pregabalin and Abdominal-Pain

Adhesions are the most common cause of chronic abdominal pain after surgery. Surgical adhesiolysis can relieve symptoms in selected patients, but many require other treatments. The aim of this study is to evaluate analgesic treatments other than abdominal surgery in chronic pain related to adhesions.. A search was conducted in PubMed, Embase, and Central. Studies with patients suffering from chronic postoperative pain related to adhesions and undergoing all types' analgesic treatment were included. The primary outcome was the number of patients who improved in pain at long-term follow-up (at least 1 year). Secondary outcomes included improvement in pain at 3 months follow-up, quality of life, and physical functioning.. Searches identified 3022 citations. Four studies were included, one trial, one cohort study, and two case reports. The primary outcome was not reported. In a small trial (. Low level of evidence is available regarding analgesic treatments of chronic abdominal and pelvic pain related to adhesions. The benefit of pregabalin is doubtful; nerve modulation is promising in a selected group.HighlightsAdhesions are a frequent cause of chronic abdominal and pelvic pain after surgery.Many patients are not good candidates for surgery (Adhesiolysis) or have relapses of pain.There is an important knowledge gap regarding non-surgical analgesic treatment.Analgesia in adhesion-related chronic abdominal pain after surgery.

Topics: Abdominal Pain; Analgesia; Analgesics; Chronic Pain; Cohort Studies; Humans; Neoplasm Recurrence, Local; Pain, Postoperative; Pelvic Pain; Pregabalin; Quality of Life; Tissue Adhesions

Pregabalin is a calcium channel α2δ ligand that modifies visceral hypersensitivity in IBS patients. Clinical data for pregabalin in IBS are lacking.. To test the efficacy of pregabalin on gastrointestinal symptoms in IBS patients.. A double-blind, placebo-controlled trial was performed. Adults meeting IBS Rome III criteria with ≥3 pain attacks per month were randomised to pregabalin 225 mg vs placebo twice daily for 12 weeks. Questionnaires were completed weekly. The primary endpoint was average pain Bowel Symptom Scale (BSS) scores weeks 9-12. An intention-to-treat analysis of covariance evaluated treatment effects on quantitative endpoints, adjusting for age and gender. Adequate relief and change in pain score were assessed using a chi-squared test.. Eighty-five patients were recruited and randomised. Sample characteristics include: mean age 39.4 (SD = 14.6); 73 (86%) female; 37 (44%) IBS-D, 29 (35%) IBS-M, 18 (21%) IBS-C. The pregabalin arm had lower average pain-BSS scores weeks 9-12 (25 vs 42, P = 0.008). Compared with placebo, the overall IBS BSS severity score was lower in the pregabalin arm (26 vs 42, P = 0.009). Differences were observed for the diarrhoea-BSS and bloating-BSS scores (P = 0.049 and 0.016, respectively). No differences between groups were seen for constipation-BSS scores. Adequate relief was not different between the two arms (46% vs 36%, P = 0.35). 63% pregabalin vs 45% placebo had a change in pain score ≥30 at week 12 from baseline (P = 0.10). Post-treatment IBS-QoL scores did not differ between groups.. This trial suggests that pregabalin may be beneficial for IBS abdominal pain, bloating and diarrhoea.

Topics: Abdominal Pain; Adult; Constipation; Diarrhea; Double-Blind Method; Female; Humans; Irritable Bowel Syndrome; Male; Middle Aged; Pain Measurement; Pregabalin; Surveys and Questionnaires; Treatment Outcome; Young Adult

Chronic pain related to postoperative abdominal adhesions is a common problem with no standard analgesic regimen currently established. In a double-blind, placebo-controlled trial, we examined the effects of pregabalin on pain modulation in patients with prior abdominal surgery and documented adhesion. The primary outcome measure was pain relief documented by a 2-point change on the Likert pain scale with a secondary pain measure of sleep interruption. A total of 18 women were randomized to receive either the drug (n = 11) or placebo (n = 7). Thirteen patients (eight pregabalin, five placebo) completed the blinded phase and 10 patients (seven pregabalin, three placebo) completed the open-label phase. Statistical analysis was performed in two settings: 1) Week 0 (as the baseline) through the end of Week 7 of the blinded fixed-dose phase; and 2) Week 7 (as the baseline) along With weeks 8 through 11 of the open-label phase. The pain score result from the blinded phase setting indicated that the amount of decrease was significantly greater in the drug group (P = 0.024), whereas the pain score result from the open-label setting indicated that the amount of decrease was significantly greater in the placebo group (P = 0.043). Only the sleep score result in the open-label setting was significantly greater in the placebo group (P = 0.024). We conclude that pregabalin significantly reduced patient-documented pain scores compared with placebo in our small cohort of patients with abdominal adhesion pain.

