Efficacy and safety of pregabalin versus amitriptyline in patients with painful diabetic neuropathy

Background: Painful diabetic neuropathy is a common complication of long standing diabetes mellitus. Amitriptyline is commonly used to treat painful diabetic neuropathy. Pregabalin has been shown to be effective in the treatment of painful diabetic neuropathy with lesser adverse effects. Sustained release (SR) of pregabalin has the advantage of once daily dosing and a better patient compliance. Hence, this study was planned to compare the efficacy and safety of pregabalin-SR with amitriptyline in painful diabetic neuropathy.Methods: It is a prospective, open labelled, randomized controlled study. A total of 80 patients diagnosed with painful diabetic neuropathy based on Diabetic neuropathy symptom score and Michigan neuropathy screening instrument, were randomized into two groups to receive amitriptyline and pregabalin SR. Amitriptyline was started at 25mg OD and pregabalin SR 75mg OD for 6 weeks with optional dose titration. Patients were assessed for pain relief by using visual analogue scale and an overall improvement in their general condition by patient’s global impression of change scale. Adverse drug reactions were recorded on each follow up.Results: All patients had significant improvement in pain relief in both the treatment groups. The median VAS (visual analogue scale) score was slightly higher in pregabalin SR group (25 vs 22) however it was not statistically significant. Intergroup comparison did not show any significant differences between the treatment groups. Good and moderate pain relief were noted in 37(92.5%) and 3(7.5%) patients on amitriptyline and 36 (90%) and 4 (10%) patients on pregabalin SR respectively. The common adverse effects reported in amitriptyline group were drowsiness (27.5%) and dry mouth (17.5%) and in pregabalin-SR group were drowsiness (15%) and dizziness (5%). No serious adverse event was reported in either of the groups.Conclusions: In patients with painful diabetic neuropathy both amitriptyline and pregabalin-SR are equally effective in alleviating pain and improving the patient’s general condition, but pregabalin-SR has the advantage of fewer adverse effects and convenient dosage timing.

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Pregabalin versus oxcarbazepine in painful diabetic neuropathy in elderly population: Efficacy and safety in terms of pain relief, cognitive function, and overall quality of life

Indian Journal of Pain ◽

10.4103/ijpn.ijpn_76_17 ◽

2018 ◽

Vol 32 (1) ◽

pp. 40

Author(s):

Hammad Usmani ◽

SyedH Amir ◽

Farah Nasreen ◽

SheeluS Siddiqi ◽

Muazzam Hasan ◽

...

Keyword(s):

Quality Of Life ◽

Cognitive Function ◽

Pain Relief ◽

Diabetic Neuropathy ◽

Elderly Population ◽

Painful Diabetic Neuropathy ◽

Efficacy And Safety

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A Comparative Randomised Clinical Study Between Nebulised Fentanyl and Intravenous Fentanyl For Post Operative Pain Relief

Journal of the Bangladesh Society of Anaesthesiologists ◽

10.3329/jbsa.v27i1.28997 ◽

2016 ◽

Vol 27 (1) ◽

pp. 27-30

Author(s):

Reza Ershad ◽

Md Mozaffer Hossain ◽

Mohammad Shafiqul Alam ◽

AKM Asaduzzaman

Keyword(s):

