Morphine, gabapentin, or their combination for neuropathic pain. Export

@article{citeulike:2538699, abstract = {BACKGROUND: The available drugs to treat neuropathic pain have incomplete efficacy and dose-limiting adverse effects. We compared the efficacy of a combination of gabapentin and morphine with that of each as a single agent in patients with painful diabetic neuropathy or postherpetic neuralgia. METHODS: In this randomized, double-blind, active placebo-controlled, four-period crossover trial, patients received daily active placebo (lorazepam), sustained-release morphine, gabapentin, and a combination of gabapentin and morphine--each given orally for five weeks. The primary outcome measure was mean daily pain intensity in patients receiving a maximal tolerated dose; secondary outcomes included pain (rated according to the Short-Form McGill Pain Questionnaire), adverse effects, maximal tolerated doses, mood, and quality of life. RESULTS: Of 57 patients who underwent randomization (35 with diabetic neuropathy and 22 with postherpetic neuralgia), 41 completed the trial. Mean daily pain (on a scale from 0 to 10, with higher numbers indicating more severe pain) at a maximal tolerated dose of the study drug was as follows: 5.72 at baseline, 4.49 with placebo, 4.15 with gabapentin, 3.70 with morphine, and 3.06 with the gabapentin-morphine combination (P<0.05 for the combination vs. placebo, gabapentin, and morphine). Total scores on the Short-Form McGill Pain Questionnaire (on a scale from 0 to 45, with higher numbers indicating more severe pain) at a maximal tolerated dose were 14.4 with placebo, 10.7 with gabapentin, 10.7 with morphine, and 7.5 with the gabapentin-morphine combination (P<0.05 for the combination vs. placebo, gabapentin, and morphine). The maximal tolerated doses of morphine and gabapentin were lower (P<0.05) with the combination than for each drug as single agent. At the maximal tolerated dose, the gabapentin-morphine combination resulted in a higher frequency of constipation than gabapentin alone (P<0.05) and a higher frequency of dry mouth than morphine alone (P<0.05). CONCLUSIONS: Gabapentin and morphine combined achieved better analgesia at lower doses of each drug than either as a single agent, with constipation, sedation, and dry mouth as the most frequent adverse effects.}, address = {Department of Anesthesiology, Queen's University, Kingston, Ont, Canada. gilroni@post.queensu.ca}, author = {Gilron, Ian and Bailey, Joan M. and Tu, Dongsheng and Holden, Ronald R. and Weaver, Donald F. and Houlden, Robyn L.}, citeulike-article-id = {2538699}, citeulike-linkout-0 = {http://dx.doi.org/10.1056/NEJMoa042580}, citeulike-linkout-1 = {http://content.nejm.org/cgi/content/abstract/352/13/1324}, citeulike-linkout-2 = {http://view.ncbi.nlm.nih.gov/pubmed/15800228}, citeulike-linkout-3 = {http://www.hubmed.org/display.cgi?uids=15800228}, day = {31}, doi = {10.1056/NEJMoa042580}, issn = {1533-4406}, journal = {The New England journal of medicine}, keywords = {gabapentin, neuropathic-pain}, month = {March}, number = {13}, pages = {1324--1334}, posted-at = {2008-03-16 08:08:13}, priority = {3}, title = {Morphine, gabapentin, or their combination for neuropathic pain.}, url = {http://dx.doi.org/10.1056/NEJMoa042580}, volume = {352}, year = {2005} }

TY - JOUR ID - citeulike:2538699 L3 - citeulike-article-id:2538699 N2 - BACKGROUND: The available drugs to treat neuropathic pain have incomplete efficacy and dose-limiting adverse effects. We compared the efficacy of a combination of gabapentin and morphine with that of each as a single agent in patients with painful diabetic neuropathy or postherpetic neuralgia. METHODS: In this randomized, double-blind, active placebo-controlled, four-period crossover trial, patients received daily active placebo (lorazepam), sustained-release morphine, gabapentin, and a combination of gabapentin and morphine--each given orally for five weeks. The primary outcome measure was mean daily pain intensity in patients receiving a maximal tolerated dose; secondary outcomes included pain (rated according to the Short-Form McGill Pain Questionnaire), adverse effects, maximal tolerated doses, mood, and quality of life. RESULTS: Of 57 patients who underwent randomization (35 with diabetic neuropathy and 22 with postherpetic neuralgia), 41 completed the trial. Mean daily pain (on a scale from 0 to 10, with higher numbers indicating more severe pain) at a maximal tolerated dose of the study drug was as follows: 5.72 at baseline, 4.49 with placebo, 4.15 with gabapentin, 3.70 with morphine, and 3.06 with the gabapentin-morphine combination (P<0.05 for the combination vs. placebo, gabapentin, and morphine). Total scores on the Short-Form McGill Pain Questionnaire (on a scale from 0 to 45, with higher numbers indicating more severe pain) at a maximal tolerated dose were 14.4 with placebo, 10.7 with gabapentin, 10.7 with morphine, and 7.5 with the gabapentin-morphine combination (P<0.05 for the combination vs. placebo, gabapentin, and morphine). The maximal tolerated doses of morphine and gabapentin were lower (P<0.05) with the combination than for each drug as single agent. At the maximal tolerated dose, the gabapentin-morphine combination resulted in a higher frequency of constipation than gabapentin alone (P<0.05) and a higher frequency of dry mouth than morphine alone (P<0.05). CONCLUSIONS: Gabapentin and morphine combined achieved better analgesia at lower doses of each drug than either as a single agent, with constipation, sedation, and dry mouth as the most frequent adverse effects. IS - 13 JF - The New England journal of medicine SN - 1533-4406 AD - Department of Anesthesiology, Queen's University, Kingston, Ont, Canada. gilroni@post.queensu.ca EP - 1334 TI - Morphine, gabapentin, or their combination for neuropathic pain. VL - 352 SP - 1324 KW - gabapentin KW - neuropathic-pain AU - Gilron, Ian AU - Bailey, Joan AU - Tu, Dongsheng AU - Holden, Ronald AU - Weaver, Donald AU - Houlden, Robyn PY - 2005/03/31/ UR - http://dx.doi.org/10.1056/NEJMoa042580 ER -