Update on gabapentin therapy of neuropathic pain

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Consult Pharm. 2003 Feb;18(2):158-78.

Update on gabapentin therapy of neuropathic pain.

Guay DR.

OBJECTIVE: To provide current information regarding the efficacy and

tolerability of the anticonvulsant gabapentin in the management of

neuropathic pain.

DATA SOURCES: A MEDLINE search was conducted to identify pertinent

studies, case reports, letters, and reviews in the English language

published from 1986 through October 2002. Additional references were

obtained from the bibliographies of these articles.

STUDY SELECTION: All studies evaluating any aspect of use of

gabapentin as an analgesic.

DATA SYNTHESIS: Numerous case reports and series (total N = 750) have

suggested efficacy of gabapentin in daily doses of up to 3.6 g.

Controlled trials in painful diabetic neuropathy, postherpetic

neuralgia, and multiple sclerosis have confirmed the potential

utility of this agent in a variety of neuropathic pain syndromes

(total N = 511). Central nervous system side effects are of most

concern with gabapentin. The absence of significant drug-drug

interactions makes this agent a preferred treatment choice, as

opposed to anticonvulsants such as carbamazepine or lamotrigine.

CONCLUSION: In human pain models using patients with neuropathic

pain, gabapentin has been found effective against both spontaneous

and evoked pain, and these effects are independent of the pain

source. Gabapentin, in doses ranging up to 3.6 g/day, has

demonstrated efficacy in a variety of neuropathic pain states,

including those refractory to agents such as the tricyclic

antidepressants (TCA) and other anticonvulsants. A major question

today is whether gabapentin should be considered as first-line

therapy (i.e., even before a trial of a TCA or carbamazepine) or as

second-line therapy for individuals unresponsive to or intolerant of

TCAs and/or carbamazepine.