Pain Relief ◽

Visual Analogue Scale ◽

Adverse Effects ◽

Respiratory Depression ◽

Analogue Scale ◽

Analgesic Efficacy ◽

Randomised Clinical Trial ◽

Post Operative Pain ◽

Prolonged Duration ◽

First Onset

Background and Aim: Intravenous (IV) route for fentanyl administration is very effective for postoperative pain relief, but complications such as respiratory depression, bradycardia and hypotension have limited this route. The aim of this randomised clinical trial was to compare the efficacy of nebulised fentanyl with IV fentanyl for post-operative pain relief after lower abdominal surgery. Methods:In the post-operative wards, at the time of first onset of pain( visual analogue scale- VAS score > 5) patients were randomised into two groups and either fentanyl IV 2 ìg/kg or by nebulisation of solution containing 4 ?g/kg fentanyl over 6-8 min in 120 patients divided into two groups of 60 each. Observation were made for pain relief by visual analogue scale score 0-10. Adverse effects such as respiratory depression, bradycardia and hypotension were also recorded. Statistical analysis was performed using Medcalc software version 12, 2012. (MedCalc Software, Ostend, Belgium). Results: In the nebulisation group, it was observed that the analgesic efficacy of fentanyl had little delayed onset (10 min vs. 5 min). Nebulisation with 4 ?g/kg fentanyl produced analgesia at par to 2 ?g/kg IV fentanyl with prolonged duration (90 min vs. 30 min) and with significantly less adverse effects. Conclusions:This study shows that nebulisation with 4 ìg/kg fentanyl may be used as an alternative to IV 2 ìg/kg fentanyl for adequate post-operative pain relief.Journal of Bangladesh Society of Anaesthesiologists 2014; 27(1): 27-30

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The effect of CYP2D6 and CYP2C9 gene polymorphisms on the efficacy and safety of the combination of tramadol and ketorolac used for postoperative pain management in patients after video laparoscopic cholecystectomy

Drug Metabolism and Personalized Therapy ◽

10.1515/dmdi-2021-0112 ◽

2021 ◽

Vol 0 (0) ◽

Author(s):

Andranik Alexandrovich Muradian ◽

Dmitry Alekseevich Sychev ◽

Dmitry Alekseevich Blagovestnov ◽

Zhannet Alimovna Sozaeva ◽

Kristina Anatolyevna Akmalova ◽

...

Keyword(s):

Laparoscopic Cholecystectomy ◽

Postoperative Pain ◽

Pain Relief ◽

Visual Analogue Scale ◽

Gastrointestinal Bleeding ◽

Analogue Scale ◽

Pain Syndrome ◽

Postoperative Pain Relief ◽

Mcgill Pain Questionnaire ◽

Efficacy And Safety

Abstract Objectives One of the key components of ERAS is adequate pain control in the postoperative period. There are no rational schemes for postoperative pain relief. At the same time, adequate postoperative pain relief promotes early activation and early rehabilitation of patients and shortens the duration of the postoperative stay, and does not cause postoperative complications associated with analgesia (weakness, intestinal paresis, nausea and vomiting). The aims of the present study are to assess the possible association of CYP2D6 and CYP2C9 polymorphisms with the efficacy and safety of tramadol and ketorolac in postoperative pain. Methods A total of 107 patients were genotyped for CYP2D6 and CYP2C9 polymorphisms. All patients underwent laparoscopic cholecystectomy. Postoperative pain relief was carried out with ketorolac and tramadol. Postoperative pain syndrome was assessed using a visual analogue scale and McGill pain questionnaire. The profile of side effects was assessed by the dynamics of red blood counts as a possible trigger for the development of gastrointestinal bleeding according to the method of global assessment of triggers. Results Pain was statistically significantly lower in CYP2C9*2 carriers, according to visual analogue scale (VAS): after 12 h – by 1.5 (p=0.002); after 24 h – by 1.1 (p=0.012); after 36 h – by 1.05 (p=0.004); after 48 h – by 0.7 (p=0.026). In CYP2C9*3 carriers the results were not statistically significant. In carriers of CYP2D6*4 pain syndromes were higher at all-time intervals, but statistically reliable results were obtained only after 2 h – by 1.01 (p=0.054) and after 24 h – by 0.8 (p=0.035). The profile of adverse reactions for NSAIDs was evaluated by the dynamics of hemoglobin and erythrocyte indices. A more pronounced decrease in the relative difference in hemoglobin levels was noted in CYP2C9*2 and CYP2C9*3 polymorphism carriers – by 1.7 (p=0.00268) and-by 2.2 (p=0.000143), respectively. Conclusions CYP2D6 and CYP2C9 can predict analgesic effectiveness of tramadol and ketorolac. CYP2C9 can predict the risk of gastrointestinal bleeding, including those hidden to ketorolac.

