Effects of pregabalin on central sensitization in patients with chronic
pancreatitis in a randomized, controlled trial.
Author(s): Bouwense SA, Olesen SS, Drewes AM, Poley JW, van Goor H, Wilder-Smith OH.
Affiliation(s): Pain and Nociception Neuroscience Research Group, Department of Surgery, Radboud
University Nijmegen Medical Center, Nijmegen, The Netherlands.
Publication date & source: 2012, PLoS One. , 7(8):e42096
BACKGROUND: Intense abdominal pain is the dominant feature of chronic
pancreatitis. During the disease changes in central pain processing, e.g. central
sensitization manifest as spreading hyperalgesia, can result from ongoing
nociceptive input. The aim of the present study is to evaluate the effect of
pregabalin on pain processing in chronic pancreatitis as assessed by quantitative
sensory testing (QST).
METHODS: This randomized, double-blind, placebo-controlled trial evaluated
effects of pregabalin on pain processing. QST was used to quantify pain
processing by measuring thresholds to painful electrical and pressure stimulation
in six body dermatomes. Descending endogenous pain modulation was quantified
using the conditioned pain modulation (CPM) paradigm to elicit a DNIC (diffuse
noxious inhibitory controls) response. The main effect parameter was the change
in the sum of all body pain threshold values after three weeks of study treatment
versus baseline values between both treatment groups.
RESULTS: 64 patients were analyzed. No differences in change in sum of pain
thresholds were present for pregabalin vs. placebo after three weeks of
treatment. For individual dermatomes, change vs. baseline pain thresholds was
significantly greater in pregabalin vs. placebo patients for electric pain
detection threshold in C5 (P = 0.005), electric pain tolerance threshold in C5 (P
= 0.04) and L1 (P = 0.05), and pressure pain tolerance threshold in T4 (P =
0.004). No differences were observed between pregabalin and placebo regarding
conditioned pain modulation.
CONCLUSION: Our study provides first evidence that pregabalin has moderate
inhibitory effects on central sensitization manifest as spreading hyperalgesia in
chronic pancreatitis patients. These findings suggest that QST can be of clinical
use for monitoring pain treatments in the context of chronic pain.
TRIAL REGISTRATION: ClinicalTrials.gov NCT00755573.