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Neuropathic pain (NP) is a subtype of chronic pain syndrome defined by International Association of the Study of Pain (IASP) as a “pain caused by a lesion or disease of the somatosensory system.” Consequence of CNS or PNS lesions are activities generated in the somatosensory system without peripheral afferent stimulation. The pathophysiology of the somatosensory system is injury causing complex ectopic signaling between neuronal pathways. There are several types of antineuropathic medications that are currently utilized to treat this subtype of pain, including gabapentin, pregabalin, and duloxetine, amongst others.
Pregabalin is a treatement with a complexe mechanism of action. It’s an antiepileptic drug used as adjunctive treatment of partial epilepsy, it is also taken in the treatment of neuropathic pain, and generalized anxiety disorder, in addition to epilepsy. Some of the advantages of pregabalin include. pharmacokinetics, safety, and tolerability. Clinical trials have demonstrated the efficacy of pregabalin comparable to benzodiazepines, without risk of abuse.
Objectives
to assess the efficacy of pregabalin in patients with generalized anxiety disorder in the Ar-Razi university psychiatric hospital in Salé in Morocco
Methods
To assess the place of pregabalin in the treatement of anxiety disorders through patients hospitalized in the Ar-Razi university psychiatric hospital in Salé in Morocco The evaluation instruments are: For anxiety the Hamilton Anxiety Scale and For therapeutic efficacy CGI-therapeutic index
Results
based on the results of our study on the patients who have improved after an optimal duration of treatment, in conjunction with psychological monitoring, we retain that pregabalin can significantly improve the quality of life of anxious patients and also guarantee them a better prognosis
Conclusions
Pregabalin was significantly more efficacious for the treatment of psychic and somatic symptoms of generalized anxiety disorder and was well tolerated by most study patients.
Benzodiazepines, Z-drugs and gabapentinoids are commonly prescribed medications with multiple indications that have the potential for misuse and dependence. Benzodiazepines enhance the effect of the neurotransmitter gamma-aminobutyric acid (GABA) at the GABA-A receptor, resulting in sedative, anxiolytic, hypnotic, anticonvulsant and muscle relaxant properties. The ‘Z-drugs’ (zopiclone and zolpidem) are non-benzodiazepine hypnotics that also have an agonist effect at the GABA-A receptor. The gabapentinoids (pregabalin and gabapentin) act to decrease central neuronal excitability by binding to α2-δ protein subunits of voltage-activated calcium channels on the neuronal membrane. They were initially marketed as antiepileptic drugs, but are now licensed for use in neuropathic pain and generalised anxiety disorder. This chapter considers each class in turn, exploring the pharmacokinetics, metabolism and potential desired effects that lead to misuse. A practical method for assessing people with potential dependence is described for each substance, as well as strategies to support stabilisation, withdrawal and relapse prevention.
Pregabalin is an analogue of gamma-aminobutyric acid (GABA). Recent reports suggest illicit pregabalin use may be increasing among youth, however its addictive potential has not been well established (1).
Objectives
Drug seeking behavior and chronic drug use are associated with defcits in glutamate clearance and activation of postsynaptic glutamatergic receptors (2). Based upon multiple studies, we compare here the addiction and misuse risks of pregabalin with those of traditional psychoactive substances (3).
Methods
Users of pregabalin were identified from 1st January 2019 to 31 December 2019 in Oran Addictology service, at west Algeria. The aim of the study was to establish the addictive potential of pregabalin and to compare the addiction risks of pregabalin with traditional psychoactive substances in west Algerian population. Clinical diagnosis was established according DSM-5 diagnosis criteria.
Results
A total of 92 cases of pregabalin abuse or dependence were identified. The principal population at risk consists of patients with other current or past substance use disorders, for the most part opioid and multi-drug users, the age group were between 17-38 years old, mostly single men. The mean daily dose of pregabalin was 1200 mg. Almost all patients experienced withdrawal symptoms when pregabalin was discontinued.
