low-dose imipramine

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Abstract

Purpose

Painful neuropathic conditions of cancer pain often show little response to nonopioid and opioid analgesics but may be eased by antidepressants and anticonvulsants. Although gabapentin is effective in the treatment of neuropathic pain in patients with cancer, some patients experience intolerable side effects sufficient to warrant discontinuation. The aim of this study was to see whether low-dose gabapentin is effective in treating cancer-related neuropathic pain when combined with low-dose imipramine.

Methods

Fifty-two cancer patients diagnosed as having neuropathic pain were allocated into four groups: G400-I group took gabapentin 200 mg and imipramine 10 mg every 12 h orally; G400 group took gabapentin 200 mg every 12 h orally; G800 group took gabapentin 400 mg every 12 h orally; I group took imipramine 10 mg every 12 h orally.

Results

Low-dose gabapentin–imipramine significantly decreased the total pain score and daily paroxysmal pain episodes. Several patients developed mild adverse symptoms in the four groups, and three patients discontinued treatment due to severe adverse events in the G800 group.

Conclusion

Low-dose gabapentin–antidepressant combination with opioids was effective in managing neuropathic cancer pain without severe adverse effects.

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References

  1. Ross JR, Goller K, Hardy J, Riley J, Broadley K, A’hern R, Williams J. Gabapentin is effective in the treatment of cancer-related neuropathic pain: a prospective, open-label study. J Palliat Med. 2005;8:1118–26.

    Article  CAS  PubMed  Google Scholar 

  2. Cavenagh J, Good P, Ravenscroft P. Neuropathic pain: are we out of the woods yet? Intern Med J. 2006;36:251–5.

    Article  CAS  PubMed  Google Scholar 

  3. Eisenberg E, McNicol ED, Carr DB. Efficacy and safety of opioid agonists in the treatment of neuropathic pain of nonmalignant origin: systematic review and meta-analysis of randomized controlled trials. JAMA. 2005;293:3043–52.

    Article  CAS  PubMed  Google Scholar 

  4. World Health Organization. Cancer pain relief. Geneva, Switzerland: WHO; 1996. http://www.painpolicy.wisc.edu/publicat/cprguid.htm

  5. Berger A, Dukes E, Mercadante S, Oster G. Use of antiepileptics and tricyclic antidepressants in cancer patients with neuropathic pain. Eur J Cancer Care. 2006;15:138–45.

    Article  CAS  Google Scholar 

  6. Dworkin RH, O’Connor AB, Backonja M, Farrar JT, Finnerup NB, Jensen TS, Kalso EA, Loeser JD, Miaskowski C, Nurmikko TJ, Portenoy RK, Rice AS, Stacey BR, Treede RD, Turk DC, Wallace MS. Pharmacologic management of neuropathic pain: evidence-based recommendations. Pain. 2007;132:237–51.

    Article  CAS  PubMed  Google Scholar 

  7. Gilron I, Bailey JM, Tu D, Holden RR, Weaver DF, Houlden RL. Morphine, gabapentin, or their combination for neuropathic pain. N Engl J Med. 2005;352(13):1324–34.

    Article  CAS  PubMed  Google Scholar 

  8. Keskinbora K, Pekel AF, Aydinli I. Gabapentin and an opioid combination versus opioid alone for the management of neuropathic cancer pain: a randomized open trial. J Pain Symptom Manage. 2007;34:183–9.

    Article  CAS  PubMed  Google Scholar 

  9. Oneschuk D, Al-Shahri MZ. The pattern of gabapentin use in a tertiary palliative care unit. J Palliat Care. 2003;19:185–7.

    PubMed  Google Scholar 

  10. Gilron I, Max MB. Combination pharmacotherapy for neuropathic pain: current evidence and future directions. Expert Rev Neurother. 2005;5:823–30.

    Article  CAS  PubMed  Google Scholar 

  11. Caraceni A, Zecca E, Bonezzi C, Arcuri E, Yaya Tur R, Maltoni M, Visentin M, Gorni G, Martini C, Tirelli W, Barbieri M, Conno F. Gabapentin for neuropathic cancer pain: a randomized controlled trial from the Gabapentin Cancer Pain Study Group. J Clin Oncol. 2004;22:2909–17.

