Skip to main content

Advertisement

Log in

Post hoc analysis of pregabalin vs. non-pregabalin treatment in patients with cancer-related neuropathic pain: better pain relief, sleep and physical health

  • Research Articles
  • Published:
Clinical and Translational Oncology Aims and scope Submit manuscript

Abstract

Background and purpose

A previous study of cancer-related neuropathic pain (NP) found that a 10-fold increase in pregabalin (PGB) use increased patients’ satisfaction with treatment. Further research of PGB vs. non-pregabalin (non-PGB) treatment was carried out to assess if the use of more specific NP-targeting drugs, such as PGB, in combined therapy, in patients with cancer-related NP, provides better health outcomes.

Patients and methods

Post hoc analysis of PGB-vs. non-PGB-treated patients in a 2-month epidemiological, prospective, multicentre study to assess NP prevalence and management in cancer pain patients visiting radiotherapy oncologic units. Patients undertook the Brief Pain Inventory (BPI), Hospital Anxiety and Depression Scale (HADS), the Medical Outcomes Sleep Scale (MOS-Sleep) and the short form (SF-12) Health Survey.

Results

A total of 273 patients with no previous PGB treatment: 162 were treated with PGB polytherapy and 111 with other treatments. At 8 weeks, satisfaction with treatment was 92.6% (PGB) vs. 78.9% (non-PGB), p=0.0024, and benzodiazepine use 37.8% (non-PGB) vs. 19.8% (PGB), p=0.0009. The decreases in BPI total pain intensity and total interference with activities and in MOS overall sleep problems index were signifi cantly larger in the PGB group.

Conclusions

The addition of more specifi c NP-targeting drugs to usual treatment, such as PGB, in NP cancer patients provides more satisfaction with treatment and better outcomes in terms of pain intensity, interference with activities and sleep than treatments without specific NP-targeting drugs. Anxiolytic profile of PGB could allow for less use of benzodiazepines.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References

  1. IASP (1994) Part III: pain terms, a current list with definitions and notes on usage. In: Classification of chronic pain, 2nd edition. IASP Press, Seattle, pp 209–213

    Google Scholar 

  2. Chang VT, Janjan N, Jain S, Chau C (2006) Update in cancer pain syndromes. J Palliat Med 9:1414–1434

    Article  PubMed  Google Scholar 

  3. Caraceni A, Portenoy RK (1999) An international survey of cancer pain characteristics and syndromes. IASP task force on cancer pain. International Association for the Study of Pain. Pain 82:263–274

    CAS  Google Scholar 

  4. Stute P, Soukup J, Menzel M et al (2003) Analysis and treatment of different types of neuropathic cancer pain. J Pain Symptom Manage 26:1123–1131

    Article  PubMed  Google Scholar 

  5. Burton AW, Fanciullo GJ, Beasley RD, Fisch MJ (2007) Chronic pain in the cancer survivor: a new frontier. Pain Med 8:189–198

    Article  PubMed  Google Scholar 

  6. Twycross R, Harcourt J, Bergl S (1996) A survey of pain in patients with advanced cancer. J Pain Symptom Manage 12:273–282

    Article  PubMed  CAS  Google Scholar 

  7. Fan G, Hadi S, Chow E (2007) Symptom clusters in patients with advanced-stage cancer referred for palliative radiation therapy in an outpatient setting. Support Cancer Ther 4:157–162

    Article  PubMed  Google Scholar 

  8. Walsh D, Rybicki L (2006) Symptom clustering in advanced cancer. Support Care Cancer 14:831–836

    Article  PubMed  Google Scholar 

  9. Horowitz SH (2007) The diagnostic workup of patients with neuropathic pain. Med Clin North Am 91:21–30

    Article  PubMed  Google Scholar 

  10. Stacey BR (2005) Management of peripheral neuropathic pain. Am J Phys Med Rehab 84:S4–16

    Google Scholar 

  11. Sun V, Borneman T, Piper B et al (2008) Barriers to pain assessment and management in cancer survivorship. J Cancer Surviv 2:65–71

    Article  PubMed  Google Scholar 

  12. Sinnott C (2002) Problems recruiting cancer patients to a comparative clinical trial of drug treatments for neuropathic pain in palliative care. J Pain Symptom Manage 23:270–272