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Efficacy and Safety of Mexiletine in the Treatment of Painful Diabetic Neuropathy. The Mexiletine Study Group

Diabetes Care ◽

10.2337/diacare.20.10.1594 ◽

1997 ◽

Vol 20 (10) ◽

pp. 1594-1597 ◽

Cited By ~ 97

Author(s):

P. Oskarsson ◽

J.-G. Ljunggren ◽

P.-E. Lins

Keyword(s):

Diabetic Neuropathy ◽

Study Group ◽

Painful Diabetic Neuropathy ◽

Efficacy And Safety

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Efficacy and Safety of 25% Trichloroacetic Acid Peel Versus 30% Salicylic Acid Peel in Mild-to-Moderate Acne Vulgaris: A Comparative Study

Dermatology Practical & Conceptual ◽

10.5826/dpc.1103a63 ◽

2021 ◽

pp. 2021063

Author(s):

Surabhi Dayal ◽

Satbir Singh ◽

Priyadarshini Sahu

Keyword(s):

Salicylic Acid ◽

Adverse Effects ◽

Comparative Study ◽

Clinical Efficacy ◽

Trichloroacetic Acid ◽

Acne Vulgaris ◽

Efficacy And Safety ◽

Inflammatory Lesions ◽

Treatment Groups ◽

Proven Efficacy

Background: Both salicylic acid (SA) and trichloroacetic acid (TCA) have proven efficacy with goodsafety profiles in the treatment of acne vulgaris. Objectives: This study compared the clinical efficacy and safety of 25% TCA and 30% SA peels in thetreatment of mild and moderate acne vulgaris. Methods: Patients with mild or moderate acne vulgaris were randomized into 2 groups of 25 personseach, and treated with either the TCA peel or the SA peel at 2-week intervals for 12 weeks. Evaluationof active acne was done by individual lesion counts (comedones, papules and pustules) and calculationof the Michaelsson acne score (MAS). Results: Both peels led to significant decrease in individual lesion counts and MAS compared to baselinevalues, without significant differences between the treatment groups. Thus, the peels had equivalentefficacy against acne vulgaris. The TCA peel was better in treating non-inflammatory lesions,while the SA peel was better for inflammatory lesions, but the differences were not significant. Noserious adverse effects were recorded, but more patients in the TCA peel group experienced burningand stinging sensations. Conclusion: The efficacy of 25% TCA is comparable to that of 30% SA in mild-to-moderate acnevulgaris, but safety and tolerability were better with the SA peel than TCA peel.

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Surgical Outcome of Microvascular Decompression for Trigerminal Neuralgia in Terms of Pain Control Using Visual Analogue Scale

Pakistan Journal Of Neurological Surgery ◽

10.36552/pjns.v24i3.470 ◽

2020 ◽

Vol 24 (3) ◽

Author(s):

RIAZ-UR- REHMAN ◽

MUHAMMAD NAWAZ KHAN ◽

ATTIYA NASIR SIDDIQUE ◽

AKBAR JAMAL

Keyword(s):

Pain Relief ◽

Visual Analogue Scale ◽

Trigeminal Neuralgia ◽

Pain Control ◽

Analogue Scale ◽

Visual Analogue Score ◽

Definitive Treatment ◽

Inclusion Criteria ◽

Good Pain Relief ◽

Vascular Decompression

Objective: The aim of conducting this study was to evaluate the outcome of a Micro vascular Decompression procedure for the definitive treatment of Trigeminal Neuralgia in our setup. Material and Methods: This observational prospective study was carried out in Neurosurgery unit Hayatabad Medical Complex, Peshawar. A total of 50 patients operated for micro vascular decompression surgeries were enrolled in the study, both genders and any age were in inclusion criteria. Patients previously operated for trigeminal neuralgia were excluded from the study. Post operatively all patients were followed for 1year to calculate the outcome in terms of pain control using visual analogue score (VAS). Immediate pain relief during the first post-operative week and trigeminal neuralgia pain at 1 year post op were recorded and graded into three categories based on Visual Analogue Scale (VAS) such as Excellent: 0-2 , Good: 3-6, Fail/Poor: 7 – 10. Results: 50 patients fulfilled the inclusion criteria. 22 were male & 28 were female with an age range from 42-78 years. Average duration of disease was 5 years. In 30 patients, clinically v2-v3 were predominantly involved, in remaining 14 patient v1-v2 were involved & only in 6 patients all three branches were involved. Among all operated 50 patients 18(36%) had excellent pain relief, 26 (52%) had good pain relief & 6 (12%) had fail/poor pain relief. Conclusion: From this data it was concluded that micro vascular decompression is an effective surgical procedure in relieving pain of trigeminal neuralgia in patients who are refractive to medical treatment.

