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[PMID]:29279555
[Au] Autor:Masuda R; Ajimi J; Murata T
[Ad] Endereço:Department of Anesthesiology, Tokai University Hachioji Hospital.
[Ti] Título:Pharmacotherapy for Neuropathic Pain in Japan.
[So] Source:J Nippon Med Sch;84(6):258-267, 2017.
[Is] ISSN:1347-3409
[Cp] País de publicação:Japan
[La] Idioma:eng
[Ab] Resumo:Neuropathic pain (NeP) results from injury to, or disease of, the peripheral or central components of the neural systems involved in pain. In contrast to inflammatory pain, NeP can persist after healing from the initial injury has resolved. Antipyretic agents, such as non-steroidal anti-inflammatory drugs, steroids, and acetaminophen are ineffective, while specific agents such as gabapentinoids, antidepressants, antiepileptics, and opioids are effective in treating NeP. In this review, we address the definition of NeP, pharmacotherapy for NeP in Japan, pain classification, setting goals for successful NeP medication, and the Japanese algorithm for the pharmacotherapy of NeP with specific prescription guidance.
[Mh] Termos MeSH primário: Aminas/administração & dosagem
Analgésicos Opioides/administração & dosagem
Anticonvulsivantes/administração & dosagem
Antidepressivos/administração & dosagem
Ácidos Cicloexanocarboxílicos/administração & dosagem
Cloridrato de Duloxetina/administração & dosagem
Neuralgia/tratamento farmacológico
Pregabalina/administração & dosagem
Ácido gama-Aminobutírico/administração & dosagem
[Mh] Termos MeSH secundário: Idoso
Algoritmos
Aminas/efeitos adversos
Analgésicos Opioides/efeitos adversos
Anticonvulsivantes/efeitos adversos
Antidepressivos/efeitos adversos
Ácidos Cicloexanocarboxílicos/efeitos adversos
Esquema de Medicação
Cloridrato de Duloxetina/efeitos adversos
Feminino
Seres Humanos
Japão
Neuralgia/classificação
Manejo da Dor
Pregabalina/efeitos adversos
Ácido gama-Aminobutírico/efeitos adversos
[Pt] Tipo de publicação:CASE REPORTS; JOURNAL ARTICLE; REVIEW
[Nm] Nome de substância:
0 (Amines); 0 (Analgesics, Opioid); 0 (Anticonvulsants); 0 (Antidepressive Agents); 0 (Cyclohexanecarboxylic Acids); 55JG375S6M (Pregabalin); 56-12-2 (gamma-Aminobutyric Acid); 6CW7F3G59X (gabapentin); 9044SC542W (Duloxetine Hydrochloride)
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180222
[Lr] Data última revisão:
180222
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171228
[St] Status:MEDLINE
[do] DOI:10.1272/jnms.84.258


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[PMID]:29390451
[Au] Autor:Wang SL; Wang H; Nie HY; Bu G; Shen XD; Wang H
[Ti] Título:The efficacy of pregabalin for acute pain control in herpetic neuralgia patients: A meta-analysis.
[So] Source:Medicine (Baltimore);96(51):e9167, 2017 Dec.
[Is] ISSN:1536-5964
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:OBJECTIVE: This meta-analysis aimed to illustrate the efficacy and safety of preganalin for pain management in patients with postherpetic neuralgia (PHN). METHODS: In July 2017, a systematic computer-based search was conducted in PubMed, EMBASE, Web of Science, Cochrane Database of Systematic Reviews, and Google database. Data on patients with PHN that compared pregabalin versus placebo were retrieved. The endpoints were the visual analog scale (VAS) at 8 weeks, the percentage of 30% and 50% pain responders; sleep interference score and improvement in patient global impression of change (PGIC). After testing for publication bias and heterogeneity between studies, data were aggregated for random-effects models when necessary. RESULTS: Seven clinical studies with 2192 patients (pregabalin group = 1381, control group = 811) were finally included in the meta-analysis. Pregabalin was associated with reduced pain scores at 8 weeks, corresponding to a reduction of 11.23 points (95% CI, -14.33, -8.13, P = .000) on a 100-point VAS. Pregabalin was also associated with a more percentage of 30% and 50% pain responders than controls (P < .05). Meanwhile, pregabalin can decrease sleep interference score and improvement in PGIC than control groups (P < .05). CONCLUSIONS: Pregabalin was efficacious in the reduction of postoperative pain and improvement the sleep quality in patients with PHN.
