Pregabalin Vs. Opioids for the Treatment of Neuropathic Cancer Pain: A Prospective, Head-to-Head, Randomized, Open-Label Study

Objectives Neuropathic cancer pain (NCP) is a common manifestation of cancer and/or its treatment. Treatment following the WHO analgesic ladder provides relief for the majority of cancer pain patients; however, concern remains that opioids may be less efficacious for neuropathic pain (NP) compared w...

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Bibliographic Details
Published in:Pain practice 2014-01, Vol.14 (1), p.32-42
Main Authors: Raptis, Efklidis, Vadalouca, Athina, Stavropoulou, Evmorfia, Argyra, Eriphili, Melemeni, Aikaterini, Siafaka, Ioanna
Format: Article
Language:English
Subjects:
adjuvants
Aged
Analgesics, Opioid - pharmacology
Analgesics, Opioid - therapeutic use
cancer pain
Female
fentanyl
gamma-Aminobutyric Acid - analogs & derivatives
gamma-Aminobutyric Acid - pharmacology
gamma-Aminobutyric Acid - therapeutic use
Humans
Male
Middle Aged
Neoplasms - drug therapy
Neoplasms - epidemiology
Neuralgia - drug therapy
Neuralgia - epidemiology
neuropathic
neuropathic cancer pain
opioids
Pain Measurement - drug effects
Pain Measurement - methods
Pregabalin
Prospective Studies
Treatment Outcome
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Summary:Objectives Neuropathic cancer pain (NCP) is a common manifestation of cancer and/or its treatment. Treatment following the WHO analgesic ladder provides relief for the majority of cancer pain patients; however, concern remains that opioids may be less efficacious for neuropathic pain (NP) compared with nociceptive pain, often necessitating the use of higher doses. Adjuvants, such as pregabalin, have shown to be efficacious for the treatment of NP, although data come mostly from noncancer studies. The comparative efficacy and safety of opioids versus adjuvants has not been studied for NCP. The aim of this study was to directly compare pregabalin versus a strong opioid for the treatment of NCP. Methods A total of 120 patients, diagnosed with “definite” NCP, were randomized into two groups and received increasing doses of either oral pregabalin or transdermal fentanyl for 28 days. VAS score, patient satisfaction, need for opioid rescue, and adverse events (AEs) were recorded. Results In the pregabalin group, a significantly higher proportion of patients achieved at least 30% reduction in VAS compared with the fentanyl group (73.3%, 95% CI: 60.3%–83.93 vs. 36.7%, 95% CI: 24.5%–50.1%, P 
ISSN:1530-7085
1533-2500
DOI:10.1111/papr.12045