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Pregabalin for Neuropathic Pain and Itch in Recessive Dystrophic Epidermolysis Bullosa
(American Medical Association (AMA), 2024-12-01)
Margarita Calvo
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Macarena Tejos-Bravo
;
Alvaro Passi-Solar
;
Fernanda Espinoza
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FUENTES BUSTOS, MARIA IGNACIA
<jats:sec><jats:title>Importance</jats:title><jats:p>Patients with recessive dystrophic epidermolysis bullosa (RDEB) experience neuropathic pain and itch. There is a lack of evidence on any treatment for these symptoms in patients with RDEB.</jats:p></jats:sec><jats:sec><jats:title>Objectives</jats:title><jats:p>To test the efficacy of pregabalin in the treatment of neuropathic pain and itch in patients with RDEB.</jats:p></jats:sec><jats:sec><jats:title>Design, Setting, and Participants</jats:title><jats:p>A randomized, double-blinded, crossover trial of oral pregabalin (50-300 mg/d) vs placebo was conducted at 2 sites, Toronto (Canada) and Santiago (Chile) from January 1, 2019, to December 31, 2020. Patients eligible to participate were diagnosed with RDEB, aged 8 to 40 years, not pregnant or lactating (if female), and had evidence of probable neuropathic pain and itching defined as distal thermal sensory loss (confirmed by thermal roller), score of 4 or greater on the <jats:italic>Douleur Neuropathique</jats:italic> 4 questionnaire (DN4), and score greater than 4 on the 10-point visual analog scale [VAS]). Patients with a clinically important or poorly controlled medical or psychiatric condition or pregabalin intolerance or allergy were excluded. Of 41 patients screened, 3 were not eligible and 28 declined enrollment. Data analyses were performed in 2021 through 2023.</jats:p></jats:sec><jats:sec><jats:title>Intervention</jats:title><jats:p>Participants received both pregabalin and matched placebo (titrated to a maximum-tolerated dose of 300 mg/day) in a randomized sequence so that comparisons could be made within participants and between groups.</jats:p></jats:sec><jats:sec><jats:title>Main Outcomes and Measures</jats:title><jats:p>Difference in the mean pain and itch scores between pregabalin and placebo treatment (measured using VAS) before and after intervention.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>In all, 10 participants were randomized to 2 groups, 6 patients (mean [SD] age, 26.7 [8.1] years; 3 females [50%]) in group 1, and 4 patients (mean [SD] age, 26.5 [7.8] years, 2 females [50%]) in group 2. Group 1 received a sequence of pregabalin-placebo while group 2 received placebo-pregabalin. Pregabalin significantly reduced mean (SD) pain scores by 1.9 (1.5) points when controlling for sequence and treatment period vs baseline, while placebo had 0.1 (2.0) points of reduction. The effect of pregabalin was a mild but significant reduction in itch compared to baseline (mean [SD] points, 0.9 [2.2]), whereas the placebo produced no reduction (0.1 [2.5]). The mean pregabalin dose was generally well tolerated.</jats:p></jats:sec><jats:sec><jats:title>Conclusions and Relevance</jats:title><jats:p>The results of this randomized crossover trial indicate that pregabalin significantly reduced pain and itch scores from baseline compared to placebo in patients with RDEB. This feasibility study provided preliminary data on the efficacy of pregabalin in managing pain and itch in RDEB and gathered essential data to inform the design of a larger cohort trial.</jats:p></jats:sec><jats:sec><jats:title>Trial Registration</jats:title><jats:p>ClinicalTrials.gov Identifier: <jats:ext-link xmlns:xlink="http://www.w3.org/1999/xlink" ext-link-type="uri" xlink:href="https://clinicaltrials.gov/study/NCT03928093">NCT03928093</jats:ext-link></jats:p></jats:sec>
Scopus© Citations 3 2
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Latin-American guidelines for opioid use in chronic nononcologic pain
(2017)
Argelia Lara-Solares
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Carlos Aguayo Zamora
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César Amescua García
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João Batista Santos Garcia
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María del Rosario Berenguel Cook
<jats:p>Aim: Latin-American experts in the use of opioids in patients with chronic nononcologic pain (CNOP) have updated existing recommendations to current Latin-American reality. Methods: Several key opinion leaders from Latin America participated in a face-to-face meeting in Guatemala (April 2015) to discuss the use of opioids in CNOP. Subgroups of experts worked on specific topics, reviewed the literature and shaped the final manuscript. Results: The expert panel developed guidelines taking into consideration the utility of both opioid and nonopioid analgesics and factors pertaining to their efficacy, safety, adherence, administration and risks for abuse/addiction. Conclusion: Latin-American guidelines for the use of opioids in CNOP should improve pain relief and patients’ quality of life by increasing access to these effective agents.</jats:p>
3Scopus© Citations 18
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Receptors involved in dexketoprofen analgesia in murine visceral pain
(2020)
V Noriega
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F Sierralta
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P Poblete
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N Aranda
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R Sotomayor-Zárate
52Scopus© Citations 2
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Undertreatment of pain and low use of opioids in Latin America
(2018)
César Amescua García
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Joao Batista Santos Garcia
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María del Rosario Berenguel Cook
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Frantz Colimon
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José Alberto Flores Cantisani
<jats:p> Pain is highly prevalent among the adult Latin American population. However, many patients with moderate to severe pain do not have access to effective pain management with opioids due to limited access to healthcare, overuse of nonopioid analgesics, regulatory barriers and lack of appropriate information about opioids. There is scarce training on use of opioids among physicians and other healthcare providers, which leads to misconceptions, mainly related to a fear of prescribing opioids. Although opioids are safe and effective drugs for the treatment of moderate to severe chronic pain, the use of opioids in Latin American nations is clearly below standards compared with developed countries. </jats:p>
8Scopus© Citations 22

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