[Mh] Termos MeSH primário: Analgésicos/uso terapêutico
Neuralgia Pós-Herpética/tratamento farmacológico
Pregabalina/uso terapêutico
[Mh] Termos MeSH secundário: Seres Humanos
Neuralgia Pós-Herpética/complicações
Transtornos do Sono-Vigília/etiologia
Transtornos do Sono-Vigília/prevenção & controle
Escala Visual Analógica
[Pt] Tipo de publicação:JOURNAL ARTICLE; META-ANALYSIS; REVIEW
[Nm] Nome de substância:
0 (Analgesics); 55JG375S6M (Pregabalin)
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180220
[Lr] Data última revisão:
180220
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:180203
[St] Status:MEDLINE
[do] DOI:10.1097/MD.0000000000009167


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[PMID]:29245223
[Au] Autor:Kim JC; Byun S; Kim S; Lee SY; Lee JH; Ahn S
[Ad] Endereço:aDepartment of Anesthesiology and Pain Medicine, Hando General Hospital, Ansan-sibDepartment of Anesthesiology and Pain Medicine, School of Medicine, Catholic University of Daegu, DaegucDepartment of Anesthesiology and Pain Medicine, CHA Bundang Medical Center, CHA University, Seongnam-si, South Korea.
[Ti] Título:Effect of preoperative pregabalin as an adjunct to a multimodal analgesic regimen in video-assisted thoracoscopic surgery: A randomized controlled trial.
[So] Source:Medicine (Baltimore);96(49):e8644, 2017 Dec.
[Is] ISSN:1536-5964
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Depending on the type of injury, the pain mechanisms are multifactorial. Preoperative pregabalin administrations as an adjunct to a multimodal postoperative pain management strategy have been tested in various surgical settings. The purpose of current study was to evaluate the effects of preoperative pregabalin administration on postoperative pain intensity and rescue analgesic requirement following video-assisted thoracoscopic surgery (VATS). METHODS: Sixty adult patients undergoing VATS were randomly assigned either to receive pregabalin 150 mg (Pregabalin group) or placebo (Control group) 1 hour before anesthesia. Primary efficacy variable was pain intensity. Secondary efficacy variables were the requirement of rescue analgesics, total volume of intravenous patient-controlled analgesia (IV-PCA), and adverse effects induced by pregabalin or IV-PCA. RESULTS: Pain intensity scores at post-anesthesia care unit (PACU), 6 and 24 hours were lower significantly in the Pregabalin group compared with the Control group (mean [SD]; 5.6 [2.0] vs 6.8 [1.8]; mean difference: 1.2, 95% CI of difference: 0.2166-2.1835, P = .018, mean [SD]; 3.8 [1.9] vs 5.6 [1.4]; mean difference: 1.8, 95% CI of difference: 1.0074-2.7260, P = .001 and mean [SD]; 2.6 [1.6] vs 3.5 [1.5]; mean difference: 0.9, 95% CI of difference: 0.0946-1.7054, P = .029, respectively]. Also, the frequency of additional rescue drug administered at PACU (median [interquartile range]; 2 [2-3] vs 1 [1-2], P = .027) was significantly less in the Pregabalin group. The incidences of adverse effects related to pregabalin or IV-PCA were not different between the groups. CONCLUSION: A single administration of pregabalin 150 mg before VATS decreased postoperative pain scores and incidence of additional rescue analgesics in the immediate postoperative period without increased risk of adverse effects.
[Mh] Termos MeSH primário: Analgésicos/administração & dosagem
Dor Pós-Operatória/tratamento farmacológico
Pregabalina/administração & dosagem
Pré-Medicação
Cirurgia Torácica Vídeoassistida/efeitos adversos
[Mh] Termos MeSH secundário: Idoso
Analgesia Controlada pelo Paciente/utilização
Método Duplo-Cego
Quimioterapia Combinada
Feminino
Seres Humanos
Masculino
Meia-Idade
Manejo da Dor/métodos
Dor Pós-Operatória/etiologia
Resultado do Tratamento
[Pt] Tipo de publicação:JOURNAL ARTICLE; RANDOMIZED CONTROLLED TRIAL
[Nm] Nome de substância:
0 (Analgesics); 55JG375S6M (Pregabalin)
[Em] Mês de entrada:1712
[Cu] Atualização por classe:171222
[Lr] Data última revisão:
171222
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:171217
[St] Status:MEDLINE
[do] DOI:10.1097/MD.0000000000008644


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[PMID]:28466100
[Au] Autor:Karube N; Ito S; Sako S; Hirokawa J; Yokoyama T
[Ad] Endereço:Department of Dental Anesthesiology, Faculty of Dental Science, Kyushu University, Fukuoka, 812-8582, Japan.
[Ti] Título:Sedative effects of oral pregabalin premedication on intravenous sedation using propofol target-controlled infusion.
[So] Source:J Anesth;31(4):586-592, 2017 Aug.