    Article  PubMed  Google Scholar 

  13. Backonja MM, Serra J (2004) Pharmacologic management part 1: better-studied neuropathic pain diseases. Pain Med 5[Suppl 1]:S28–47

    Article  Google Scholar 

  14. Portenoy RK, Foley KM, Inturrisi CE (1990) The nature of opioid responsiveness and its implications for neuropathic pain: new hypotheses derived from studies of opioid infusions. Pain 43:273–286

    Article  PubMed  CAS  Google Scholar 

  15. Mercadante S, Gebbia V, David F et al (2009) Tools for identifying cancer pain of predominantly neuropathic origin and opioid responsiveness in cancer patients. J Pain 10:594–600

    PubMed  Google Scholar 

  16. Levy MH, Chwistek M, Mehta RS (2008) Management of chronic pain in cancer survivors. Cancer J 14:401–409

    Article  PubMed  Google Scholar 

  17. Montero Homs J, Gutierrez-Rivas E, Pardo Fernandez J, Navarro Darder C (2005) [Epidemiological study of prevalence, incidence and neuropathic pain characterization in neurology units. Prevadol study]. Neurologia 20:385–389

    PubMed  CAS  Google Scholar 

  18. Perez C, Saldana MT, Navarro A et al (2009) Prevalence and characterization of neuropathic pain in a primary-care setting in Spain: a crosssectional, multicentre, observational study. Clin Drug Investig 29:441–450

    Article  PubMed  Google Scholar 

  19. Obermann M, Yoon MS, Sensen K et al (2008) Effi cacy of pregabalin in the treatment of trigeminal neuralgia. Cephalalgia 28:174–181

    Article  PubMed  CAS  Google Scholar 

  20. Zareba G (2005) Pregabalin: a new agent for the treatment of neuropathic pain. Drugs Today (Barc) 41:509–516

    Article  CAS  Google Scholar 

  21. Sommer M, Bachmann CG, Liebetanz KM et al (2007) Pregabalin in restless legs syndrome with and without neuropathic pain. Acta Neurol Scand 115:347–350

    Article  PubMed  CAS  Google Scholar 

  22. Finnerup NB, Jensen TS (2007) Clinical use of pregabalin in the management of central neuropathic pain. Neuropsychiatr Dis Treat 3:885–891

    PubMed  CAS  Google Scholar 

  23. Pohl RB, Feltner DE, Fieve RR, Pande AC (2005) Efficacy of pregabalin in the treatment of generalized anxiety disorder: double-blind, placebo-controlled comparison of bid versus tid dosing. J Clin Psychopharmacol 25:151–158

    Article  PubMed  CAS  Google Scholar 

  24. Sabatowski R, Galvez R, Cherry DA et al (2004) Pregabalin reduces pain and improves sleep and mood disturbances in patients with post-herpetic neuralgia: results of a randomised, placebo-controlled clinical trial. Pain 109:26–35

    Article  PubMed  CAS  Google Scholar 

  25. Pae CU (2009) Pregabalin augmentation to antidepressants in patients with major depressive disorder. Prog Neuropsychopharmacol Biol Psychiatry 33:577–578

    Article  PubMed  Google Scholar 

  26. Fairchild A, Chow E (2007) Role of radiation therapy and radiopharmaceuticals in bone metastases. Curr Opin Support Palliat Care 1:169–173

    Article  PubMed  Google Scholar 

  27. Chow E (2007) Update on radiation treatment for cancer pain. Curr Opin Support Palliat Care 1:11–15

    Article  PubMed  Google Scholar 

  28. Mañas A, Monroy JL, Ramos AA et al (2010) Prevalence of neuropathic pain in radiotherapy oncology units. Int J Radiat Oncol Biol Phys [Epub ahead of print]

  29. Bouhassira D, Attal N, Alchaar H et al (2005) Comparison of pain syndromes associated with nervous or somatic lesions and development of a new neuropathic pain diagnostic questionnaire (dn4). Pain 114:29–36

    Article  PubMed  Google Scholar 

  30. Badia X, Muriel C, Gracia A et al (2003) [Validation of the Spanish version of the brief pain inventory in patients with oncological pain]. Med Clin (Barc) 120:52–59

    Article  Google Scholar 

  31. Zigmond AS, Snaith RP (1983) The hospital anxiety and depression scale. Acta Psychiatr Scand 67:361–370

    Article  PubMed  CAS  Google Scholar 

  32. Rejas J, Ribera MV, Ruiz M, Masrramon X (2007) Psychometric properties of the MOS (Medical Outcomes Study) sleep scale in patients with neuropathic pain. Eur J Pain 11:329–340