Topics: Abdomen; Abdominal Pain; Adult; Analgesics; Chronic Pain; Double-Blind Method; Female; gamma-Aminobutyric Acid; Humans; Middle Aged; Pain Measurement; Postoperative Complications; Pregabalin; Sleep Wake Disorders; Tissue Adhesions; Treatment Outcome

Pain is a disabling symptom for patients with chronic pancreatitis (CP) and difficult to treat. Evidence from basic science and human studies indicates that pain processing by the central nervous system is abnormal and resembles that observed in patients with neuropathic pain disorders. We investigated whether agents used to treat patients with neuropathic pain are effective in CP.. We conducted a randomized, double-blind, placebo-controlled trial to evaluate the effects of the gabapentoid pregabalin as an adjuvant analgesic. We measured pain relief, health status, quality of life, and tolerability in 64 patients with pain from CP; they were randomly assigned to groups given increasing doses of pregabalin or placebo (control) for 3 consecutive weeks. The primary end point was pain relief, based on a visual analogue scale documented by a pain diary. Secondary end points included Patients' Global Impression of Change (PGIC) score, changes in physical and functional scales, pain character, quality of life, and tolerability.. Pregabalin, compared with placebo, caused more effective pain relief after 3 weeks of treatment (36% vs 24%; mean difference, 12%; 95% confidence interval, 22%-2%; P = .02). The percentage of patients with much or very much improved health status (PGIC score) at the end of the study was higher in the pregabalin than the control group (44% vs 21%; P = .048). Changes in physical and functional scales, pain character, quality of life, and number of serious adverse events were comparable between groups.. In a placebo-controlled trial, pregabalin is an effective adjuvant therapy for pain in patients with CP.

Topics: Abdominal Pain; Adult; Aged; Analgesics; Double-Blind Method; Female; gamma-Aminobutyric Acid; Health Status; Humans; Male; Middle Aged; Pain Measurement; Pancreatitis, Chronic; Pregabalin; Quality of Life

Eosinophilic colitis is a rare clinical condition that belongs to the group of eosinophilic gastrointestinal disorders. Its occurrence can be primary or secondary to infection, medications, or autoimmune/hematological conditions. We present a case of a young female adult with severe chronic fatigue syndrome, widespread chronic pain, including functional abdominal pain, who developed severe eosinophilic colitis following successive treatments with gabapentin and pregabalin. On both occasions, symptoms manifested as abdominal pain, diarrhea, and eosinophilia and improved upon discontinuation of the medications. Magnetic resonance imaging of the small bowel demonstrated an ascending colon colitis, and endoscopic investigations confirmed florid colitis mainly in the ascending colon with biopsies demonstrating a dense eosinophilic infiltrate with micro-abscesses. Serum eosinophil counts correlated well with the timing of the agents' administration. There was no other organ involvement. Symptoms improved upon discontinuation of the drugs and steroid administration. Eosinophilic colitis is an exceptionally rare entity and its mechanism of action is still unclear. Suspicion of eosinophilic colitis should be raised if a patient presents with abdominal pain, diarrhea, and peripheral eosinophilia following treatment with pregabalin or gabapentin.. Die eosinophile Kolitis ist eine sehr seltene Krankheit aus der Gruppe der eosinophilen Magen-Darm-Erkrankungen. Als Auslöser gelten Primär- und Sekundärinfektionen, Medikamente, sowie autoimmune und hämatologische Erkrankungen. Unser Fall beschreibt eine junge, weibliche Erwachsene mit schwerem chronischem Müdigkeitssyndrom und generalisierten chronischen Schmerzen, darunter funktionellen Unterleibsschmerzen, welche unter Behandlung mit Gabapentin und Pregabalin an einer schweren eosinophilen Kolitis erkrankte. Zu zwei unterschiedlichen Zeitpunkten wies die Patientin abdominelle Schmerzen, Diarrhoe und ein Eosinophilie auf, mit jeweils Verbesserung der Symptomatik nach Sistieren der Medikamenteneinnahme. In einer Kernspintomografie stellte sich eine Kolitis des aufsteigenden Kolons dar. Endoskopisch konnte eine floride Kolitis, vorwiegend im Kolon ascendens, bestätigt werden, mit Nachweis einer dichten eosinophilen Infiltration mit Mikroabszessen in den Biopsien. Die serologische Eosinophilie korrelierte zeitlich mit der Medikamenteneinnahme. Andere Organe waren nicht beteiligt. Die Symptomatik verbesserte sich nach Absetzen der Medikamente und Verabreichung von Steroiden. Die eosinophile Kolitis ist eine ausgesprochen seltene Erkrankung mit bisher noch unklarem Wirkmechanismus. Bei Patienten mit abdominellen Schmerzen, Diarrhoe und peripherer Eosinophilie unter einer Therapie mit Pregabalin oder Gabapentin sollte der Verdacht auf eine eosinophile Kolitis gestellt werden.

