pregabalin and Breakthrough-Pain

Cancer-induced bone pain (CIBP) affects one third of patients with cancer. Radiotherapy remains the gold-standard treatment; however, laboratory and clinical work suggest that pregabalin may be useful in treating CIBP. The aim of this study was to examine pregabalin in patients with CIBP receiving radiotherapy.. A multicenter, double-blind randomized trial of pregabalin versus placebo was conducted. Eligible patients were age ≥ 18 years, had radiologically proven bone metastases, were scheduled to receive radiotherapy, and had pain scores ≥ 4 of 10 (on 0-to-10 numeric rating scale). Before radiotherapy, baseline assessments were completed, followed by random assignment. Doses of pregabalin and placebo were increased over 4 weeks. The primary end point was treatment response, defined as a reduction of ≥ 2 points in worst pain by week 4, accompanied by a stable or reduced opioid dose, compared with baseline. Secondary end points assessed average pain, interference of pain with activity, breakthrough pain, mood, quality of life, and adverse events.. A total of 233 patients were randomly assigned: 117 to placebo and 116 to pregabalin. The most common cancers were prostate (n = 88; 38%), breast (n = 77; 33%), and lung (n = 42; 18%). In the pregabalin arm, 45 patients (38.8%) achieved the primary end point, compared with 47 (40.2%) in the placebo arm (adjusted odds ratio, 1.07; 95% CI, 0.63 to 1.81; P = .816). There were no statistically significant differences in average pain, pain interference, or quality of life between arms. There were differences in mood (P = .031) and breakthrough pain duration (P = .037) between arms. Outcomes were compared at 4 weeks.. Our findings do not support the role of pregabalin in patients with CIBP receiving radiotherapy. The role of pregabalin in CIBP with a clinical neuropathic pain component is unknown.

Topics: Activities of Daily Living; Adult; Affect; Aged; Analgesics; Analgesics, Opioid; Bone and Bones; Breakthrough Pain; Chemoradiotherapy; Double-Blind Method; Female; Humans; Male; Middle Aged; Neoplasms; Pain Management; Pain Measurement; Palliative Care; Pregabalin; Quality of Life

To evaluate the analgesic effect of pregabalin combined with intrathecal sufentanil infusion for the treatment of breakthrough pain in patients with bone metastases.. A total of 60 breakthrough pain patients with bone metastases were randomly divided to 3 groups: group A (pregabalin combined with intrathecal sufentanil infusion group, n=20), group B (placebo combined with intrathecal sufentanil infusion group, n=20) and group C (oral morphine sulfate controlled-release tablet group, n=20). The differences in visual analogue scale (VAS) between background pain and breakthrough pain, the seizure frequency of breakthrough pain, general satisfaction and side effects of the 3 groups were observed.. The seizure frequency and VAS of breakthrough pain in group A decreased significantly after the treatment (P<0.05) and the general satisfaction was the best among the the 3 groups (P<0.05), with less nausea and vomiting, constipation, drowsiness and fewer other side effects.. Pregabalin combined with intrathecal sufentanil infusion can effectively relieve breakthrough pain in patients with bone metastases.

Topics: Analgesics, Opioid; Bone Neoplasms; Breakthrough Pain; gamma-Aminobutyric Acid; Humans; Injections, Spinal; Morphine; Pain Measurement; Pain, Postoperative; Pregabalin; Sufentanil

Topics: Acetaminophen; Aged; Analgesics; Anesthesia, Local; Anesthetics, Local; Breakthrough Pain; Celecoxib; Epinephrine; Humans; Lidocaine; Mohs Surgery; Oxycodone; Pain Management; Pain, Postoperative; Pregabalin; Ropivacaine; Vasoconstrictor Agents

