Gabapentin and pregabalin bind to the alpha-2-delta calcium channel subunit and represent a novel analgesic drug class. The evidence base supporting their use for chronic neuropathic and early postsurgical pain is reviewed.
Multiple, large, high-quality trials have demonstrated the safety and efficacy of gabapentin and pregabalin in neuropathic pain. Treatment-related improvement of pain and sleep positively impact upon quality of life. Sedation, dizziness and ataxia are important and relatively common adverse effects, however. Accumulating evidence indicates that gabapentin, and possibly pregabalin, also exert important effects following surgery. Multiple high-quality trials have demonstrated analgesic and opioid-sparing efficacy with gabapentin following various surgical procedures. Gabapentin and pregabalin reduce movement-evoked pain and this can lead to enhanced functional postoperative recovery. Postoperative opioid sparing is of questionable relevance since few trials have shown reduced opioid-related adverse effects. Sedation, dizziness and ataxia have been reported in only a few trials. Future larger-scale perioperative trials focused on safety assessment are needed, however.
Gabapentin and pregabalin are efficacious treatments for neuropathic and postsurgical pain. Future research addressing several specific questions would serve to better delineate their optimal roles in treating these and other pain conditions.
Departments of Anesthesiology and Pharmacology & Toxicology, Queen's University, Kingston, Ontario, Canada and Department of Anesthesiology, Kingston General Hospital, Queen's University, Ontario, Canada
Correspondence to Ian Gilron, MD, MSc, FRCPC, Director, Clinical Pain Research, Departments of Anesthesiology and Pharmacology & Toxicology, Queen's University, 76 Stuart St, Kingston, ON K7L 2V7, Canada Fax: +613 548 1375; e-mail: email@example.com