Conclusions
The misuse of pregabalin often leads to abuse and dependence, mostly in the context of multiple drug addiction, especially in youth population.
This systematic review aims to identify published randomized controlled trials (RCTs) that evaluated the use of anticonvulsants for the prevention and/or treatment of delirium among older adults.
Methods:
A comprehensive search of databases: MEDLINE ALL (Ovid), Embase (Ovid), PsycINFO (Ovid), Web of Science Core Collection and Cochrane Central Register of Controlled was conducted.
Results:
The search identified four RCTs that evaluated the use of anticonvulsants among older adults with delirium. One RCT evaluated the perioperative use of gabapentin among individuals undergoing spinal surgery and the development of postoperative delirium. One RCT evaluated the relationship between the use of perioperative gabapentin and the development of postoperative delirium among individuals undergoing spinal surgery and hip and knee arthroplasty. Two post-hoc analyses of RCTs evaluated the use of gabapentin and pregabalin among individuals undergoing total knee arthroplasty (TKA) and total hip arthroplasty (THA). The perioperative use of gabapentin reduced the incidence of postoperative delirium among older adults undergoing spinal surgery. The perioperative use of gabapentin did not reduce the rates, severity or duration of postoperative delirium among older adults who were undergoing spine and hip and knee arthroplasty. The perioperative use of gabapentin did not reduce the incidence or duration of postoperative delirium among older adults undergoing elective TKA. The perioperative use of pregabalin did not reduce the incidence of postoperative delirium among older adults undergoing elective THA. Gabapentin and pregabalin were well tolerated among the individuals enrolled in these trials. There were no RCTs identified that evaluated the use of other anticonvulsants for the prevention and/or treatment of delirium among older adults.
Conclusions:
Based on current evidence, the routine use of anticonvulsants for the prevention and/or treatment of delirium among older adults cannot be recommended.
To evaluate the effectiveness and tolerability of pregabalin in the management of the discontinuation of benzodiazepines in long-term users.
Subjects and methods
We performed a 12-week, prospective, uncontrolled, non-interventional, and observational study in patients aged 18 years old or above, who met DSM-IV-TR criteria for benzodiazepine dependence without other major psychiatry disorder. Evaluations included the Benzodiazepine Withdrawal Symptom Questionnaire, the Hamilton Anxiety Rating Scale, the Clinical Global Impression Scale, and the Sheehan Disability Scale. A urine drug screen for benzodiazepines was performed at baseline and every 4 weeks thereafter. The primary effectiveness variable was success rate, defined as achievement of benzodiazepine-free status at week 12 according to the urine drug screen.
Results and discussion
The mean dose at week 12 was 315 (±166) mg/day. The success rate of the benzodiazepine taper in the primary efficacy population (n = 282) was 52% (95% confidence interval [CI], 46–58). Success rates for women and men were 58% (95% CI, 49–67) and 46% (95% CI, 38–55), respectively. The success rates did not differ according to either the benzodiazepine of abuse or the presence of other substance use disorders. Significant and clinically relevant improvements were observed in withdrawal and anxiety symptoms, as well as in patients’ functioning. At week 12, tolerability was rated as good or excellent by 90% and 83% of the clinicians and patients, respectively.
Conclusion
Our results suggest that pregabalin is an efficacious and well-tolerated adjunctive treatment for benzodiazepine withdrawal.
Glutamate dysfunction has been shown to be associated with pathophysiology of obsessive–compulsive disorder (OCD). Our objective is to survey the effects of pregabalin (a glutamate-modulating agent) as an augmenting treatment for resistant OCD.
Patients and methods.
In this 12-week double-blind placebo-controlled clinical trial, 56 patients with resistant OCD were randomly allocated to receive either pregabalin or placebo plus their current medication (sertraline). Yale–Brown Obsessive Compulsive Scale (Y-BOCS) was used to evaluate the outcomes. Adverse effects were also registered.
Results.
