Pregabalin vs. gabapentin in the treatment of neuropathic pain: a comprehensive systematic review and meta-analysis of effectiveness and safety

Frontiers in Pain Research, Journal Year: 2025, Volume and Issue: 5

Published: Jan. 7, 2025

Neuropathic pain is a prevalent and burdensome condition, both pregabalin gabapentin are widely used for its treatment. However, there lack of clarity regarding their comparative efficacy safety. This meta-analysis aims to evaluate compare the effectiveness safety vs. in managing neuropathic pain. study followed PRISMA guidelines employed PICOS search strategy. Comparative studies (clinical trials cohort studies) were included, with patients treated either or gabapentin. Primary outcomes assessed Data extracted from PubMed, Embase, Scopus, Cochrane Collaboration Library databases. The risk bias was evaluated using Review Manager tool. Statistical analysis performed 5.4.1 software, calculating effect sizes conducting sensitivity based on medication dosage. A total 14 3,346 analyzed. Pregabalin showed superior results compared Visual Analog Scale (VAS) at various time intervals up 12-14 weeks (SMD -0.47, 95% CI -0.74 -0.19). group also had significant improvements SF-12/SF-36/EQ-5D scores 0.39, 0.11-0.68) experienced more days no/mild (MD 9.00, 8.93-9.07) fewer severe -3.00, -4.96 -1.04). resulted lower opioid consumption (OR 0.50, 0.33-0.76). Gabapentin higher incidence nausea vomiting. Sensitivity supported pregabalin. In conclusion, demonstrated faster alleviating than did. Additionally, it improved patient-reported outcomes, consumption, led adverse events. https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=565208, PROSPERO (CRD42024565208).

Language: Английский

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Nanotherapeutics for Alleviating Anesthesia‐Associated Complications

Advanced Science, Journal Year: 2024, Volume and Issue: 11(15)

Published: Feb. 11, 2024

Abstract Current management of anesthesia‐associated complications falls short in terms both efficacy and safety. Nanomaterials with versatile properties unique nano‐bio interactions hold substantial promise as therapeutics for addressing these complications. This review conducts a thorough examination the existing nanotherapeutics highlights strategies developing prospective nanomedicines to mitigate anesthetics‐related toxicity. Initially, general, regional, local anesthesia along commonly used anesthetics related prevalent side effects are introduced. Furthermore, employing nanotechnology prevent alleviate is systematically demonstrated from three aspects, that is, 1) safe nano‐formulization anesthetics; 2) nano‐antidotes sequester overdosed alter their pharmacokinetics; 3) pharmacodynamic activities treat Finally, prospects challenges facing clinical translation anesthesia‐related discussed. work provides comprehensive roadmap effective toxicity, which can potentially revolutionize

Language: Английский

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Opioid-free versus opioid-based anesthesia in pancreatic surgery

BMC Anesthesiology, Journal Year: 2022, Volume and Issue: 22(1)

Published: Jan. 4, 2022

Opioid-free anesthesia (OFA) is associated with significantly reduced cumulative postoperative morphine consumption in comparison opioid-based (OBA). Whether OFA feasible and may improve outcomes pancreatic surgery remains unclear.Perioperative data from 77 consecutive patients who underwent resection were included retrospectively reviewed. Patients received either an OBA intraoperative remifentanil (n = 42) or 35). a combination of continuous infusions dexmedetomidine, lidocaine, esketamine. In OBA, also single bolus intrathecal morphine. All propofol, sevoflurane, dexamethasone, diclofenac, neuromuscular blockade. Postoperative pain management was achieved by wound infiltration patient-controlled The primary outcome (Numerical Rating Scale, NRS). Opioid within 48 h after extubation, length stay, adverse events 90 days, 30-day mortality as secondary outcomes. Episodes bradycardia hypotension requiring rescue medication considered safety outcomes.Compared to NRS (3 [2-4] vs 0 [0-2], P < 0.001) opioid (36 [24-52] 10 [2-24], 0.005) both less the group. Length stay shorter 4 days (14 [7-46] [6-16], 0.001). (P 0.03), fistula 0.0002) delayed gastric emptying 0.0001) identified only independent factors for stay. comprehensive complication index (CCI) lowest (24.9 ± 25.5 14.1 23.4, 0.03). There no differences demographics, operative time, blood loss, bradycardia, vasopressors administration time extubation among groups.In this series, during independently better outcome, particular lower rate complications justify future randomized trials test hypothesis that shorten

Language: Английский

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Analgesic Alkaloids Derived From Traditional Chinese Medicine in Pain Management

