Gabapentinoids

  • Sergio Canavero
  • Vincenzo Bonicalzi
Chapter

Abstract

Despite regulatory approval, gabapentinoids are not superior to much cheaper agents. Clinically meaningful pain relief with gabapentinoids is achieved in fewer than 20% of patients with discrete diagnoses, and patients with poorly defined disorders such as fibromyalgia fare even worse, with reductions in pain intensity across a number of conditions being very modest, approximately 1.2 points on a 10-point scale [1]. Gabapentin does not have proven utility as a monotherapy in the experience of SCI patients [2], and in the only comparator study with an active placebo, gabapentin was found ineffective for SCI pain [3]. In an RCT which also included nine CP patients, relief greater than 50% was seen in only 21% of patients (14% on placebo) over 8 weeks [4]. In SCI pain, clomipramine is more effective than gabapentin (55% vs. 48% of patients relieved) [5] and so is amitriptyline. The number needed to treat (NNT) of pregabalin for peripheral neuropathic pain in short-term studies (3 months) is 7.7 (6.5–9.4) of gabapentin 6.3 (5–8.4) and of gabapentin extended release and gabapentin enacarbil 8.3 (6.2–13): these compare unfavorably with tricyclics (NNT: 3.6) and are in the same range as SNRIs (NNT 6.4, 5.2–8.4). For central pain, similar figures apply, with about one-third of patients reporting 30% or more relief at short term in controlled, sponsored studies. Some authors emphasize a better profile for throbbing pain, pins and needles, and evoked pains (Tables 15.1, 15.2, 15.3, and 15.4).

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Copyright information

© Springer International Publishing AG 2018

Authors and Affiliations

  • Sergio Canavero
    • 1
  • Vincenzo Bonicalzi
    • 2
  1. 1.HEAVEN/GEMINI International Collaborative GroupTurinItaly
  2. 2.AOUCittà della Salute e della Scienza di Torino, Department of Neurosciences, Rita Levi MontalciniUniversità di TorinoTurinItaly

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