ProHealth health Vitamin and Natural Supplement Store and Health
Log In  |  My Account  |  View Cart  View Your ProHealth Vitamin and Supplement Shopping Cart
800-366-6056  |  Contact Us  |  Help

|
|
|
|
 
Print Page
Email Article

A Review of Antiepileptic Drugs for Neuropathic Pain and Fibromyalgia

  [ 20 votes ]   [ 2 Comments ]
www.ProHealth.com • December 2, 2013

previous article next article

Editor's comment: Antiepileptic drugs – also called anticonvulsants or antiseizure medications – are frequently used to treat neuropathic pain and fibromyalgia.  Lyrica (pregabalin) – the first drug to be approved for fibromyalgia – is an antiepileptic.  This study reviews available research assessing the effectiveness of antiepileptic drugs for neuropathic pain and FM.  They concluded that the evidence from clinical trials only supported the use of two antiepileptics – gabapentin and pregabalin – for neuropathic pain and FM.  What's interesting is that although the drugs only worked for a minority of patients, when it worked, it worked really well – providing at least a 50% reduction in pain intensity.

Antiepileptic drugs for neuropathic pain and fibromyalgia - an overview of Cochrane reviews.

By Philip J. Wiffen, et al.

Plain Language Summary: (abstract follows)

Neuropathic pain is pain coming from damaged nerves. It is different from pain messages carried along healthy nerves from damaged tissue (e.g., a fall, cut, or arthritic knee). Neuropathic pain is treated by different medicines than pain from damaged tissue. Medicines such as paracetamol or ibuprofen are probably not effective in neuropathic pain, while medicines that are sometimes used to treat depression or epilepsy can be very effective in some people with neuropathic pain. Our understanding of fibromyalgia (a condition of persistent, widespread pain and tenderness, sleep problems, and fatigue) is lacking, but fibromyalgia can respond to the same medicines as neuropathic pain.

Antiepileptic drugs (previously called anticonvulsants) are used for treating epilepsy, but have also been used for treating neuropathic pain and fibromyalgia. Many of the drugs have been the subject of individual Cochrane reviews. In August 2013 we collected all these Cochrane reviews on antiepileptic drugs together to provide an overview. Individual antiepileptic drugs work in different ways, and there is no expectation that they are equally effective.

We found that only for gabapentin and pregabalin was there some evidence that they worked in long-term nerve pain with diabetes (painful diabetic neuropathy) and pain after shingles (postherpetic neuralgia). Pregabalin also had evidence of efficacy in central neuropathic pain (typically pain after stroke) and in fibromyalgia. The drugs work very well in some people with these painful conditions, with pain reduced by half. However, only between 1 in 10 and 1 in 4 people will get this level of benefit, depending on the pain condition and the drug. Most people will get no pain relief.

The antiepileptic drugs produced side effects in most people taking them, and for about 1 in 4 these could not be tolerated so they stopped taking the drug. Serious side effects were no more common with antiepileptic drugs than with a harmless placebo.

The evidence we found did not meet current best standards, and as a result it may overestimate benefit. The biggest concern is a lack of any evidence for most drugs in most types of neuropathic pain and fibromyalgia. For lacosamide and lamotrigine there is evidence of a lack of effect; for other antiepileptic drugs (including carbamazepine, clonazepam, phenytoin, valproate) there is no evidence of effect or insufficient evidence of effect.

Abstract:

BACKGROUND: Antiepileptic drugs have been used for treating different types of neuropathic pain, and sometimes fibromyalgia. Our understanding of quality standards in chronic pain trials has improved to include new sources of potential bias. Individual Cochrane reviews using these new standards have assessed individual antiepileptic drugs. An early review from this group, originally published in 1998, was titled 'Anticonvulsants for acute and chronic pain'. This overview now covers the neuropathic pain aspect of that original review, which was withdrawn in 2009.

OBJECTIVES:
To provide an overview of the relative analgesic efficacy of antiepileptic drugs that have been compared with placebo in neuropathic pain and fibromyalgia, and to report on adverse events associated with their use.

METHODS: We included reviews published in the Cochrane Database of Systematic Reviews up to August 2013 (Issue 7). We extracted information from each review on measures of efficacy and harm, and methodological details concerning the number of participants, the duration of studies, and the imputation methods used, in order to judge potential biases in available data. We analysed efficacy data for each painful condition in three tiers, according to outcome and freedom from known sources of bias. The first tier met current best standards - at least 50% pain intensity reduction over baseline (or its equivalent), without the use of last observation carried forward (LOCF) for dropouts, an intention-to-treat (ITT) analysis, in parallel group studies with at least 200 participants lasting eight weeks or more. The second tier used data from at least 200 participants where one or more of the above conditions were not met. The third tier of evidence related to data from fewer than 200 participants, or with several important methodological problems that limited interpretation.

MAIN RESULTS: No studies reported top tier results. For gabapentin and pregabalin only we found reasonably good second tier evidence for efficacy in painful diabetic neuropathy and postherpetic neuralgia. In addition, for pregabalin, we found evidence of efficacy in central neuropathic pain and fibromyalgia. Point estimates of numbers needed to treat for an additional beneficial effect (NNTs) were in the range of 4 to 10 for the important outcome of pain intensity reduction over baseline of 50% or more. For other antiepileptic drugs there was no evidence (clonazepam, phenytoin), so little evidence that no sensible judgement could be made about efficacy (valproic acid), low quality evidence likely to be subject to a number of biases overestimating efficacy (carbamazepine), or reasonable quality evidence indicating little or no effect (lamotrigine, oxcarbazepine, topiramate). Lacosamide recorded such a trivial statistical superiority over placebo that it was unreliable to conclude that it had any efficacy where there was possible substantial bias. Any benefits of treatment came with a high risk of adverse events and withdrawal because of adverse events, but serious adverse events were not significantly raised, except with oxcarbazepine.