Topics: Abdominal Pain; Adolescent; Colitis; Colitis, Microscopic; Eosinophilia; Fatigue Syndrome, Chronic; Female; Gabapentin; Humans; Pregabalin

Pregabalin, a ligand of alpha(2)delta subunits of voltage-gated calcium channels, reduces visceral hypersensitivity associated with irritable bowel syndrome. However, effects of pregabalin on bowel function are not well described. We investigated the effects of pregabalin on bowel dysfunction and colonic nociceptive threshold in sensitized rats. Increased fecal pellet output was evoked by non-ulcerogenic stress. Decreased colonic nociceptive threshold was induced in separate rats by administration of 2,4,6-trinitrobenzene sulfonic acid (TNBS) into the lumen of the proximal colon. Fecal pellet output was significantly increased during 2h restraint stress. Oral pregabalin (10-100mg/kg, p.o.) inhibited this increased fecal output dose-dependently, but did not change fecal output in naïve rats. The response threshold to distension of the non-inflamed distal colon was significantly decreased seven days after TNBS administration. An anti-hyperalgesic effect of pregabalin (30-100mg/kg, p.o.) that opposed the decreased colonic nociceptive threshold in TNBS-sensitized rats was observed, but nociceptive thresholds were not changed in naïve rats. Moreover, pregabalin was more potent in reducing disturbed defecation compared with reduction in nociceptive threshold to distension in TNBS-sensitized rats. This is the first report that pregabalin modulates stress-induced defecation in rats. These data indicate that pregabalin can ameliorate both altered defecation and decreases in colonic nociceptive threshold, suggesting that pregabalin might warrant investigation for the treatment of irritable bowel syndrome.

Topics: Abdominal Pain; Analgesics; Animals; Defecation; Dose-Response Relationship, Drug; gamma-Aminobutyric Acid; Irritable Bowel Syndrome; Male; Pain Threshold; Pregabalin; Rats; Rats, Sprague-Dawley; Restraint, Physical; Stress, Psychological; Trinitrobenzenesulfonic Acid

In irritable bowel syndrome, the main objectives of the treatment are the relief of abdominal pain then the improvement of bowel disturbances. Spasmolytic agents, or clays remain routinely the first line pharmacological options. The efficacy of dietary recommendations is not validated in most of the cases while dietary fibers, mainly insoluble fibers, may even worsen abdominal discomfort. In C-IBS, osmotic laxatives or macrogol are effective to improve colonic transit while loperamide and also colestyramine can be prescribed to reduce the number of stools of D-IBS patients. When the first line treatment fails to improve symptoms, antidepressants (tricyclic rather than SSRs) can be prescribed at lower doses than that recommended for depression. In meta-analysis, the odds ratio for pain relief varies from 2 to 4 and strongly depends on the patient's compliance to the treatment. Probiotics, pregabalin and even antibiotics (i.e neomycin, metronidazole or rifaximin), are possible new therapeutic options. Few clinical trials suggest that ramosetron (a new 5HT3 antagonist), octreotide, melatonin, or lidocain could be also discussed in the future. A non pharmacological therapeutic approach has to be considered, particularly in patients with severe symptoms, in combination with pharmacological treatment.

Topics: Abdominal Pain; Analgesics; Anesthetics, Local; Anti-Bacterial Agents; Antidepressive Agents; Central Nervous System Depressants; Diet; Dietary Fiber; gamma-Aminobutyric Acid; Gastrointestinal Agents; Humans; Irritable Bowel Syndrome; Lidocaine; Melatonin; Octreotide; Parasympatholytics; Pregabalin; Probiotics; Serotonin Antagonists

Pregabalin, which binds to the alpha2-delta subunit of voltage-gated calcium channels, increased the threshold for pain during colorectal distension (CRD) in irritable bowel syndrome (IBS) patients. We tested the effects of oral pregabalin on the visceral pain-related viscerosomatic and autonomic cardiovascular responses to CRD and colonic compliance in rats.. The activity of the abdominal musculature (viscerosomatic response), monitored by electromyography and intracolonic manometry, and changes in blood pressure and heart rate, monitored by telemetry, were assessed simultaneously in conscious rats during CRD.. Pregabalin (10-200 micromol kg(-1), p.o.) inhibited dose dependently the viscerosomatic response to phasic, noxious CRD (12 distensions at 80 mm Hg). At 200 mumol kg(-1), pregabalin also reduced the increase in blood pressure and heart rate associated with noxious CRD. Moreover, pregabalin (200 micromol kg(-1), p.o.) reduced the visceromotor response to ascending phasic CRD (10-80 mm Hg) and significantly increased the threshold pressure for response. During phasic CRD (2-20 mm Hg), pregabalin (200 micromol kg(-1), p.o.) increased intracolonic volume, resulting in a shift to the left of the pressure-volume relationship curve, indicative of an increase of compliance.. Pregabalin reduced the viscerosomatic and autonomic responses associated with CRD-induced visceral pain and increased colonic compliance in rats. These observations confirm the analgesic activity of pregabalin on visceral pain and support the translational value of the CRD model to humans. Ligands for the alpha2-delta subunit might represent interesting compounds for the treatment of visceral pain disorders, such as IBS.

Topics: Abdominal Pain; Administration, Oral; Analgesics; Animals; Blood Pressure; Calcium Channels; Colon; Compliance; Dilatation, Pathologic; Disease Models, Animal; Dose-Response Relationship, Drug; Female; gamma-Aminobutyric Acid; Heart Rate; Irritable Bowel Syndrome; Manometry; Pregabalin; Protein Subunits; Rats; Rats, Sprague-Dawley