669 EFFICACY AND SAFETY OF PREGABALIN IN THE TREATMENT OF PATIENTS WITH GENERALISED ANXIETY DISORDER AND COMORBID CHRONIC PAIN CONDITIONS

BackgroundPharmacological and conventional non-pharmacological treatments are only moderately effective in treating generalised anxiety disorder (GAD). Recently, repetitive transcranial magnetic stimulation (rTMS) has attracted interest because of its potential therapeutic value.AimTo investigate the efficacy and safety of rTMS treatment for GAD.MethodsLiterature studies published in English or Chinese were screened in 10 electronic databases up to 5 December 2018. The included studies’ bias risk was assessed using Cochrane risk of bias assessment tool. Meta-analysis was performed to compute the standardised mean difference (SMD) and risk ratio (RR) along with its 95% CIs through using RevMan V.5.3. Heterogeneity was inspected by I2 and the χ2 test. We performed subgroup analysis and meta-regression to investigate heterogeneity. We used funnel plot to assess publication bias. We used the GRADE approach to assess the whole quality of evidence.ResultsTwenty-one studies, with a total sample size of 1481, were analysed. The risk of bias in most studies included is moderate, the majority of which are lacking of blinding methods of treatment allocation. The treatment had beneficial effects in the rTMS group compared with the control group in mean anxiety score (SMD=−0.68; 95% CI −0.89 to −0.46). None of the 21 studies included here reported severe adverse events. As for dropout rates, there are no statistically significant differences between the two groups (RR 1.14, 95% CI 0.72 to 1.82) or adverse events (RR 0.95, 95% CI 0.77 to 1.18). No particular influence on the heterogeneity of any variable was observed. The risk of publication bias was low. According to the GRADE approach, the evidence levels of primary outcome (treatment effects) and secondary outcomes (acceptability and safety) were rated as ‘medium’.ConclusionThe use of rTMS combined with medication treatment may have a significant positive anti-anxiety effect on patients with GAD. However, we should interpret the results cautiously due to the relatively high heterogeneity of the meta-analysis. Future high-quality clinical trials are needed to confirm our results.

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P.4.a.006 A fixed dose study of the efficacy and safety of duloxetine for the treatment of generalised anxiety disorder

European Neuropsychopharmacology ◽

10.1016/s0924-977x(06)70587-9 ◽

2006 ◽

Vol 16 ◽

pp. S451 ◽

Cited By ~ 1

Author(s):

H. Koponen ◽

C. Allgulander ◽

Y.L. Pritchett ◽

J. Erickson ◽

M.J. Detke ◽

...

Keyword(s):

Anxiety Disorder ◽

Fixed Dose ◽

Efficacy And Safety ◽

Generalised Anxiety Disorder ◽

Dose Study

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Efficacy and Safety of Antidepressants as Analgesics in Chronic Pain: A Review

European Psychiatry ◽

10.1016/j.eurpsy.2017.01.2248 ◽

2017 ◽

Vol 41 (S1) ◽

pp. S234-S234 ◽

Cited By ~ 4

Author(s):

J. Fennema ◽

S. Petrykiv ◽

L. de Jonge ◽

M. Arts

Keyword(s):

Chronic Pain ◽

Neuropathic Pain ◽

Low Back Pain ◽

Back Pain ◽

Selective Serotonin Reuptake Inhibitors ◽

Maximum Tolerated Dose ◽

Health Concern ◽

Low Back ◽

Efficacy And Safety ◽

Chronic Pain Conditions

IntroductionDue to the aging population worldwide, chronic pain is becoming an important public health concern. Chronic pain is bidirectional associated with psychiatric disorders including depression and anxiety. Antidepressants are widely used as adjuvant therapy for the treatment of chronic pain for many disorders.Objectives and aimsTo review available literature on the efficacy and safety of antidepressants for the treatment of chronic pain, including neuropathic pain, fibromyalgia, low back pain, and chronic headache or migraine.MethodsWe performed a detailed literature review through PubMed, EMBASE and Cochrane's Library to assess the efficacy and safety of antidepressants in chronic pain conditions.ResultsIn neuropathic pain, fibromyalgia, low back pain, and chronic headaches/migraine, tricyclic antidepressants (TCAs) showed a significant analgesic effect. Selective serotonin reuptake inhibitors (SSRIs) are not effective for the treatment of low back pain and headaches or migraine. Venlafaxine, a serotonin norepinephrine reuptake inhibitor (SNRI) showed significant improvement of fibromyalgia and neuropathic pain. Duloxetine (SNRI) also reduced the pain in fibromyalgia.ConclusionTCAs are the ‘gold standard’ antidepressant analgesics. However, an electrocardiogram and postural blood pressure should be implemented prior to TCA treatment and TCAs should be initiated at low dosages and subsequently increased to the maximum tolerated dose. One should pay attention to their cardiotoxic potential, especially in the older population. For the treatment of neuropathic pain, SNRIs are second-line agents. Although better tolerated, in most types of chronic pain conditions, the effectiveness of SSRIs is limited. To conclude: start low, go slow, and prescribe with caution.Disclosure of interestThe authors have not supplied their declaration of competing interest.