AUTHORS' CONCLUSIONS:
Clinical trial evidence supported the use of only gabapentin and pregabalin in some neuropathic pain conditions (painful diabetic neuropathy, postherpetic neuralgia, and central neuropathic pain) and fibromyalgia. Only a minority of people achieved acceptably good pain relief with either drug, but it is known that quality of life and function improved markedly with the outcome of at least 50% pain intensity reduction. For other antiepileptic drugs there was no evidence, insufficient evidence, or evidence of a lack of effect; this included carbamazepine. Evidence from clinical practice and experience is that some patients can achieve good results with antiepileptics other than gabapentin or pregabalin. There is no firm evidence to answer the important pragmatic questions about which patients should have which drug, and in which order the drugs should be used. There is a clinical effectiveness research agenda to provide evidence about strategies rather than interventions, to produce the overall best results in a population, in the shortest time, and at the lowest cost to healthcare providers.

Source: The Cochrane Database of Systematic Reviews, November 11, 2013. By Philip J Wiffen, Sheena Derry, R Andrew Moore, Dominic Aldington, Peter Cole, Andrew S C Rice, Michael PT Lunn, Katri Hamunen, Maija Haanpaa, Eija A Kalso.  Pain Research and Nuffield Department of Clinical Neurosciences, University of Oxford, Pain Research Unit, Churchill Hospital, Oxford, Oxfordshire, UK, OX3 7LE.



previous article
  Rating 4.2 (20 votes) next article




DISCUSS THIS ARTICLE   (2 existing comments) Post a Comment 


mechanism is different and broad.
Posted by: IanH
Dec 3, 2013
Both gabapentin and pregabalin act on the a2d-1 subunnit of voltage-gated calcium channels. Mainly the pre-synaptic terminals of the dorsal root ganglion neurons and probably the dorsal root horn neurons. These have been implicated in the fibromyalgia pathology.

Gabapentin also modulates NMDA receptors, pKc and some inflammatory cytokines or their miRNA.

This is why pregabalin and gabapentin can be effective. Those people with spinal compression fracture or stenosis will benefit most. Some people seem not to have spinal involvement and seem to benefit less. Of course this is also very muddy due to unclear diagnostic criteria.
Reply Reply

Lyrica's side effects
Posted by: lindacb
Jan 15, 2014
I was on Lyrica for about 4 years. While it did ease some of my symptoms, I had really bad side effects. I lost brain cells - I lost my math and language. It was hard for me to have a conversations without forgetting nouns. My friends got used to playing charades with me when I talked. I remember looking at 45 divided by 3 and couldn't figure it out in my head. I knew I knew it at one time. I was an A math student. I was able to regain those skills by going to "Brain Fitness" classes. I gained 40 lbs. It also gave me ADHD (which I never had), and dyslexia. I got off of Lyrica last year. My thoughts are much sharper and all of the above symptoms are gone. I am in more pain though. I am sensitive to the weather and weather changes now. It never got rid of the neuropathy in my feet and am still looking for a solution for that. That's my two cents. I will never go back on that drug again!
Reply Reply
 
Free Chronic Fatigue Syndrome and Fibromyalgia Newsletters
Subscribe to
Our FREE
Newsletter
Subscribe Now!
Receive up-to-date ME/CFS & Fibromyalgia treatment and research news
 Privacy Guaranteed  |  View Archives

Save on Your Next Order

Featured Products
OsteoTec™ UC-II® OsteoTec™ UC-II®
A True Breakthrough in Joint health
Natural Resveratrol Natural Resveratrol
Powerful Antioxidant Support + Positive Anti-aging Effects
FibroSleep™ by ProHealth FibroSleep™ by ProHealth
The All-in-One Natural Sleep Aid
Vitamin D3 5000 IU Vitamin D3 5000 IU
Give your body a boost with the sunshine vitamin
Ultra EPA  - Fish Oil Ultra EPA - Fish Oil
Ultra concentrated source of essential fish oils

Most Viewed Articles
What's the Hidden Cause Behind YOUR Fibromyalgia Flares? [more]

Pridgen Reports Fibromyalgia Antiviral Trial Results “Very Positive”: Predicts New Approach Will Be ... [more]

Massage Therapy Studies for Fibromyalgia Reviewed [more]

How to Limit or Minimize Your Fibromyalgia Flare [more]

Mitochondrial Dysfunction, Post-Exertional Malaise and CFS/ME [more]

VIDEO: IACFS/ME Conference - Summary of Research by Dr. Komaroff [more]

The Devil Is In The Details – A Herpes Simplex Virus Inquiry For Fibromyalgia and Chronic Fatigue Sy... [more]

Sympathetic Nervous System Dysfunction in FIbromyalgia and Overlapping Conditions [more]

Review of Nutritional Supplements Used for ME/CFS and FM [more]

FREE: Stop Feeding Yourself PAIN Guide [more]


FIBROMYALGIA RESOURCES
What is Fibromyalgia?
Fibromyalgia 101
Fibromyalgia Symptoms
Fibromyalgia Treatments
| CFS RESOURCES
What is CFS?
ME/CFS 101
ME/CFS Symptoms
ME/CFS Treatments
| FORUMS
Fibromyalgia
ME/CFS
ADVANCED MEDICAL LABS
WHOLESALE  |  AFFILIATES
GUARANTEE
CONTACT US
PRIVACY
RSS
SITE MAP
ProHealth on Facebook  ProHealth on Twitter  ProHealth on Pinterest  ProHealth on Google Plus
Credit Card Processing