    Article  PubMed  Google Scholar 

  33. Badia X, Salamero M, Alonso J (2002) La medida de la salud. Guía de escalas de medición en español. In: Edimac con Fundación Lilly, Barcelona

  34. Saif MW, Hashmi S (2008) Successful amelioration of oxaliplatin-induced hyperexcitability syndrome with the antiepileptic pregabalin in a patient with pancreatic cancer. Cancer Chemother Pharmacol 61:349–354

    Article  PubMed  Google Scholar 

  35. Ravnefjord A, Brusberg M, Larsson H et al (2008) Effects of pregabalin on visceral pain responses and colonic compliance in rats. Br J Pharmacol 155:407–416

    Article  PubMed  CAS  Google Scholar 

  36. Ling B, Coudore F, Decalonne L et al (2008) Comparative antiallodynic activity of morphine, pregabalin and lidocaine in a rat model of neuropathic pain produced by one oxaliplatin injection. Neuropharmacology 55:724–728

    Article  PubMed  CAS  Google Scholar 

  37. Chiechio S, Zammataro M, Caraci F et al (2009) Pregabalin in the treatment of chronic pain: an overview. Clin Drug Investig 29:203–213

    Article  PubMed  CAS  Google Scholar 

  38. Cloos JM, d'Ferreira V (2009) Current use of benzodiazepines in anxiety disorders. Curr Opin Psychiatry 22:90–95

    Article  PubMed  Google Scholar 

  39. Hidalgo RB, Tupler LA, Davidson JR (2007) An effect-size analysis of pharmacologic treatments for generalized anxiety disorder. J Psychopharmacol 21:864–872

    Article  PubMed  CAS  Google Scholar 

  40. Twycross R (1994) The risks and benefi ts of corticosteroids in advanced cancer. Drug Saf 11:163–178

    Article  PubMed  CAS  Google Scholar 

  41. Gibbs M (2009) The role of transdermal fentanyl patches in the effective management of cancer pain. Int J Palliat Nurs 15:354–359

    PubMed  Google Scholar 

  42. Radbruch L, Elsner F (2004) Clinical experience with transdermal fentanyl for the treatment of cancer pain in germany. Keio J Med 53:23–29

    Article  PubMed  CAS  Google Scholar 

  43. Kim SW, Shin IS, Kim JM et al (2008) Effectiveness of mirtazapine for nausea and insomnia in cancer patients with depression. Psychiatry Clin Neurosci 62:75–83

    Article  PubMed  CAS  Google Scholar 

  44. Theobald DE, Kirsh KL, Holtsclaw E et al (2002) An open-label, crossover trial of mirtazapine (15 and 30 mg) in cancer patients with pain and other distressing symptoms. J Pain Symptom Manage 23:442–447

    Article  PubMed  CAS  Google Scholar 

  45. Cankurtaran ES, Ozalp E, Soygur H et al (2008) Mirtazapine improves sleep and lowers anxiety and depression in cancer patients: superiority over imipramine. Support Care Cancer 16:1291–1298

    Article  PubMed  Google Scholar 

  46. Freynhagen R, Grond S, Schupfer G et al (2007) Efficacy and safety of pregabalin in treatment refractory patients with various neuropathic pain entities in clinical routine. Int J Clin Pract 61:1989–1996

    Article  PubMed  CAS  Google Scholar 

  47. Hays RD, Martin SA, Sesti AM, Spritzer KL (2005) Psychometric properties of the medical outcomes study sleep measure. Sleep Med 6:41–44

    Article  PubMed  Google Scholar 

  48. Hindmarch I, Dawson J, Stanley N (2005) A double-blind study in healthy volunteers to assess the effects on sleep of pregabalin compared with alprazolam and placebo. Sleep 28:187–193

    PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to María Pérez.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Mañas, A., Ciria, J.P., Fernández, M.C. et al. Post hoc analysis of pregabalin vs. non-pregabalin treatment in patients with cancer-related neuropathic pain: better pain relief, sleep and physical health. Clin Transl Oncol 13, 656–663 (2011). https://doi.org/10.1007/s12094-011-0711-0

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12094-011-0711-0

Keywords

Navigation