[Is] ISSN:1438-8359
[Cp] País de publicação:Japan
[La] Idioma:eng
[Ab] Resumo:PURPOSE: The sedative effects of pregabalin during perioperative period have not been sufficiently characterized. The aim of this study was to verify the sedative effects of premedication with pregabalin on intravenous sedation (IVS) using propofol and also to assess the influences of this agent on circulation, respiration, and postanesthetic complications. METHODS: Ten healthy young volunteers underwent 1 h of IVS using propofol, three times per subject, on separate days (first time, no pregabalin; second time, pregabalin 100 mg; third time, pregabalin 200 mg). The target blood concentration (C ) of propofol was increased in a stepwise fashion based on the bispectral index (BIS) value. Ramsay's sedation score (RSS) was determined at each propofol C . Propofol C was analyzed at each sedation level. Circulation and respiration during IVS and complications were also verified. RESULTS: Propofol C was reduced at BIS values of 60 and 70 in both premedicated groups (100 mg: p = 0.043 and 0.041; 200 mg: p = 0.004 and 0.016, respectively) and at a BIS value of 80 in the pregabalin 200 mg group (p < 0.001). Propofol C was decreased at RSS 4-6 in the pregabalin 100 mg group (RSS 4: p = 0.047; RSS 5: p = 0.007; RSS 6: p = 0.014), and at RSS 3-6 in the pregabalin 200 mg group (RSS 3-5: p < 0.001; RSS 6: p = 0.002). CONCLUSION: We conclude that oral premedication with pregabalin reduces the amount of propofol required to obtain an acceptable and adequate sedation level.
[Mh] Termos MeSH primário: Hipnóticos e Sedativos/administração & dosagem
Pregabalina/administração & dosagem
Pré-Medicação/métodos
Propofol/administração & dosagem
[Mh] Termos MeSH secundário: Adulto
Anestesia/métodos
Sedação Consciente/métodos
Eletroencefalografia
Feminino
Seres Humanos
Masculino
Adulto Jovem
[Pt] Tipo de publicação:CLINICAL TRIAL; JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Hypnotics and Sedatives); 55JG375S6M (Pregabalin); YI7VU623SF (Propofol)
[Em] Mês de entrada:1712
[Cu] Atualização por classe:171207
[Lr] Data última revisão:
171207
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170504
[St] Status:MEDLINE
[do] DOI:10.1007/s00540-017-2366-7


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[PMID]:28938502
[Au] Autor:Zellner N; Eyer F; Zellner T
[Ti] Título:[Alarming Pregabalin Abuse in Munich: Prevalence, Patterns of Use and Complications].
[Ti] Título:Alarmierender Pregabalin-Missbrauch: Prävalenz im Münchener Raum, Konsummuster und Komplikationen..
[So] Source:Dtsch Med Wochenschr;142(19):e140-e147, 2017 Sep.
[Is] ISSN:1439-4413
[Cp] País de publicação:Germany
[La] Idioma:ger
[Ab] Resumo:Pregabalin is used e. g. for the treatment of neuropathic pain and anxiety disorder. Recently, its potential for abuse and addiction has become apparent. From 2008 - 2015, we searched our database for the term "Pregabalin", including all patients treated in our department and all calls to the Poison Information Centre (PIC) Munich.From October 2013 to September 2014, all patients were included in a cohort study who either were admitted with a drug intoxication or who presented themselves for a course of detoxification (except ethanol). From 2008 - 2015, 263 patients with Pregabalin abuse were treated. The number of cases per year increased from 0 - 5 in 2008 - 2011 to 105 in 2015. In 2008, the PIC received 3 calls concerning Pregabalin abuse, in 2015 the number of calls was 71. From 2013 - 2014, 80 out of 370 patients had consumed Pregabalin. It was the fifth most frequently abused substance. Pregabalin users had consumed more additional substances than other patients (median 4 1 2 3 4 5 6 vs. 2 1 2 3 4 5 6, p < 0.001) and they were more often in an opioid substitution treatment (41.2 vs. 21.7 %, p < 0.001).The most co-abused drugs were benzodiazepines (66.3 %), methadone (48.8 %), buprenorphine (32.5 %) and heroin (22.5 %). 88.0 % of all intoxicated patients had moderate to severe symptoms of intoxication like impaired consciousness (74.0 %), respiratory distress, (40.0 %), agitation/aggressiveness (28.0 %), restlessness (14.0 %), hallucinations (8.0 %) or seizures (8.0 %).The semi-quantitative urine concentration was 51.4 ± 66.0 mg/g Creatinine for intoxicated patients and 26.1 ±â€Š23.0 for patients admitted for detoxification (n = 58; p = 0.034). Pregabalin abuse increases continuously and constitutes a significant health issue. Particularly patients with a history of substance abuse are vulnerable. Physicians should be aware of the substantial potential of Pregabalin for abuse and addiction and they should know the dangers of an intoxication.
[Mh] Termos MeSH primário: Pregabalina
Transtornos Relacionados ao Uso de Substâncias
[Mh] Termos MeSH secundário: Alemanha
Seres Humanos
Prevalência
Transtornos Relacionados ao Uso de Substâncias/complicações
Transtornos Relacionados ao Uso de Substâncias/epidemiologia
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
55JG375S6M (Pregabalin)
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171005
[Lr] Data última revisão:
171005
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170923
[St] Status:MEDLINE
[do] DOI:10.1055/s-0043-104228


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[PMID]:28906391
[Au] Autor:Liu B; Liu R; Wang L
[Ad] Endereço:aDepartment of Anesthesiology, Linyi People's Hospital bDepartment of Anesthesiology, Women and Children's Health Care Hospital of Linyi, Shandong, China.
