Korean J Pain.  2020 Jan;33(1):3-12. 10.3344/kjp.2020.33.1.3.

Pregabalin and gabapentin in neuropathic pain management after spinal cord injury: a systematic review and meta-analysis

• Davari M
• Amani B
• Amani B
• Khanijahani A
• Akbarzadeh A
• Shabestan R

• KMID: 2506637
• DOI: http://doi.org/10.3344/kjp.2020.33.1.3

Abstract

Neuropathic pain after spinal cord injury (SCI) has a significant negative impact on the patients’ quality of life. The objective of this systematic review is to examine the safety and efficacy of pregabalin (PGB) and gabapentin (GBP) in the treatment of neuropathic pain due to SCI. PubMed, the Cochrane Library, Embase, Scopus, and the Web of Science were searched up to December 2018. The reference lists of key and review studies were reviewed for additional citations. The quality of the studies was evaluated using the Cochrane Collaboration’s tools for assessing the risk of bias. A meta-analysis was performed for primary and secondary outcomes. Eight studies were eligible for inclusion. Meta-analysis of PGB vs. placebo showed that PGB was effective for neuropathic pain (standardized mean difference [SMD] = –0.40; 95% confidence interval [CI]: –0.78, –0.01), anxiety (MD = –0.68; 95% CI:–0.77, –0.59), depression (mean difference [MD] = –0.99; 95% CI: –1.08, –0.89), and sleep interference (MD = –1.08; 95% CI: –1.13, –1.02). Also, GBP was more effective than a placebo for reducing pain. No significant difference was observed between the efficacy of the two drugs (MD = –0.37; 95% CI: –1.67, 0.93). There was no significant difference between the two drugs for discontinuation due to adverse events (risk ratio = 3.00; 95% CI: 0.81, 11.15). PGB and GBP were effective vs. placebos in decreasing neuropathic pain after SCI. Also, there was no significant difference between the two drugs for decreasing pain and adverse events.

Keyword

Anxiety; Depression; Gabapentin; Meta-Analysis; Neuralgia; Pain; Pregabalin; Spinal Cord Injuries; Systematic Review

Figure

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  Fig. 1 Study flow diagram preferred reporting items for systematic reviews and meta-analyses (PRISMA).

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  Fig. 2 Risk of bias.

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  Fig. 3 Pooled mean difference (MD) of pregabalin (PGB) vs. gabapentin (GBP) for pain outcome. There was no significant difference between two drugs for reducing pain. SD: standard deviation, CI: confidence interval, df: degree of freedom.

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  Fig. 4 Pooled mean difference (MD) of pregabalin (PGB) vs. placebo (PBO) for outcomes of pain (A), anxiety (B), depression (C), and sleep interference (D). PGB is effective vs. PBO for all outcomes. SD: standard deviation, CI: confidence interval, df: degree of freedom.

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  Fig. 5 Pooled risk ratio (RR) of pregabalin (PGB) vs. gabapentin (GBP) for adverse events (AEs). There was no significant difference between two drugs for AEs. CI: confidence interval, df: degree of freedom.

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  Fig. 6 Pooled risk ratio (RR) of pregabalin (PGB) vs. placebo (PBO) for adverse events. There was no significant difference between PGB and PBO for discontinuation, somnolence, and peripheral edema. The incidence of dizziness was higher for PGB. CI: confidence interval, df: degree of freedom.

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