A Randomized Study of the Effects of Gabapentin on Postamputation Pain (original) (raw)
Related papers
innovative publication
Introduction: In addition to anticonvulsant property of gabapentin, it was demonstrated that gabapentin also possesses analgesic property. In this randomized control trial the efficacy of gabapentin for postoperative pain relief was studied on 60 adult patients of either sex, belonging to ASA grade I or II, in the age range of 18-60 years posted for lower limb surgeries under spinal analgesia. Methods: The patients were randomly divided into two groups of 30 patients each. Group A patients (n=30) received oral gabapentin 1200 mg 2 hours prior to scheduled surgery and the same dose was given at 9:00 am on the first and second postoperative days. Group B (n=30) served as control group received only placebo capsules. Subarachnoid block was established in both the groups by administering 4 ml of hyperbaric bupivacaine. Vital parameters such as heart rate, blood pressure respiratory rate along with pain assessment (VAS) were recorded at regular intervals in the postoperative period. Rescue analgesia was provided with intramuscular butorphanol. Results: It was observed that patients in group A exhibited excellent quality of postoperative pain relief as compared to group B (P<0.0001). The requirement of opioids in the form of butorphanol was greatly reduced in group A as compared to group B (P<0.0001). Patient satisfaction using verbal rating scale was higher in Group A as compared to group B (P<0.0001). Minor side effects encountered were mild sedation, shivering, nausea, vomiting and dizziness which showed no significant difference between the groups. Conclusion: Oral administration of gabapentin holds great promise for excellent postoperative pain relief and reduction in the overall requirement of opioids without producing significant side effects.
Efficacy of gabapentin in treating chronic phantom limb and residual limb pain
Journal of Rehabilitation Research and Development, 2005
Twenty-four adults with phantom limb pain (PLP) and/or residual limb pain (RLP) participated in a double-blind crossover trial. Participants were randomly assigned to receive gabapentin or placebo and later crossed over to the other treatment, with a 5-week washout interval in which they did not receive medication. Gabapentin was titrated from 300 mg to the maximum dose of 3,600 mg. Measures of pain intensity, pain interference, depression, life satisfaction, and functioning were collected throughout the study. Analyses revealed no significant group differences in pre-to posttreatment change scores on any of the outcome measures. More than half of the participants reported a meaningful decrease in pain during the gabapentin phase compared with about one-fifth who reported a meaningful decrease in pain during the placebo phase. In this trial, gabapentin did not substantially affect pain. More research on the efficacy of gabapentin to treat chronic PLP and RLP is needed. Abbreviations: ANOVA = analysis of variance, BPI = Brief Pain Inventory, CES-D = Center for Epidemiologic Studies Depression Scale, CHART = Craig Handicap Assessment and Reporting Technique, FIM = Functional Independence Measure, GABA = gamma-aminobutyric acid, NRS = numerical rating scale, PLP = phantom limb pain, RLP = residual limb pain, SF-MPQ = short-form McGill Pain Questionnaire, SWLS = Satisfaction with Life Scale, VAS = visual analog scale.
Management of Post-Amputation Pain
2020
INTRODUCTION: The prevalence of amputation and post-amputation pain (PAP) is rising. There are two main types of PAP: residual limb pain (RLP) and phantom limb pain (PLP), with an estimated 95% of people with amputations experiencing one or both. MEDICAL MANAGEMENT: The majority of chronic PAP is due to phantom limb pain, which is neurogenic in nature. Common medications used include tricyclic antidepressants, gabapentin, and opioids. Newer studies are evaluating alternative drugs such as ketamine and local anesthetics. REHABILITATION MANAGEMENT: Mirror visual feedback and cognitive behavioral therapy are often effective adjunct therapies and have minimal adverse effects. SURGICAL MANAGEMENT: Neuromodulatory treatment and surgery for neuromas have been found to help select patients with PAP. CONCLUSION: PAP is a complex condition with mechanisms that can be located at the residual limb, spinal cord, and brain-or a combination. This complex pain can be difficult to treat. The mainstays of treatment are largely medical, but several surgical options are also being studied.
Strategies for prevention of lower limb post-amputation pain: A clinical narrative review
Journal of Anaesthesiology Clinical Pharmacology
Postamputation limb pain or phantom limb pain (PLP) develops due to the complex interplay of peripheral and central sensitization. The pain mechanisms are different during the initial phase following amputation as compared with the chronic PLP. The literature describes extensively about the management of established PLP, which may not be applicable as a preventive strategy for PLP. The novelty of the current narrative review is that it focuses on the preventive strategies of PLP. The institution of preoperative epidural catheter prior to amputation and its continuation in the immediate postoperative period reduced perioperative opioid consumption (Level II). Optimized preoperative epidural or intravenous patient-controlled analgesia starting 48 hours and continuing for 48 hours postoperatively decreased PLP at 6 months (Level II). Preventive role of epidural LA with ketamine (Level II) reduced persistent pain at 1 year and LA with calcitonin decreased PLP at 12 months (Level II). Peripheral nerve catheters have opioid sparing effect in the immediate postoperative period in postamputation patients (Level I), but evidence is low for the prevention of PLP (Level III). Gabapentin did not reduce the incidence or intensity of postamputation pain (Level II). The review in related context mentions evidence regarding therapeutic role of gabapentanoids, peripheral nerve catheters, and psychological therapy in established PLP. In future, randomized controlled trials with long-term follow-up of patients receiving epidural analgesia, perioperative peripheral nerve catheters, oral gabapentanoids, IV ketamine, or mechanism-based modality for prevention of PLP as primary outcome are required.