[Ti] Título:A meta-analysis of the preoperative use of gabapentinoids for the treatment of acute postoperative pain following spinal surgery.
[So] Source:Medicine (Baltimore);96(37):e8031, 2017 Sep.
[Is] ISSN:1536-5964
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Gabapentinoid drugs, which include gabapentin and pregabalin, play an established role in the management of neuropathic pain. However, whether preoperative administration of gabapentinoids has a beneficial role in controlling acute pain after spinal surgery is unknown. We performed a systematic review and meta-analysis of randomized controlled trials (RCTs) to determine the efficacy and safety of the preoperative use of gabapentinoids (gabapentin and pregabalin) for the treatment of acute postoperative pain following spinal surgery. METHODS: In March 2017, a systematic computer-based search was conducted in PubMed, EMBASE, Web of Science, Cochrane Library, and Google databases. RCTs comparing gabapentinoids (gabapentin and pregabalin) with placebo in patients undergoing spine surgery were retrieved. The primary endpoint was the visual analogue scale (VAS) score with rest or mobilization at 6, 12, 24, and 48 hours and cumulative morphine consumption at 24 and 48 hours. The secondary outcomes were complications of nausea, vomiting, sedation, dizziness, headache, urine retention, pruritus, and visual disturbances. After tests for publication bias and heterogeneity among studies were performed, data were aggregated for random-effects models when necessary. RESULTS: Sixteen clinical studies (gabapentin group n = 8 and pregabalin group n = 8) were ultimately included in the meta-analysis. Gabapentinoids were associated with reduced pain scores at 6, 12, 24, and 48 hours. Similarly, gabapentinoids were associated with a reduction in cumulative morphine consumption at 24 and 48 hours. Furthermore, gabapentinoids can significantly reduce the occurrence of nausea, vomiting, and pruritus. There were no significant differences in the occurrence of sedation, dizziness, headache, visual disturbances, somnolence, or urine retention. CONCLUSIONS: Preoperative use of gabapentinoids was able to reduce postoperative pain, total morphine consumption, and morphine-related complications following spine surgery. Further studies should determine the optimal dose and whether pregabalin is superior to gabapentin in controlling acute pain after spine surgery.
[Mh] Termos MeSH primário: Dor Aguda/tratamento farmacológico
Aminas/uso terapêutico
Analgésicos/uso terapêutico
Ácidos Cicloexanocarboxílicos/uso terapêutico
Dor Pós-Operatória/tratamento farmacológico
Pregabalina/uso terapêutico
Coluna Vertebral/cirurgia
Ácido gama-Aminobutírico/uso terapêutico
[Mh] Termos MeSH secundário: Dor Aguda/etiologia
Aminas/efeitos adversos
Analgésicos/efeitos adversos
Ácidos Cicloexanocarboxílicos/efeitos adversos
Seres Humanos
Pregabalina/efeitos adversos
Ensaios Clínicos Controlados Aleatórios como Assunto
Ácido gama-Aminobutírico/efeitos adversos
[Pt] Tipo de publicação:JOURNAL ARTICLE; META-ANALYSIS; REVIEW
[Nm] Nome de substância:
0 (Amines); 0 (Analgesics); 0 (Cyclohexanecarboxylic Acids); 55JG375S6M (Pregabalin); 56-12-2 (gamma-Aminobutyric Acid); 6CW7F3G59X (gabapentin)
[Em] Mês de entrada:1709
[Cu] Atualização por classe:171004
[Lr] Data última revisão:
171004
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170915
[St] Status:MEDLINE
[do] DOI:10.1097/MD.0000000000008031


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[PMID]:28857179
[Au] Autor:Androsova G; Krause R; Borghei M; Wassenaar M; Auce P; Avbersek A; Becker F; Berghuis B; Campbell E; Coppola A; Francis B; Wolking S; Cavalleri GL; Craig J; Delanty N; Koeleman BPC; Kunz WS; Lerche H; Marson AG; Sander JW; Sills GJ; Striano P; Zara F; Sisodiya SM; Depondt C; EpiPGX Consortium
[Ad] Endereço:Luxembourg Center for Systems Biomedicine, University of Luxembourg, Esch-sur-Alzette, Luxembourg.
[Ti] Título:Comparative effectiveness of antiepileptic drugs in patients with mesial temporal lobe epilepsy with hippocampal sclerosis.
[So] Source:Epilepsia;58(10):1734-1741, 2017 Oct.