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Thermal antinociception after dexmedetomidine administration in cats: A comparison between intramuscular and oral transmucosal administration

Journal of Feline Medicine and Surgery ◽

10.1016/j.jfms.2009.03.009 ◽

2009 ◽

Vol 11 (10) ◽

pp. 829-834 ◽

Cited By ~ 40

Author(s):

Louisa S. Slingsby ◽

Polly M. Taylor ◽

Taylor Monroe

Keyword(s):

Standard Deviation ◽

Visual Analogue Scale ◽

Analogue Scale ◽

General Linear Model ◽

Test Drug ◽

Treatment Groups ◽

Antinociceptive Effects ◽

Sedation Scores ◽

Transmucosal Administration ◽

Over Time

Dexmedetomidine 40 μg/kg was administered either intramuscularly (IM) or oral transmucosally (OTM) to 12 cats in a randomised cross-over study. Thermal nociceptive thresholds and visual analogue scale (VAS) sedation scores were obtained before and at regular intervals up to 24 h after test drug administration. The summary measures of overall mean threshold, overall mean VAS sedation plus onset, offset and duration of analgesia were investigated using a univariate general linear model. There were no significant differences between treatment groups. Data are presented as mean±standard deviation: delta T mean increase over time (IM 6°C±3°C, OTM 6°C±2°C); overall mean VAS (IM 43±9 OTM 39±1); onset (IM 35±32 and OTM 30±40 min); offset (IM 96±56 and OTM 138±135 min); duration (IM 61±47 OTM 99±124 min). Dexmedetomidine is well absorbed through the oral mucosa in cats since OTM and IM administration of dexmedetomidine 40 μg/kg produced similar overall sedative and antinociceptive effects.

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Sympathetic Blocks Provided Sustained Pain Relief in a Patient with Refractory Painful Diabetic Neuropathy

Case Reports in Anesthesiology ◽

10.1155/2012/285328 ◽

2012 ◽

Vol 2012 ◽

pp. 1-5 ◽

Cited By ~ 3

Author(s):

Jianguo Cheng ◽

Anuj Daftari ◽

Lan Zhou

Keyword(s):

Nervous System ◽

Pain Relief ◽

Sympathetic Nervous System ◽

Diabetic Neuropathy ◽

Critical Role ◽

Sensory Neuropathy ◽

Painful Diabetic Neuropathy ◽

Nerve Blocks ◽

Sympathetic Nervous ◽

Sympathetic Blocks

The sympathetic nervous system has been implicated in pain associated with painful diabetic neuropathy. However, therapeutic intervention targeted at the sympathetic nervous system has not been established. We thus tested the hypothesis that sympathetic nerve blocks significantly reduce pain in a patient with painful diabetic neuropathy who has failed multiple pharmacological treatments. The diagnosis of small fiber sensory neuropathy was based on clinical presentations and confirmed by skin biopsies. A series of 9 lumbar sympathetic blocks over a 26-month period provided sustained pain relief in his legs. Additional thoracic paravertebral blocks further provided control of the pain in the trunk which can occasionally be seen in severe diabetic neuropathy cases, consequent to extensive involvement of the intercostal nerves. These blocks provided sustained and significant pain relief and improvement of quality of life over a period of more than two years. We thus provided the first clinical evidence supporting the notion that sympathetic nervous system plays a critical role in painful diabetic neuropathy and sympathetic blocks can be an effective management modality of painful diabetic neuropathy. We concluded that the sympathetic nervous system is a valuable therapeutic target of pharmacological and interventional modalities of treatments in painful diabetic neuropathy patients.

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