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Conclusion

Moderate-quality evidence shows that oral pregabalin at a dose of 300 mg or 600 mg daily has a significant effect on pain in people with moderate or severe neuropathic pain post-shingles or due to diabetes. Low-quality evidence suggests that oral pregabalin is effective after trauma from stroke or spinal cord injury. Pregabalin does not appear to be effective for neuropathic pain associated with HIV. There is very limited evidence for neuropathic back pain, neuropathic cancer pain, and other forms of neuropathic pain.

background

Neuropathic pain results from damage to the nervous system. It differs from pain signals transmitted by damaged tissue (e.g., from a fall, cut, or arthritic knee) along healthy nerves. Neuropathic pain is often treated with different drugs than pain caused by damaged tissue. Medications, sometimes used for depression or epilepsy, may be effective in some people with neuropathic pain. One of these drugs is pregabalin. Our definition of a good result was high pain relief and the ability to take the drug without side effects that lead to treatment discontinuation.

Study characteristics

For this update, we searched for clinical trials using pregabalin to treat neuropathic pain in adults in April 2018. We found 31 new studies with 8,045 participants. In total, we included 45 studies in which 11,906 participants were randomly assigned to either pregabalin, placebo, or another drug. The studies lasted from 2 to 16 weeks. Most studies reported beneficial endpoints that people with neuropathic pain consider important. Results were mainly available for pain after shingles and pain due to nerve damage in diabetes.

Main results

Shingles pain was reduced by half or more in 3 out of 10 people with pregabalin at a dose of 300 mg or 600 mg daily and in 2 out of 10 people with placebo. The pain was reduced by a third or more in 5 out of 10 people with pregabalin at a dose of 300 mg or 600 mg daily and in 3 out of 10 people with placebo. Diabetes pain was relieved by half or more in 3 or 4 out of 10 people with pregabalin at a dose of 300 mg or 600 mg daily, and in 2 or 3 out of 10 people with placebo. Pain was reduced by a third or more in 5 or 6 out of 10 people with pregabalin at a dose of 300 mg or 600 mg daily and in 4 or 5 out of 10 people with placebo. Pregabalin also helped people with different diagnoses (likely mainly post-shingles and diabetes pain) and people with post-stroke pain. It did not help HIV-infected people with neuropathic pain. There was no reliable evidence for other types of neuropathic pain.

Side effects were more common with pregabalin (6 out of 10) than with placebo (5 out of 10). Dizziness and sleepiness occurred in about 1 to 3 in 10 people who took pregabalin. Serious side effects were not common and did not differ between pregabalin and placebo. About 1 in 10 people stopped taking pregabalin because of side effects.

Pregabalin is helpful for some people with chronic neuropathic pain. However, it is not possible to predict who the drug will and will not help with. Current knowledge suggests that short-term use (maybe 4 weeks) is best for assessing effectiveness.

Quality of the evidence

We rated the quality of the evidence on four levels: very low, low, moderate and high. Very low quality evidence means that we are very uncertain about the results. High quality evidence means that we have great confidence in the results. We judged that most of the evidence was of moderate quality, which means that while research gives a good indication of the likely effect, the effect could be significantly different. The main problems were the small size of some studies and inadequate reporting of important methodological information. The results have not changed significantly since the 2009 review.