[Is] ISSN:1528-1167
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:OBJECTIVE: Mesial temporal lobe epilepsy with hippocampal sclerosis (MTLE-HS) is a common epilepsy syndrome that is often poorly controlled by antiepileptic drug (AED) treatment. Comparative AED effectiveness studies in this condition are lacking. We report retention, efficacy, and tolerability in a cohort of patients with MTLE-HS. METHODS: Clinical data were collected from a European database of patients with epilepsy. We estimated retention, 12-month seizure freedom, and adverse drug reaction (ADR) rates for the 10 most commonly used AEDs in patients with MTLE-HS. RESULTS: Seven hundred sixty-seven patients with a total of 3,249 AED trials were included. The highest 12-month retention rates were observed with carbamazepine (85.9%), valproate (85%), and clobazam (79%). Twelve-month seizure freedom rates varied from 1.2% for gabapentin and vigabatrin to 11% for carbamazepine. Response rates were highest for AEDs that were prescribed as initial treatment and lowest for AEDs that were used in a third or higher instance. ADRs were reported in 47.6% of patients, with the highest rates observed with oxcarbazepine (35.7%), topiramate (30.9%), and pregabalin (27.4%), and the lowest rates with clobazam (6.5%), gabapentin (8.9%), and lamotrigine (16.6%). The most commonly reported ADRs were lethargy and drowsiness, dizziness, vertigo and ataxia, and blurred vision and diplopia. SIGNIFICANCE: Our results did not demonstrate any clear advantage of newer versus older AEDs. Our results provide useful insights into AED retention, efficacy, and ADR rates in patients with MTLE-HS.
[Mh] Termos MeSH primário: Anticonvulsivantes/uso terapêutico
Epilepsia do Lobo Temporal/tratamento farmacológico
Hipocampo/patologia
[Mh] Termos MeSH secundário: Adolescente
Adulto
Idoso
Aminas/uso terapêutico
Ataxia/induzido quimicamente
Benzodiazepinas/uso terapêutico
Carbamazepina/análogos & derivados
Carbamazepina/uso terapêutico
Ácidos Cicloexanocarboxílicos/uso terapêutico
Bases de Dados Factuais
Diplopia/induzido quimicamente
Tontura/induzido quimicamente
Epilepsia do Lobo Temporal/patologia
Epilepsia do Lobo Temporal/fisiopatologia
Feminino
Frutose/análogos & derivados
Frutose/uso terapêutico
Seres Humanos
Letargia/induzido quimicamente
Masculino
Meia-Idade
Pregabalina/uso terapêutico
Estudos Retrospectivos
Esclerose
Resultado do Tratamento
Triazinas/uso terapêutico
Ácido Valproico/uso terapêutico
Vertigem/induzido quimicamente
Vigabatrina/uso terapêutico
Transtornos da Visão/induzido quimicamente
Adulto Jovem
Ácido gama-Aminobutírico/uso terapêutico
[Pt] Tipo de publicação:COMPARATIVE STUDY; JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Amines); 0 (Anticonvulsants); 0 (Cyclohexanecarboxylic Acids); 0 (Triazines); 0H73WJJ391 (topiramate); 12794-10-4 (Benzodiazepines); 2MRO291B4U (clobazam); 30237-26-4 (Fructose); 33CM23913M (Carbamazepine); 55JG375S6M (Pregabalin); 56-12-2 (gamma-Aminobutyric Acid); 614OI1Z5WI (Valproic Acid); 6CW7F3G59X (gabapentin); GR120KRT6K (Vigabatrin); U3H27498KS (lamotrigine); VZI5B1W380 (oxcarbazepine)
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171010
[Lr] Data última revisão:
171010
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170901
[St] Status:MEDLINE
[do] DOI:10.1111/epi.13871


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[PMID]:28809936
[Au] Autor:Shanthanna H; Gilron I; Rajarathinam M; AlAmri R; Kamath S; Thabane L; Devereaux PJ; Bhandari M
[Ad] Endereço:Department of Anesthesiology, St Joseph's Healthcare, McMaster University, Hamilton, Ontario, Canada.
[Ti] Título:Benefits and safety of gabapentinoids in chronic low back pain: A systematic review and meta-analysis of randomized controlled trials.
[So] Source:PLoS Med;14(8):e1002369, 2017 Aug.
