A comparative efficacy of amitriptyline, gabapentin, and pregabalin in
neuropathic cancer pain: a prospective randomized double-blind placebo-controlled
Author(s): Mishra S, Bhatnagar S, Goyal GN, Rana SP, Upadhya SP.
Affiliation(s): Unit of Anaesthesiology, Dr. B. R. Ambedkar, Institute Rotary Cancer Hospital,
All India Institute of Medical Sciences, New Delhi. firstname.lastname@example.org
Publication date & source: 2012, Am J Hosp Palliat Care. , 29(3):177-82
Neuropathic pain is difficult to diagnose and difficult to treat with certainty.
So the aim of the study was to evaluate comparative clinical efficacy of
pregabaline with amitriptyline and gabapentin in neuropathic cancer pain. A total
of 120 patients with cancer having severe neuropathic cancer pain were enrolled
in the study after taking approval from Institutional Ethics Committee and
divided in to 4 groups: group AT-amitriptyline, group GB-gabapentin, group
PG-pregabalin, and group PL-placebo. Oral morphine was used for rescue analgesic
for continued pain. Pain score (Visual Analogue scale) and secondary outcome
measures such as intensity of lancinating, dysesthesia, and burning on numerical
rating scale, Global satisfaction score (GSS), Eastern Co-operative Oncology
Group scoring (ECOG), and adverse effects were assessed. At the end of study
there was significant decrease in pain score in group PG as compared to the other
groups; group AT (P = .003), group GB (P = .042), and group PL (P = .024).
Percentage of patients with lancinating pain and dysesthesia were significantly
less in group PG as compared to groups GB and PL. All the patients in group PL
needed rescue morphine. After 4 visits, maximum improvement in ECOG scoring and
GSS scoring was observed in group PG patients. Our results suggested that all
antineuropathic drugs are effective in relieving cancer-related neuropathic pain.
There was statistically and clinically significant morphine sparing effect of
pregabaline in relieving neuropathic cancer pain and neuropathic symptoms as
compared to other antineuropathic drugs.