Frontiers in Pharmacology, Journal Year: 2022, Volume and Issue: 13

Published: May 10, 2022

Chronic pain is one of the most prevalent health problems. The establishment chronic complex. Current medication for mainly dependent on anticonvulsants, tricyclic antidepressants and opioidergic drugs. However, they have limited therapeutic efficacy, some even with severe side effects. We turned our interest into alkaloids separated from traditional Chinese medicine (TCM), that usually act multiple drug targets. In this article, we introduced best-studied analgesic derived TCM, including tetrahydropalmatine, aloperine, oxysophocarpine, matrine, sinomenine, ligustrazine, evodiamine, brucine, tetrandrine, Stopholidine, lappaconitine, focusing their mechanisms potential clinical applications. To better describe mechanism these alkaloids, adopted concept drug-cloud (dCloud) theory. dCloud illustrated full spectrum multitarget analgesics two dimensions, which are “direct efficacy”, inhibition ion channels, activating γ-Aminobutyric Acid/opioid receptors, to suppress signal directly; “background reducing neuronal inflammation/oxidative stress, glial cell activation, restoring balance between excitatory inhibitory neurotransmission, cure root causes pain. Empirical evidence showed combination beneficial 30–50% patients. promote discovery effective combinations, an ancient regimen combines herbal drugs “Jun”, “Chen”, “Zuo”, “Shi” properties. dCloud, “Jun” acts directly major symptom disease; “Chen” generates background effects; “Zuo” has salutary supportive functions; facilitates delivery targeted tissue. Subsequently, using concept, interpreted effect established compositions containing TCM may contribute alternative model.

Language: Английский

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Chronic alcohol induced mechanical allodynia by promoting neuroinflammation: A mouse model of alcohol‐evoked neuropathic pain

British Journal of Pharmacology, Journal Year: 2023, Volume and Issue: 180(18), P. 2377 - 2392

Published: April 13, 2023

Abstract Background and Purpose Chronic pain is considered a key factor contributing to alcohol use disorder (AUD). The mechanisms responsible for chronic associated with consumption are unknown. We evaluated the development of in mouse model dependence investigate role neuroinflammation. Experimental Approach chronic‐intermittent ethanol two‐bottle choice CIE‐2BC paradigm generates three groups: alcohol‐dependent escalating intake, nondependent (moderate drinking) alcohol‐naïve control male female mice. measured mechanical allodynia during withdrawal after last voluntary drinking. Immunoblotting was used evaluate protein levels IBA‐1, CSFR, IL‐6, p38 ERK2/1 spinal cord tissue dependent non‐dependent animals. Key Results found significant escalation drinking group compared group. developed 72 h withdrawal, which completely reversed observed an increased hypersensitivity naïve 50% Increased IBA‐1 CSFR expression both hypersensitivity‐abstinence related neuropathy‐alcohol mice, IL‐6 ERK1/2 activation mice hypersensitivity‐related abstinence, but not alcohol‐evoked neuropathic pain. Conclusions Implications induces two distinct conditions specific type exposure: abstinence‐related about half

Language: Английский

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Postoperative pain after different doses of remifentanil infusion during anaesthesia: a meta-analysis

BMC Anesthesiology, Journal Year: 2024, Volume and Issue: 24(1)

Published: Jan. 13, 2024

Abstract Background This meta-analysis aimed to explore the correlation between different doses of remifentanil-based anaesthesia and postoperative pain in randomised trials. Methods The electronic databases including PubMed, Cochrane, clinical trial registries, Google Scholar were searched up November 2022 for controlled trials (RCTs) that assessed dose dependent efficacy remifentanil intensity hyperalgesia. Results 31 studies involving 2019 patients included analysis. Compared with high administration, low showed less at 1-2 h (weighted mean differences (WMD): 0.60, 95% CI, 0.05 1.15), 3-8 (WMD: 0.38, 0.00 0.75), 24 0.26, 0.04 0.48) 48 0.32, 0.09 0.55). Remifentanil-free regimen failed decrease score 0.10, -0.10 0.30) 0.15, -0.22 0.52) comparison anaesthesia. After excluding heterogeneity, was closely correlated ( P =0.03). In addition, not associated incidence nausea vomiting (PONV) =0.37). Conclusions Our reveals infusion is recommendable general maintenance. No evidence suggests remifentanil-free has superiority reducing pain. Moreover, doesn’t have a effect initiating PONV. Trial registration protocol present study registered PROSPERO (CRD42022378360).