    Article  CAS  PubMed  Google Scholar 

  12. Hall S, Gallagher RM, Gracely E, Knowlton C, Wescules D. The terminal cancer patient: effects of age, gender, and primary tumor site on opioid dose. Pain Med. 2003;4:125–34.

    Article  PubMed  Google Scholar 

  13. Kannan TR, Saxena A, Bhatnagar S, Barry A. Oral ketamine as an adjuvant to oral morphine for neuropathic pain in cancer patients. J Pain Symptom Manage. 2002;23:60–5.

    Article  CAS  PubMed  Google Scholar 

  14. Caraceni A, Zecca E, Martini C, De Conno F. Gabapentin as an adjuvant to opioid analgesia for neuropathic cancer pain. J Pain Symptom Manage. 1999;17:441–5.

    Article  CAS  PubMed  Google Scholar 

  15. Backonja M, Beydoun A, Edwards KR, Schwartz SL, Fonseca V, Hes M, LaMoreaux L, Garofalo E. Gabapentin for the symptomatic treatment of painful neuropathy in patients with diabetes mellitus: a randomized controlled trial. JAMA. 1998;280:1831–6.

    Article  CAS  PubMed  Google Scholar 

  16. Rowbotham M, Harden N, Stacey B, Bernstein P, Magnus-Miller L. Gabapentin for the treatment of postherpetic neuralgia: a randomized controlled trial. JAMA. 1998;280:1837–42.

    Article  CAS  PubMed  Google Scholar 

  17. Mueller ME, Gruenthal M, Olson WL, Olson WH. Gabapentin for relief of upper motor neuron symptoms in multiple sclerosis. Arch Phys Med Rehabil. 1997;78:521–4.

    Article  CAS  PubMed  Google Scholar 

  18. Vadalouca A, Siafaka I, Argyra E, Vrachnou E, Moka E. Therapeutic management of chronic neuropathic pain: an examination of pharmacologic treatment. Ann N Y Acad Sci. 2006;1088:164–86.

    Article  CAS  PubMed  Google Scholar 

  19. Hayashida K, Eisenach JC. Multiplicative interactions to enhance gabapentin to treat neuropathic pain. Eur J Pharmacol. 2008;598:21–6.

    Article  CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Multidisciplinary Pain Centre, School of Medicine, Aichi Medical University, 21 Karimata, Nagakutecho, Aichigun, Aichi, 480-1195, Japan

    Young-Chang P. Arai, Takako Matsubara, Kazuhiro Shimo, Katsutoshi Suetomi, Makoto Nishihara, Takahiro Ushida, Chiharu Suzuki, Akiko Kinoshita, Miki Kondo, Satuki Matsubara, Ruiko Hayashi, Yukio Tohyama, Kikuyo Nishida & Maki Arakawa

  2. Department of Gastroenterology, School of Medicine, Aichi Medical University, Aichigun, Aichi, Japan

    Kunio Kobayashi

Authors
  1. Young-Chang P. Arai
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  2. Takako Matsubara
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  3. Kazuhiro Shimo
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  4. Katsutoshi Suetomi
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  5. Makoto Nishihara
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  6. Takahiro Ushida
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  7. Kunio Kobayashi
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  8. Chiharu Suzuki
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  9. Akiko Kinoshita
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  10. Miki Kondo
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  11. Satuki Matsubara
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  12. Ruiko Hayashi
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  13. Yukio Tohyama
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  14. Kikuyo Nishida
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  15. Maki Arakawa
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Corresponding author

Correspondence to Young-Chang P. Arai.

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Arai, YC.P., Matsubara, T., Shimo, K. et al. Low-dose gabapentin as useful adjuvant to opioids for neuropathic cancer pain when combined with low-dose imipramine. J Anesth 24, 407–410 (2010). https://doi.org/10.1007/s00540-010-0913-6

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  • DOI: https://doi.org/10.1007/s00540-010-0913-6

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