[Is] ISSN:1549-1676
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND AND OBJECTIVE: Chronic Low Back Pain (CLBP) is very common, with a lifetime prevalence between 51% and 80%. In majority, it is nonspecific in nature and multifactorial in etiology. Pregabalin (PG) and Gabapentin (GB) are gabapentinoids that have demonstrated benefit in neuropathic pain conditions. Despite no clear rationale, they are increasingly used for nonspecific CLBP. They necessitate prolonged use and are associated with adverse effects and increased cost. Recent guidelines from the National Health Service (NHS), England, expressed concerns on their off-label use, in addition to the risk of misuse. We aimed to assess the effectiveness and safety of gabapentinoids in adult CLBP patients. METHODS: Electronic databases of MEDLINE, EMBASE, and Cochrane were searched from their inception until December 20th, 2016. We included randomized control trials reporting the use of gabapentinoids for the treatment of CLBP of >3 months duration, in adult patients. Study selection and data extraction was performed independently by paired reviewers. Outcomes were guided by Initiative on Methods, Measurement and Pain Assessment in Clinical Trials guidelines, with pain relief and safety as the primary outcomes. Meta-analyses were performed for outcomes reported in 3 or more studies. Outcomes were reported as mean differences (MDs) or risk ratios (RRs) with their corresponding 95% confidence intervals (CIs), and I2 in percentage representing the percentage variability in effect estimates that could be explained by heterogeneity. GRADE (Grading of Recommendations Assessment, Development, and Evaluation) was used to assess the quality of evidence. RESULTS: Out of 1,385 citations, eight studies were included. Based on the interventions and comparators, studies were analyzed in 3 different groups. GB compared with placebo (3 studies, n = 185) showed minimal improvement of pain (MD = 0.22 units, 95% CI [-0.5 to 0.07] I2 = 0%; GRADE: very low). Three studies compared PG with other types of analgesic medication (n = 332) and showed greater improvement in the other analgesic group (MD = 0.42 units, 95% CI [0.20 to 0.64] I2 = 0; GRADE: very low). Studies using PG as an adjuvant (n = 423) were not pooled due to heterogeneity, but the largest of them showed no benefit of adding PG to tapentadol. There were no deaths or hospitalizations reported. Compared with placebo, the following adverse events were more commonly reported with GB: dizziness-(RR = 1.99, 95% CI [1.17 to 3.37], I2 = 49); fatigue (RR = 1.85, 95% CI [1.12 to 3.05], I2 = 0); difficulties with mentation (RR = 3.34, 95% CI [1.54 to 7.25], I2 = 0); and visual disturbances (RR = 5.72, 95% CI [1.94 to 16.91], I2 = 0). The number needed to harm with 95% CI for dizziness, fatigue, difficulties with mentation, and visual disturbances were 7 (4 to 30), 8 (4 to 44), 6 (4 to 15), and 6 (4 to 13) respectively. The GRADE evidence quality was noted to be very low for dizziness and fatigue, low for difficulties with mentation, and moderate for visual disturbances. Functional and emotional improvements were reported by few studies and showed no significant improvements. CONCLUSIONS AND RELEVANCE: Existing evidence on the use of gabapentinoids in CLBP is limited and demonstrates significant risk of adverse effects without any demonstrated benefit. Given the lack of efficacy, risks, and costs associated, the use of gabapentinoids for CLBP merits caution. There is need for large high-quality trials to more definitively inform this issue. TRIAL REGISTRATION: PROSPERO CRD42016034040.
[Mh] Termos MeSH primário: Aminas/uso terapêutico
Analgésicos/uso terapêutico
Ácidos Cicloexanocarboxílicos/uso terapêutico
Dor Lombar/tratamento farmacológico
Pregabalina/uso terapêutico
Ácido gama-Aminobutírico/uso terapêutico
[Mh] Termos MeSH secundário: Aminas/efeitos adversos
Analgésicos/efeitos adversos
Ácidos Cicloexanocarboxílicos/efeitos adversos
Inglaterra
Seres Humanos
Pregabalina/efeitos adversos
Ensaios Clínicos Controlados Aleatórios como Assunto
Ácido gama-Aminobutírico/efeitos adversos
[Pt] Tipo de publicação:JOURNAL ARTICLE; META-ANALYSIS; REVIEW
[Nm] Nome de substância:
0 (Amines); 0 (Analgesics); 0 (Cyclohexanecarboxylic Acids); 55JG375S6M (Pregabalin); 56-12-2 (gamma-Aminobutyric Acid); 6CW7F3G59X (gabapentin)
[Em] Mês de entrada:1708
[Cu] Atualização por classe:170828
[Lr] Data última revisão:
170828
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170816
[St] Status:MEDLINE
[do] DOI:10.1371/journal.pmed.1002369


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[PMID]:28779491
[Au] Autor:Cooper TE; Wiffen PJ; Heathcote LC; Clinch J; Howard R; Krane E; Lord SM; Sethna N; Schechter N; Wood C
[Ad] Endereço:Cochrane Pain, Palliative and Supportive Care Group, Pain Research Unit, Churchill Hospital, Churchill Hospital, Oxford, Oxfordshire, UK, OX3 7LE.
[Ti] Título:Antiepileptic drugs for chronic non-cancer pain in children and adolescents.
[So] Source:Cochrane Database Syst Rev;8:CD012536, 2017 08 05.