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Efficacy and safety of venlafaxine extended release in children and adolescents with generalised anxiety disorder

European Neuropsychopharmacology ◽

10.1016/s0924-977x(02)80571-5 ◽

2002 ◽

Vol 12 ◽

pp. 358 ◽

Cited By ~ 2

Author(s):

N.R. Kunz ◽

A. Khan ◽

L.W. Lamm ◽

E. Nicolacopoulos ◽

L. Jenkins

Keyword(s):

Anxiety Disorder ◽

Children And Adolescents ◽

Extended Release ◽

Efficacy And Safety ◽

Generalised Anxiety Disorder

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Faculty Opinions recommendation of Efficacy and safety of pregabalin in elderly people with generalised anxiety disorder.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.1138021.618819 ◽

2009 ◽

Author(s):

Alistair Burns ◽

Boben Benjamin ◽

Leema Ahmed

Keyword(s):

Anxiety Disorder ◽

Elderly People ◽

Efficacy And Safety ◽

Generalised Anxiety Disorder

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Efficacy and safety of agomelatine for 12 weeks in non-depressed out-patients with Generalised Anxiety Disorder

http://isrctn.org/> ◽

10.1186/isrctn03554974 ◽

2012 ◽

Author(s):

Antti Ahokas

Keyword(s):

Anxiety Disorder ◽

Efficacy And Safety ◽

Generalised Anxiety Disorder

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Efficacy and safety of pregabalin in generalised anxiety disorder: A critical review of the literature

Journal of Psychopharmacology ◽

10.1177/0269881115598411 ◽

2015 ◽

Vol 29 (10) ◽

pp. 1047-1060 ◽

Cited By ~ 28

Author(s):

David S Baldwin ◽

Johan A den Boer ◽

Gavin Lyndon ◽

Birol Emir ◽

Edward Schweizer ◽

...

Keyword(s):

Anxiety Disorder ◽

Critical Review ◽

Efficacy And Safety ◽

Generalised Anxiety Disorder ◽

Review Of The Literature

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An Examination of Comorbid Generalized Anxiety Disorder and Chronic Pain on Substance Misuse in a Canadian Population-Based Survey

The Canadian Journal of Psychiatry ◽

10.1177/0706743719895340 ◽

2020 ◽

Vol 65 (6) ◽

pp. 418-425

Author(s):

Elena Bilevicius ◽

Jordana L. Sommer ◽

Matthew T. Keough ◽

Renée El-Gabalawy

Keyword(s):

Chronic Pain ◽

Back Pain ◽

Anxiety Disorder ◽

Generalized Anxiety Disorder ◽

Substance Misuse ◽

Population Based ◽

Generalized Anxiety ◽

Opioid Use ◽

Canadian Population ◽

Chronic Pain Conditions

Objectives: Chronic pain and generalized anxiety disorder (GAD) are co-occurring, and both conditions are independently associated with substance misuse. However, limited research has examined the impact of comorbid GAD and chronic pain on substance misuse. The aim of this article was to examine the associations between comorbid GAD and chronic pain conditions compared to GAD only with nonmedical opioid use, drug abuse/dependence, and alcohol abuse/dependence in a Canadian, population-based sample. Methods: Data came from the 2012 Canadian Community Health Survey–Mental Health ( N = 25,113). Multiple logistic regressions assessed the associations between comorbid GAD and chronic pain conditions (migraine, back pain, and arthritis) on substance misuse. Results: Comorbid GAD + back pain and GAD + migraine were associated with increased odds of nonmedical opioid use compared to GAD only. However, the relationship was no longer significant after controlling for additional chronic pain conditions. No significant relationship was found between GAD + chronic pain conditions with drug or alcohol abuse/dependence. Conclusions: Comorbid GAD + back pain and GAD + migraine have a unique association with nonmedical opioid use in Canadians compared to GAD only, and chronic pain multimorbidity may be driving this relationship. Results emphasize the need for screening for substance misuse and prescription access in the context of GAD and comorbid chronic pain.

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