Pregabalin for Postherpetic Neuralgia: Placebo-Controlled Trial of Fixed and Flexible Dosing Regimens on Allodynia and Time to Onset of Pain Relief

Brett R. Stacey, Jeannette A. Barrett, Ed Whalen, Kem F. Phillips, Michael C. Rowbotham

Research output: Contribution to journalArticle

99 Citations (Scopus)

Abstract

Time to onset of pain relief and improvement in allodynia in 269 patients with postherpetic neuralgia was examined in a 4-week randomized trial comparing flexibly dosed pregabalin (150-600 mg/d), fixed-dose pregabalin (300 mg/d), and placebo. For each patient with clinically meaningful pain reduction (≥30%) at end point, onset of pain relief was defined as the first study day on which a patient reported ≥1-point reduction in pain relative to baseline. Average dose achieved was 396 mg/d in the flexible-dose group compared with 295 mg/d in the fixed-dose group. Median pain relief onset times were 3.5 days (flexible-dose), 1.5 days (fixed-dose), and >4 weeks (placebo). Compared with placebo, significantly more patients in both pregabalin treatment groups achieved ≥30% and ≥50% pain reduction at end point. Almost 95% of patients had brush-evoked allodynia, with 68% having moderate to severe allodynia (≥40/100 mm). At baseline, pain and allodynia were highly correlated. Independent of treatment assignment, improvement in pain and improvement in allodynia were significantly correlated. Allodynia could serve as a useful surrogate outcome measure in future studies. Pregabalin was significantly better than placebo in alleviating allodynia (flexible-dose reduction, 26 mm; fixed-dose, 21 mm; placebo, 12 mm). Discontinuation rates due to adverse events were more frequent in the fixed-dose group. Perspective: A flexible-dose regimen reduces discontinuations, facilitates higher final doses, and results in a slightly greater pain relief. Allodynia (touch-evoked pain) can be of disabling severity and is present in nearly all patients with postherpetic neuralgia. Allodynia severity is correlated with pain severity and improvement in allodynia is correlated with clinical response.

Original languageEnglish (US)
Pages (from-to)1006-1017
Number of pages12
JournalJournal of Pain
Volume9
Issue number11
DOIs
StatePublished - Nov 2008

Fingerprint

Postherpetic Neuralgia
Hyperalgesia
Placebos
Pain
Pregabalin
Touch

Keywords

  • allodynia
  • pain
  • PHN
  • Postherpetic neuralgia
  • pregabalin
  • time to onset

ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine
  • Neurology
  • Clinical Neurology

Cite this

Pregabalin for Postherpetic Neuralgia : Placebo-Controlled Trial of Fixed and Flexible Dosing Regimens on Allodynia and Time to Onset of Pain Relief. / Stacey, Brett R.; Barrett, Jeannette A.; Whalen, Ed; Phillips, Kem F.; Rowbotham, Michael C.

In: Journal of Pain, Vol. 9, No. 11, 11.2008, p. 1006-1017.

Research output: Contribution to journalArticle

Stacey, Brett R. ; Barrett, Jeannette A. ; Whalen, Ed ; Phillips, Kem F. ; Rowbotham, Michael C. / Pregabalin for Postherpetic Neuralgia : Placebo-Controlled Trial of Fixed and Flexible Dosing Regimens on Allodynia and Time to Onset of Pain Relief. In: Journal of Pain. 2008 ; Vol. 9, No. 11. pp. 1006-1017.
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