Mishra Seema, Bhatnagar Sushma, Goyal Gaurav Nirvani, Rana Shiv Pratap Singh, Upadhya Surjya Prasad
Unit of Anaesthesiology, Dr. B. R. Ambedkar, Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi.
Am J Hosp Palliat Care. 2012 May;29(3):177-82. doi: 10.1177/1049909111412539. Epub 2011 Jul 10.
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.
神经性疼痛难以诊断且难以确切治疗。因此，本研究的目的是评估普瑞巴林与阿米替林和加巴喷丁在神经性癌痛治疗中的临床疗效比较。在获得机构伦理委员会批准后，共有120例患有严重神经性癌痛的癌症患者被纳入研究，并分为4组：AT组-阿米替林组、GB组-加巴喷丁组、PG组-普瑞巴林组和PL组-安慰剂组。口服吗啡用于持续疼痛的解救镇痛。评估疼痛评分（视觉模拟量表）和次要结局指标，如数字评分量表上的刺痛、感觉异常和灼痛强度、总体满意度评分（GSS）、东部肿瘤协作组评分（ECOG）以及不良反应。研究结束时，与其他组相比，PG组的疼痛评分显著降低；与AT组（P = 0.003）、GB组（P = 0.042）和PL组（P = 0.024）相比。与GB组和PL组相比，PG组中出现刺痛和感觉异常的患者百分比显著更低。PL组的所有患者都需要使用解救吗啡。4次就诊后观察到PG组患者的ECOG评分和GSS评分改善最大。我们的结果表明，所有抗神经病药物在缓解癌症相关神经性疼痛方面均有效。与其他抗神经病药物相比，普瑞巴林在缓解神经性癌痛和神经症状方面具有统计学和临床意义上的吗啡节省效应。
