Pregabalin Reduced Pain from Chronic Pancreatitis

A 3-week treatment with the gabapentoid pregabalin was superior to placebo and might be a useful adjunct agent for this difficult-to-treat condition.

Patients with chronic pancreatitis often have abdominal pain, which can be intractable and difficult to control. Therapeutic options are limited, and many patients become dependent on, and even addicted to, narcotic analgesics for pain control. Nonopioid agents have been suggested as adjuncts to narcotics but have not been tested in randomized studies. These include gabapentoids (gabapentin and pregabalin), which have shown efficacy in treating a wide variety of neuropathic conditions that seem to share neuropathic mechanisms and central pain processing patterns found in painful chronic pancreatitis.

To investigate the efficacy and safety of the gabapentoid pregabalin in reducing pain from chronic pancreatitis, researchers in Denmark and the Netherlands randomized 64 patients (out of 236 screened) with chronic pancreatitis and chronic abdominal pain to receive either pregabalin (escalating doses to a maximum of 300 mg twice a day) or placebo for 3 weeks in a double-blind trial. Pain relief (the primary endpoint) was measured using a visual analog scale of 0 (no pain) to 10 (worst pain imaginable). Opioid use was allowed, as long as the dose was stable. Study groups were well matched in baseline demographics and clinical characteristics.

Pain relief was better in the pregabalin group than the placebo group (decrease in average pain score, 36% vs. 24%; P=0.02). This difference of 12% translated to a number needed to treat (NNT) of 8. More pregabalin recipients than placebo recipients reported "much" or "very much" improvement in treatment response (44% vs. 21%; P=0.048). Pregabalin recipients also achieved a much larger reduction in opioid use. Adverse effects of the central nervous system were more common in the pregabalin group (feeling drunk, light-headedness), but these seemed to decrease during the course of the trial.

Comment: This is the first placebo-controlled study to assess the efficacy of gabapentoids in treating the pain of chronic pancreatitis. Pregabalin was superior to placebo, with a reasonable NNT of 8. Treatment of pain in these patients is challenging, and even small additions to our armamentariums are valuable. Although pregabalin did not eliminate pain, the effect of reducing both pain and the need for narcotic analgesics is clinically valuable. Also, a slight uptick in quality of life was seen but did not achieve statistical significance. Even though gabapentin has not yet been studied, we hope that it will also be effective. Long-term studies of these agents and others will be useful in gauging their effects in these difficult-to-treat patients. Meanwhile, use of gabapentoids as an adjunctive agent should be strongly considered in patients with painful chronic pancreatitis.

— Chris E. Forsmark, MD

Published in Journal Watch Gastroenterology September 9, 2011

# posted by roodbont @ 4:27 AM