[Is] ISSN:1469-493X
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Pain is a common feature of childhood and adolescence around the world, and for many young people, that pain is chronic. The World Health Organization (WHO) guidelines for pharmacological treatments for children's persisting pain acknowledge that pain in children is a major public health concern of high significance in most parts of the world. While in the past, pain was largely dismissed and was frequently left untreated, views on children's pain have changed over time, and relief of pain is now seen as importantWe designed a suite of seven reviews on chronic non-cancer pain and cancer pain (looking at antidepressants, antiepileptic drugs, non-steroidal anti-inflammatory drugs, opioids, and paracetamol) in order to review the evidence for children's pain utilising pharmacological interventions in children and adolescents.As the leading cause of morbidity in the world today, chronic disease (and its associated pain) is a major health concern. Chronic pain (that is pain lasting three months or longer) can occur in the paediatric population in a variety of pathophysiological classifications (nociceptive, neuropathic, or idiopathic) relating to genetic conditions, nerve damage pain, chronic musculoskeletal pain, and chronic abdominal pain, and for other unknown reasons.Antiepileptic (anticonvulsant) drugs, which were originally developed to treat convulsions in people with epilepsy, have in recent years been used to provide pain relief in adults for many chronic painful conditions and are now recommended for the treatment of chronic pain in the WHO list of essential medicines. Known side effects of antiepileptic drugs range from sweating, headache, elevated temperature, nausea, and abdominal pain to more serious effects including mental or motor function impairment. OBJECTIVES: To assess the analgesic efficacy and adverse events of antiepileptic drugs used to treat chronic non-cancer pain in children and adolescents aged between birth and 17 years, in any setting. SEARCH METHODS: We searched the Cochrane Central Register of Controlled Trials (CENTRAL) via the Cochrane Register of Studies Online, MEDLINE via Ovid, and Embase via Ovid from inception to 6 September 2016. We also searched the reference lists of retrieved studies and reviews as well as online clinical trial registries. SELECTION CRITERIA: Randomised controlled trials, with or without blinding, by any route, treating chronic non-cancer pain in children and adolescents, comparing any antiepileptic drug with placebo or an active comparator. DATA COLLECTION AND ANALYSIS: Two review authors independently assessed studies for eligibility. We planned to use dichotomous data to calculate risk ratio and number needed to treat for one additional event, using standard methods if data were available. We assessed the evidence using GRADE and created two 'Summary of findings' tables. MAIN RESULTS: We included two studies with a total of 141 participants (aged 7 to 18 years) with chronic neuropathic pain, complex regional pain syndrome type 1 (CRPS-I), or fibromyalgia. One study investigated pregabalin versus placebo in participants with fibromyalgia (107 participants), and the other study investigated gabapentin versus amitriptyline in participants with CRPS-I or neuropathic pain (34 participants). We were unable to perform any quantitative analysis.Risk of bias for the two included studies varied, due to issues with randomisation (low to unclear risk), blinding of outcome assessors (low to unclear risk), reporting bias (low to unclear risk), the size of the study populations (high risk), and industry funding in the 'other' domain (low to unclear risk). We judged the remaining domains of sequence generation, blinding of participants and personnel, and attrition as low risk of bias. Primary outcomesOne study (gabapentin 900 mg/day versus amitriptyline 10 mg/day, 34 participants, for 6 weeks) did not report our primary outcomes (very low-quality evidence).The second study (pregabalin 75 to 450 mg/day versus placebo 75 to 450 mg/day, 107 participants, for 15 weeks) reported no significant change in pain scores for pain relief of 30% or greater between pregabalin 18/54 (33.3%), and placebo 16/51 (31.4%), P = 0.83 (very low-quality evidence). This study also reported Patient Global Impression of Change, with the percentage of participants feeling "much or very much improved" with pregabalin 53.1%, and placebo 29.5% (very low-quality evidence).We downgraded the evidence by three levels to very low for one of two reasons: due to the fact that there was no evidence to support or refute the use of the intervention, or that there were too few data and the number of events was too small to be meaningful. Secondary outcomesIn one small study, adverse events were uncommon: gabapentin 2 participants (2 adverse events); amitriptyline 1 participant (1 adverse event) (6-week trial). The second study reported a higher number of adverse events: pregabalin 38 participants (167 adverse events); placebo 34 participants (132 adverse events) (15-week trial) (very low-quality evidence).Withdrawals due to adverse events were infrequent in both studies: pregabalin (4 participants), placebo (4 participants), gabapentin (2 participants), and amitriptyline (1 participant) (very low-quality evidence).Serious adverse events were reported in both studies. One study reported only one serious adverse event (cholelithiasis and major depression resulting in hospitalisation in the pregabalin group) and the other study reported no serious adverse events (very low-quality evidence).There were few or no data for our remaining secondary outcomes (very low-quality evidence).We downgraded the evidence by three levels to very low due to too few data and the fact that the number of events was too small to be meaningful. AUTHORS' CONCLUSIONS: This review identified only two small studies, with insufficient data for analysis.As we could undertake no meta-analysis, we were unable to comment about efficacy or harm from the use of antiepileptic drugs to treat chronic non-cancer pain in children and adolescents. Similarly, we could not comment on our remaining secondary outcomes: Carer Global Impression of Change; requirement for rescue analgesia; sleep duration and quality; acceptability of treatment; physical functioning; and quality of life.We know from adult randomised controlled trials that some antiepileptics, such as gabapentin and pregabalin, can be effective in certain chronic pain conditions.We found no evidence to support or refute the use of antiepileptic drugs to treat chronic non-cancer pain in children and adolescents.