Journal of Pain and Relief, 2019
Background: The aim of this study is to investigate the effect of a single dose of gabapentin, 1200 mg and one hour before surgery on postoperative pain in opioid-dependent patients undergoing lower extremity orthopedic surgeries. Methods: In this randomized double-blind clinical trial, 64 opioid-dependent patients, candidates of elective lower extremity orthopedic surgery at Chamran Hospital, Shiraz, Southern Iran, were recruited and randomly assigned to intervention (G)-1200 mg single oral dose of gabapentin an hour before surgery-and placebo (P) groups. Twenty four hour pain intensity (NRS) after surgery at 2, 4, 6, 12, 18, and 24 hour post-operative, time to the first request for analgesic and total amount of prescribed morphine were measured. The side effects of gabapentin and morphine were recorded at the mentioned time intervals. The patients' global satisfaction of the pain management was also assessed. Results: The patients in group G requested analgesic significantly later than the patients in group P (p=0.003). In the first postoperative hour group G received significantly lower amounts of morphine (p=0.038). Otherwise, no significant difference was detected between the two groups regarding the pain intensity and the amount of administered morphine. The frequency of drug-related side effects and the patients' global satisfaction were not significantly different in the two groups of the study. Conclusions: Oral gabapentin (1200 mg single bolus) can reduce the need for morphine and pain intensity only shortly (about an hour) after the operation in opioid-dependent patients undergoing orthopedic lower-extremity surgeries.
Patient care for postamputation pain and the complexity of therapies: living experiences
Pain Management
Limb amputation traumatically alters body image. Sensations rapidly prevail that the limb is still present and 85% of patients portray phantom limb pain. Throughout the testimonies of amputated patients with intense phantom limb pain, we show the difficulty in treating this chronic pain with current pharmacological and nonpharmacological therapies. Patients & methods: We qualitatively analyzed the therapeutic choices of five amputees, the effectiveness of the treatments chosen and the impact on patients' quality-of-life. Results & conclusion: In general, patients who are refractory to pharmacological treatments are in favor of trying alternative therapies. It is therefore crucial to design a combined and personalized therapeutic plan under the coordination of a multidisciplinary team for the wellbeing of the patient.
Postoperative Gabapentin to Prevent Postoperative Pain: A Randomized Clinical Trial
Anesthesiology and Pain Medicine, 2012
Gabapentin is an anticonvulsant that has postoperative analgesic effects but there have been limited studies on its postoperative administration. The present study was conducted to evaluate the effect of the postoperative oral gabapentin on pain and morphine consumption. The results indicated no significant analgesic efficacy of oral gabapentin 300 mg immediately after tibia internal fixation surgery under spinal anesthesia at time points of 2, 12 and 24 hours postoperatively.
Singapore medical journal, 2007
Gabapentin has demonstrated analgesic effects in clinical trials as a preemptive analgesic and in acute postoperative pain management. This study was conducted to evaluate whether the pre-emptive use of gabapentin could reduce postoperative pain and morphine consumption in patients after lower extremity orthopaedic surgery. 70 ASA I and II patients were randomly assigned to receive 300 mg gabapentin or placebo in a double-blind manner two hours before surgery under general anaesthesia. Postoperatively, the pain was assessed on a visual analogue scale (VAS) at 2, 4, 12, and 24 hours at rest. Morphine 0.05 mg/kg intravenously was used to treat postoperative pain on patients' demand. Total morphine consumption in the first 24 hours after surgery was also recorded. Patients in the gabapentin group had significantly lower VAS scores at all time intervals of 2, 4, 12, and 24 hours, than those in the placebo group (respectively, 55.50 [mean] +/- 15.80 [standard deviation], 57.30 +/- 19...
Postamputation Pain and Sensory Changes in Treatment-naive Patients
Anesthesiology, 2005
Background Pain after amputation is common but difficult to treat, and few controlled treatment studies exist. Methods In the current study, 94 treatment-naive posttraumatic limb amputees with phantom pain (intensity: mean visual analog scale score [0-100], 40 [95% confidence interval, 38-41]) were randomly assigned to receive individually titrated doses of tramadol, placebo (double-blind comparison), or amitriptyline (open comparison) for 1 month. Nonresponders were crossed over to the alternative active treatment. Results After 1 month, phantom pain intensity was 1 (0-2) in the 48 tramadol responders (mean dose, 448 mg [95% confidence interval, 391-505 mg]), 0 (0-0) in the 40 amitriptyline responders (55 [50-59] mg), and 0 (0-0) in the 2 placebo responders, with similar effects on stump pain. Cytochrome P-450 2D6 slow metabolizers derived greater analgesia from tramadol and less from amitriptyline compared with fast metabolizers in the first treatment week (P < 0.01). Electrica...
BMJ Open, 2020
IntroductionGabapentin is an antiepileptic drug currently licensed to treat epilepsy and neuropathic pain but has been used off-label to treat acute postoperative pain. The GAP study will compare the effectiveness, cost-effectiveness and safety of gabapentin as an adjunct to standard multimodal analgesia versus placebo for the management of pain after major surgery.Methods and analysisThe GAP study is a multicentre, double-blind, randomised controlled trial in patients aged 18 years and over, undergoing different types of major surgery (cardiac, thoracic or abdominal). Patients will be randomised in a 1:1 ratio to receive either gabapentin (600 mg just before surgery and 600 mg/day for 2 days after surgery) or placebo in addition to usual pain management for each type of surgery. Patients will be followed up daily until hospital discharge and then at 4 weeks and 4 months after surgery. The primary outcome is length of hospital stay following surgery. Secondary outcomes include pain,...