Language: Английский

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Discontinuation of psychotropic medication: a synthesis of evidence across medication classes

Molecular Psychiatry, Journal Year: 2024, Volume and Issue: 29(8), P. 2575 - 2586

Published: March 19, 2024

Abstract Pharmacotherapy is an effective treatment modality across psychiatric disorders. Nevertheless, many patients discontinue their medication at some point. Evidence-based guidance for patients, clinicians, and policymakers on rational discontinuation strategies vital to enable the best, personalized any given patient. Nonetheless, there a scarcity of guidelines strategies. In this perspective, we therefore summarize critically appraise evidence six major psychotropic classes: antidepressants, antipsychotics, benzodiazepines, mood stabilizers, opioids, stimulants. For each class, wide range topics pertaining following questions are discussed: (1) Who can (e.g., what risk factors relapse?); (2) When after 1 year or several years antidepressant use?); (3) How what’s efficacy dose reduction compared full cessation interventions mitigate relapse risk?). We thus highlight how comparing classes identify knowledge gaps, which may pave way more integrated research discontinuation.

Language: Английский

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Mechanisms, Diagnosis, Prevention and Management of Perioperative Opioid-Induced Hyperalgesia

Pain Management, Journal Year: 2021, Volume and Issue: 11(4), P. 405 - 417

Published: March 29, 2021

Opioid-induced hyperalgesia (OIH) occurs when opioids paradoxically enhance the pain they are prescribed to ameliorate. To address a lack of perioperative awareness, we present an educational review clinically relevant aspects disorder. Although mechanisms OIH thought primarily involve medullary descending pathways, it is likely multifactorial with several therapeutic targets. We provide suggested clinical definition and directions for differentiation from other diagnoses, as this may be confusing but germane appropriate management. Finally, discuss prevention including patient education analgesic management choices. As serve best treatment, risk factors, opioid mitigation, both pharmacologic non-pharmacologic strategies discussed.Lay abstract medications worsen rather than decrease pain. start in brain or brainstem before traveling through spinal cord area body, there many causes. pathway diagnoses help medication factors OIH, decreased use, non-medication discussed.

Language: Английский

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Chronic Cancer Pain: Opioids within Tumor Microenvironment Affect Neuroinflammation, Tumor and Pain Evolution

Cancers, Journal Year: 2022, Volume and Issue: 14(9), P. 2253 - 2253

Published: April 30, 2022

Pain can be a devastating experience for cancer patients, resulting in decreased quality of life. In the last two decades, immunological and pain research have demonstrated that persistence is primarily caused by neuroinflammation leading to central sensitization with brain neuroplastic alterations changes responsiveness (hyperalgesia, behavior). Cancer markedly affected tumor microenvironment (TME), complex ecosystem consisting different cell types (cancer cells, endothelial stromal leukocytes, fibroblasts neurons) release soluble mediators triggering neuroinflammation. The TME cellular components express opioid receptors (i.e., MOR) upon engagement endogenous or exogenous opioids such as morphine, initiate signaling events MOR does not only affect features quality, but also influences directly and/or indirectly growth metastasis. effects on chronic are clinically characterized altered (tolerance hyperalgesia), hallmark problematic long-term treatment non-cancer pain. significant progress made understanding immune-mediated development suggests its exploitation novel alternative immunotherapeutic approaches.

Language: Английский

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Digital Analgesic Comprising a Second-Generation Digital Health System: Increasing Effectiveness by Optimizing the Dosing and Minimizing Side Effects

Journal of Pain Research, Journal Year: 2022, Volume and Issue: Volume 15, P. 1051 - 1060

Published: April 1, 2022

Abstract: Opioids remain an essential part of the treatment chronic pain. However, their use and increasing rates misuse are associated with high morbidity mortality. The development tolerance to opioids analgesics further complicates dosing need reduce side effects. First-generation digital systems were developed improve but not always capable making clinically relevant associations do necessarily lead better clinical efficacy. A lack improved outcomes makes these less applicable for adoption by clinicians patients. There is a enhance therapeutic regimens opioids. In present paper, we analgesic that consists administered under control second-generation artificial intelligence system. Second-generation focus on patient measured based response reduced effects in single subject. algorithm regulates administration personalized manner. provides advantages both users providers. system enables dose optimization, improving effectiveness, minimizing while adherence beneficial regimens. improves clinicians' experience assists them managing reduces financial burden healthcare providers lowering opioid-related market disruptor pharma companies. Keywords: health, algorithm, opioids, tolerance,

Language: Английский

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