Shimada Yohei, Inage Kazuhide, Orita Sumihisa, Koda Masao, Yamauchi Kazuyo, Furuya Takeo, Nakamura Junichi, Suzuki Miyako, Fujimoto Kazuki, Shiga Yasuhiro, Abe Koki, Kanamoto Hirohito, Inoue Masahiro, Kinoshita Hideyuki, Norimoto Masaki, Umimura Tomotaka, Takahashi Kazuhisa, Ohtori Seiji
Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Japan.
Spine Surg Relat Res. 2017 Dec 20;1(1):40-43. doi: 10.22603/ssrr.1.2016-0012. eCollection 2017.
We examined duloxetine's effectiveness in the treatment of neuropathic pain in patients who were intolerant to continuous pregabalin administration.
The present study is a retrospective study of patients diagnosed with neuropathic pain with neuropathic leg pain as the chief complaint. We analyzed 20 cases in which pregabalin was changed to duloxetine because of adverse effects (16 cases) or treatment failure (4 cases). The incidence of adverse events after duloxetine administration was used as the primary endpoint, with the secondary endpoint being the leg pain level based on a numerical rating scale (NRS).
The incidence of adverse events after starting duloxetine was 40%. Average leg pain scores measured on the NRS were 8.4±1.4, 6.4±1.4, and 4.1±2.0 at the time of the patients' first visit, pregabalin discontinuation, and after switching to duloxetine, respectively. A significant difference in NRS scores was found between the first visit and pregabalin discontinuation and also between pregabalin discontinuation and after the switch to duloxetine (<0.05), indicating that pain decreases over time. Furthermore, NRS scores significantly declined between the patients' first visit and after the switch to duloxetine (<0.05). The improvement in NRS score was 20±12.8% after pregabalin administration and 23±12.0% after duloxetine administration compared with baseline scores (no significant difference between pregabalin and duloxetine; >0.05).
When patients with neuropathic pain are unable to tolerate pregabalin because of adverse effects, changing the medication to duloxetine may be an option.
我们研究了度洛西汀在治疗对持续服用普瑞巴林不耐受的患者神经性疼痛方面的有效性。
本研究是一项对以神经性腿部疼痛为主要诉求而被诊断为神经性疼痛患者的回顾性研究。我们分析了20例因不良反应（16例）或治疗失败（4例）而将普瑞巴林换为度洛西汀的病例。以度洛西汀给药后不良事件的发生率作为主要终点，次要终点是以数字评分量表（NRS）为基础的腿部疼痛水平。
开始使用度洛西汀后不良事件的发生率为40%。在患者首次就诊时、停用普瑞巴林时以及换用度洛西汀后，基于NRS测得的平均腿部疼痛评分分别为8.4±1.4、6.4±1.4和4.1±2.0。在首次就诊与停用普瑞巴林之间以及停用普瑞巴林与换用度洛西汀后之间，NRS评分存在显著差异（<0.05），表明疼痛随时间减轻。此外，在患者首次就诊与换用度洛西汀后之间，NRS评分显著下降（<0.05）。与基线评分相比，服用普瑞巴林后NRS评分的改善为20±12.8%，服用度洛西汀后为23±12.0%（普瑞巴林与度洛西汀之间无显著差异；>0.05）。
当神经性疼痛患者因不良反应无法耐受普瑞巴林时，将药物换为度洛西汀可能是一种选择。