Pregabalin is commonly used to relieve neuropathic pain. However, data are lacking on its efficacy for the treatment of chronic cancer pain. The purpose of this study was to determine the analgesic efficacy of pregabalin combined with morphine in the management of pancreatic cancer pain.. This study reviewed patients who were prescribed morphine and 150 mg/d pregabalin between 1 January 2017 and 10 November 2018 in our institute. The primary outcomes of this study were the average pain score and dose of morphine. Secondary outcomes included characters of breakthrough cancer pain, functional interference related to pain, anxiety/depression status, and incidence of treatment-related adverse events during the study.. A total of 240 patients with pain related to pancreatic cancer were included in the study. The results showed that patients of both combination therapy group (pregabalin+morphine) and monotherapy group (morphine) achieved similar analgesic efficacy, demonstrated by NRS (2.4 ± 0.9 vs. 2.6 ± 0.9; combination vs. monotherapy) at the end of the study. Mean daily dose of morphine used in the combination group was significant lower compared to monotherapy group (39.5 ± 16.0 mg vs. 61.5 ± 19.3 mg, net difference 23.5, 95% CI: 18.4-28.6, p <  0.001). The change of functional interference score related to pain was significantly different between combination and monotherapy group (12.0 ± 0.4 vs. 9.8 ± 4.9; net difference, 2.3; 95% CI: 1.1-3.3; p < 0.001). Patients in combination therapy group had experienced shorter duration of breakthrough cancer pain than those in monotherapy group (X. The findings of this study supported the use of pregabalin with morphine to relieve pain in patients of pancreatic cancer.

Topics: Aged; Analgesics; Breakthrough Pain; Cancer Pain; Drug Therapy, Combination; Female; Humans; Male; Middle Aged; Morphine; Neuralgia; Pain Measurement; Pancreatic Neoplasms; Pregabalin; Retrospective Studies

Calciphylaxis is a rare condition usually seen in patients with end-stage renal disease. Pain is a hallmark of this condition and can be extremely difficult to control. Anecdotal data suggests that pain management in calciphylaxis is challenging with variable approaches across the United Kingdom (UK) and internationally. A knowledge and practice survey was conducted to establish current practice in the management of pain in patients with calciphylaxis, in the UK. Based on the results and clinical experience the authors suggest a clinical practice guideline.. An online questionnaire was circulated among physicians (renal and palliative care) involved in the management of pain in calciphylaxis. The questionnaire included a mix of open-ended questions and questions with drop down options.. One hundred and six clinicians responded to the survey of which 60 (57%) respondents were from palliative medicine; the remaining 46 (43%) were from renal medicine. 31 (30%) respondents across both specialties had not encountered any patients with a diagnosis of calciphylaxis (renal-2, palliative care-29). A referral to the palliative care team was undertaken by 18% of renal physicians, 32% referred to the pain team and 50% referred to both. Only 3% of the palliative medicine respondents indicated that they had received a referral from the renal team at the time of diagnosis. Opioids were the preferred initial drug of choice for the management of all types of pain. Paracetamol was universally selected as the preferred first-choice adjuvant agent for management of all types of pain. The importance of advance care planning was highlighted with 72% undertaking advanced care planning discussions often or most of the time.. There was wide variation in the current practice of pain management in patients with calciphylaxis, with variation between renal specialists and palliative care specialists. Referral to specialists in pain management is not universal despite the severe nature of the pain experienced by patients with calciphylaxis. The data generated has facilitated the development of a clinical practice guideline to support complex pain management in a group of patients with multiple comorbidities.

Topics: Acetaminophen; Advance Care Planning; Amitriptyline; Analgesics; Analgesics, Non-Narcotic; Analgesics, Opioid; Breakthrough Pain; Calciphylaxis; Gabapentin; Humans; Kidney Failure, Chronic; Nephrology; Pain; Pain Management; Pain, Procedural; Palliative Medicine; Practice Patterns, Physicians'; Pregabalin; Referral and Consultation; Surveys and Questionnaires; United Kingdom

Topics: Analgesics; Breakthrough Pain; Female; Humans; Male; Neoplasms; Palliative Care; Pregabalin