Of the 56 patients with resistant OCD who were randomly allocated in 2 groups of pregabalin (n = 28) and placebo group (n = 28), 42 patients (22 in pregabalin group and 20 in placebo group) completed the trial. Throughout the trial, the mean score decreased from 26.13± 7.03 to 8.81 ± 3.47 in the pregabalin group (p < 0) and from 26.85 ± 4.34 to 17.63 ± 4.22 in the placebo group (p < 0). At the end of trial, 16 (57.14%) patients in the pregabalin group and 2 (7.14%) patients in the placebo group showed more than 35% decline in YBOCS (p < .01). The pregabalin group showed good tolerability and safety.
Conclusions.
Our study revealed that pregabalin, as an augmenting medication, is more effective than placebo in the treatment of patients with resistant OCD.
Sexual side effects have rarely been reported secondary to treatment with Pregabalin, a structural analogue of the inhibitory neurotransmitter gamma amino butyric acid (GABA).
Method
We present the case of AB, a 27-year-old single man with a diagnosis of recurrent depressive disorder who was prescribed pregabalin to alleviate the significant anxiety symptoms he was experiencing.
Results
A significant amelioration in anxiety symptoms was attained; however, he developed the adverse effects of acute sexual disinhibition and increased libido. These adverse effects were temporally related to treatment with pregabalin and reduced with dose reduction of this agent.
Conclusions
To date, limited published data are available relating such a reaction to pregabalin. A greater clinical recognition of this association between pregabalin and sexual disinhibition, would allow clinicians to intervene at an earlier stage of this adverse effect and potentially as in this case, management may only require dose reduction rather than treatment discontinuation.
The primary objective was to evaluate the effects of pregabalin relative to placebo in patients with chronic unilateral cervicogenic headache.
Primary and secondary end points
To assess the change from baseline in the frequency of cervicogenic headache days per 28-day period between placebo and treatment group. To assess the change from baseline in the intensity of headache, and health outcome measures.
Study design
This was a double-blind, randomized, placebo-controlled, parallel-group study, evaluating the efficacy and safety of pregabalin in patients with cervicogenic headache.
Procedures
The study consisted of two phases. A baseline of -28 days and a double-blind placebo-controlled phase: with an escalation and maintenance phase, during which patients remained at their highest dose until the end of the study, at Day 86.
Results
Forty one patients were randomized, predominantly females, with a mean age of 52 years old. At screening, both groups had, on average, 26 headache-days per month. By the final phase of the study, the number of headache days dropped to 16 per month for the pregabalin group while remaining stable for the placebo group (p=0.037). No serious adverse events were reported during the study.
Conclusion
In this study, primary objectives were achieved with a statistically significant change of ten days in frequency of headache days; with minor side effects that were well tolerated.
Pregabalin is a γ-aminobutyric acid analogue that is primarily prescribed in psychiatry for management of generalized anxiety disorder. The belief in its low potential for abuse has placed it in a superior position to other anxiolytic agents. However, more recent, concerns have been raised about the addictive potential of pregabalin. This problem has not received much attention nor has the mechanism of its development. There is also a lack of understanding of the difference in the experience of abusing pregabalin in contrast to abusing other illicit drugs. We report the case of a 55-year-old patient with a background history of multiple psychoactive substances misuse who elaborated on his own personal experience of pregabalin abuse. He consumed a month’s supply of this medication over 2 days and realized an enhancement in sexual desire and excitement. This effect should be considered when prescribing pregabalin.
There has been continuous progress in neurotherapeutics and neuropsychopharmacology in the past year. Notable are the reports of successful preliminary disease-modifying trials in Niemann-Pick disease and Friedreich's ataxia. Progress also has been made in treatment of migraine, stroke, epilepsy, multiple sclerosis, traumatic brain injury, and pain. Biomarkers are increasingly used to establish proof of pharmacology including measures of cerebrospinal fluid constituents and brain changes on magnetic resonance imaging. There is an increasing diversity of patient populations participating in clinical trials, including pediatric migraine and traumatic brain injury.