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Previous Volume 352:1324-1334 March 31, 2005 Number 13 Next

	Full Text PDF PDA Full Text PowerPoint Slide Set CME Exam Editorial by Raja, S. N. Letters Add to Personal Archive Add to Citation Manager Notify a Friend E-mail When Cited E-mail When Letters Appear PubMed Citation

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.

Source Information

From the Departments of Anesthesiology (I.G., J.M.B.) and Pharmacology and Toxicology (I.G.), the Departments of Mathematics and Statistics and Community Health and Epidemiology (D.T.), the Department of Psychology (R.R.H.), and the Department of Medicine (Division of Endocrinology) (R.L.H.), Queen's University, Kingston, Ont.; and the Departments of Medicine (Division of Neurology) and Chemistry (D.F.W.), Dalhousie University, Halifax, N.S. — both in Canada.

Address reprint requests to Dr. Gilron at the Department of Anesthesiology, Queen's University, 76 Stuart St., Kingston, ON K7L 2V7, Canada, or at gilroni{at}post.queensu.ca.

Full Text of this Article

Related Letters:

Morphine, Gabapentin, or Their Combination for Neuropathic Pain
Baillie J. K., Power I., Tesfaye S., Selvarajah D., Gilron I., Weaver D. F.
Extract | Full Text | PDF  
N Engl J Med 2005; 352:2650-2651, Jun 23, 2005. Correspondence

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