[Mh] Termos MeSH primário: Aminas/uso terapêutico
Amitriptilina/uso terapêutico
Anticonvulsivantes/uso terapêutico
Dor Crônica/tratamento farmacológico
Síndromes da Dor Regional Complexa/tratamento farmacológico
Ácidos Cicloexanocarboxílicos/uso terapêutico
Fibromialgia/tratamento farmacológico
Neuralgia/tratamento farmacológico
Pregabalina/uso terapêutico
Ácido gama-Aminobutírico/uso terapêutico
[Mh] Termos MeSH secundário: Adolescente
Aminas/efeitos adversos
Amitriptilina/efeitos adversos
Anticonvulsivantes/efeitos adversos
Criança
Ácidos Cicloexanocarboxílicos/efeitos adversos
Seres Humanos
Pregabalina/efeitos adversos
Ensaios Clínicos Controlados Aleatórios como Assunto
Ácido gama-Aminobutírico/efeitos adversos
[Pt] Tipo de publicação:JOURNAL ARTICLE; RESEARCH SUPPORT, NON-U.S. GOV'T; REVIEW
[Nm] Nome de substância:
0 (Amines); 0 (Anticonvulsants); 0 (Cyclohexanecarboxylic Acids); 1806D8D52K (Amitriptyline); 55JG375S6M (Pregabalin); 56-12-2 (gamma-Aminobutyric Acid); 6CW7F3G59X (gabapentin)
[Em] Mês de entrada:1709
[Cu] Atualização por classe:170920
[Lr] Data última revisão:
170920
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170806
[St] Status:MEDLINE
[do] DOI:10.1002/14651858.CD012536.pub2


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[PMID]:28767611
[Au] Autor:Wang YM; Xia M; Shan N; Yuan P; Wang DL; Shao JH; Ma HW; Wang LL; Zhang Y
[Ad] Endereço:aDepartment of Oncology, Chongqing Cancer Institute & Hospital & Cancer Center bDepartment of Gynaecology, Chongqing Traditional Chinese Medicine Hospital cDepartment of Obstetrics and Gynecology, The First Affiliated Hospital, Chongqing Medical University, Chongqing, China.
[Ti] Título:Pregabalin can decrease acute pain and postoperative nausea and vomiting in hysterectomy: A meta-analysis.
[So] Source:Medicine (Baltimore);96(31):e7714, 2017 Aug.
[Is] ISSN:1536-5964
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Whether the preoperative administration of pregabalin plays a beneficial role in controlling acute pain after hysterectomy is unknown. We performed a systematic review and meta-analysis of randomized controlled trials (RCTs) to determine the efficacy and safety of the preoperative use of pregabalin to treat acute postoperative pain following hysterectomy. METHODS: In April 2017, a systematic computer-based search was conducted in the PubMed, EMBASE, Web of Science, Cochrane Library, and Google databases. RCTs comparing pregabalin with placebo in patients undergoing hysterectomy were retrieved. The primary endpoint was the visual analog scale (VAS) score with rest or mobilization at 2 h, 4 and 24 hours and cumulative morphine consumption at 2, 4, 24, and 48 hours. The secondary outcomes were complications of nausea, vomiting, sedation, and dizziness. After tests for publication bias and heterogeneity among studies were performed, the data were aggregated for random-effects models when necessary. RESULTS: Ten clinical studies with 1207 patients (pregabalin = 760, control = 447) were finally included in this meta-analysis. Preoperative administration of pregabalin was associated with a significant reduction of VAS with rest or mobilization at 2, 4, and 24 hours after hysterectomy. Further, the preoperative administration of pregabalin was associated with a reduction in total morphine consumption at 2, 4, 24, and 48 hours after hysterectomy. The occurrence of morphine-related complications (nausea and vomiting) was also reduced in the pregabalin group. However, the preoperative administration of pregabalin was associated with an increase in the occurrence of dizziness. There was no significant difference in the occurrence of sedation. CONCLUSIONS: The preoperative use of pregabalin reduced postoperative pain, total morphine consumption, and morphine-related complications following hysterectomy. The doses of pregabalin were different, and large heterogeneity was the limitation of the current meta-analysis. Further studies should determine the optimal dose for controlling acute pain after hysterectomy.
[Mh] Termos MeSH primário: Analgésicos/administração & dosagem
Histerectomia
Dor Pós-Operatória/economia
Náusea e Vômito Pós-Operatório/tratamento farmacológico
Pregabalina/administração & dosagem
[Mh] Termos MeSH secundário: Feminino
Seres Humanos
Dor Pós-Operatória/tratamento farmacológico
Cuidados Pré-Operatórios
Ensaios Clínicos Controlados Aleatórios como Assunto
[Pt] Tipo de publicação:JOURNAL ARTICLE; META-ANALYSIS; REVIEW
[Nm] Nome de substância:
0 (Analgesics); 55JG375S6M (Pregabalin)
[Em] Mês de entrada:1708
[Cu] Atualização por classe:171013
[Lr] Data última revisão:
171013
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170803
[St] Status:MEDLINE
[do] DOI:10.1097/MD.0000000000007714



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