School of Pharmacy, Faculty of Medical Sciences, Newcastle University, King George VI Building, Newcastle-Upon-Tyne, NE1 7RU, UK.
Translational and Clinical Research Institute, Newcastle University, Newcastle-Upon-Tyne, UK.
Int J Clin Pharm. 2023 Jun;45(3):556-565. doi: 10.1007/s11096-022-01528-y. Epub 2023 Feb 27.
There are increasing concerns regarding the abusive potential of gabapentinoids putting at risk patients with neuropathic pain requiring long-term pain management. The evidence to support this is rather inconcusive.
This systematic review aimed to evaluate the safety and efficacy of gabapentinoids in the management of neuropathic pain with a focus on randomised controlled trials (RCTs) and categorising the side effects according to the body systems they were affecting.
Searches were conducted in MEDLINE (PubMed), EMBASE, Web of Science, PsycoINFO, and CINAHL (EBSCO), and included RCTs to identify and critically appraise studies investigating safety and therapeutic effects of gabapentionoids in adults with neuropathic pain. Data extraction was conducted using an established Cochrane form and the risk-of-bias tool was used in the assessment of quality.
50 studies (12,398 participants) were included. The majority of adverse events pertained to the nervous system (7 effects) or psychiatric (3 effects) disorders. There were more adverse effects reported with pregabalin (36 effects) than with gabapentin (22 effects). Six pregabalin studies reported euphoria as a side effect, while no studies reported euphoria with gabapentin. This was the only side effect that may correlate with addictive potential. Gabapentioids were reported to significantly reduce pain compared to placebo.
Despite RCTs documenting the adverse events of gabapentionoids on the nervous system, there was no evidence of gabapentinoid use leading to addiction, suggesting an urgent need to design studies investigating their abusive potential.
加巴喷丁类药物具有滥用潜力，这让需要长期疼痛管理的神经病理性疼痛患者面临风险，因此人们越来越关注这一点。但目前的证据尚不一致。
本系统评价旨在评估加巴喷丁类药物治疗神经病理性疼痛的安全性和疗效，重点关注随机对照试验（RCT），并根据受影响的身体系统对副作用进行分类。
在 MEDLINE（PubMed）、EMBASE、Web of Science、PsycoINFO 和 CINAHL（EBSCO）中进行检索，纳入 RCT 以识别和批判性评价评估加巴喷丁类药物治疗成人神经病理性疼痛的安全性和治疗效果的研究。使用既定的 Cochrane 表格进行数据提取，并使用风险偏倚工具评估质量。
共纳入 50 项研究（12398 名参与者）。大多数不良事件涉及神经系统（7 种效应）或精神（3 种效应）疾病。与加巴喷丁（22 种效应）相比，普瑞巴林（pregabalin）报告的不良事件更多（36 种效应）。有 6 项普瑞巴林研究报告欣快感是一种副作用，而没有研究报告加巴喷丁有欣快感。这是唯一可能与成瘾潜力相关的副作用。与安慰剂相比，加巴喷丁类药物显著降低了疼痛。
尽管 RCT 记录了加巴喷丁类药物对神经系统的不良事件，但没有证据表明加巴喷丁类药物的使用会导致成瘾，这表明迫切需要设计研究来调查它们的滥用潜力。
