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• W2017809660 abstract "To the Editor: In a recent article by Caraceni et al.,1Caraceni A Zecca E Martini C DeConno F Gabapentin as an adjuvant to opioid analgesia for neuropathic cancer pain.J Pain Symptom Manage. 1999; 17: 441-445Abstract Full Text Full Text PDF PubMed Scopus (180) Google Scholar gabapentin was judged to be efficacious as an adjuvant analgesic for neuropathic cancer pain in 20 out of 22 patients. We report on our experience of gabapentin, which was associated with a much lower incidence of efficacy. We carried out a retrospective review of the case notes of 20 patients who had been prescribed gabapentin since January 1999 (Table 1). In our review, only 9 (45%) patients reported a significant improvement in their pain following administration of gabapentin. For a further 5 patients, it was difficult to evaluate the efficacy of gabapentin due to the concomitant use of other neuropathic agents, such as amitriptyline, tramadol, and opioids. In addition, 6 patients out of the 20 who were prescribed gabapentin developed severe enough side effects to warrant the discontinuation of the drug. The most common side effects were dizziness and nausea.Table 1Use of Gabapentin in a Cancer HospitalResultsPatientsDiagnosisPain problemPrevious medicationCurrent medicationDose of gabapentinSide effectsEfficacy of gabapentin1MyelomaPostherpetic Neuralgia T4/T5 distributionMethadone Dothiepin Carbamazepine Sodium Valproate Amitriptyline300 mg tdsErectile dysfunctionDiscontinued due to side effects2Endometrial carcinomaNeuropathic pain legAmitriptyline Hydromorphone300 mg day 1 + 2Dizzy and confusedDiscontinued due to side effects3Prostatic carcinomaNeuropathic pain legOpioids Sodium Valproate AmitriptylineMST Amitriptyline300 mg tdsPain significantly improved, able to reduce opioids4NeurofibromaNeuropathic pain back, leg, and armAmitriptyline Diazepam CarbamazepineTramadol Naproxen300 mg tdsDizzy and sickDiscontinued due to side effects5SarcomaPhantom pain post limb amputationMorphine Amitriptyline300 mg tdsTremor, dose reduced to 100 mg tdsPain improved, efficacy also related to increased dose of morphine and amitriptyline in addition to gabapentin6Pyriform fossa carcinomaNeuropathic pain post radiotherapyMorphine300 mg tdsPain significantly improved, able to reduce opioids7Tongue carcinomaNeuropathic painDiclofenac AmitriptylineAmitriptyline Morphine300 mg tdsPain improved, efficacy also related to morphine and dose increase of amitriptyline8Soft palate tumorNeuropathic painOpioidsAmitriptyline300 mg tdsPain much improvedDiclofenacOpioidsParacetmol9MesotheliomaPain in back and axillary areaAmitriptyline Codydramol SevredolTramadol300 mg tdsDizzy, nauseatedStopped both gabapentin and tramadol due to side effects. Pain improved without need for further medication10MesotheliomaRadicular painTramadol300 mg tdsPain significantly better11SarcomaAmputation, phantom limb painAmitriptyline Morphine300 mg tdsErectile dysfunction may also be related to amitriptylinePain controlled, efficacy also related to use of other medications12Pelvic sarcomaRadicular pain legSodium Valproate Dothiepin Amitriptyline Tramadol DihydrocodeineMorphine400 mg tdsPain much improved by addition of gabapentin13Carcinoma of the bladderRadicular pain sciatic distribution300 mg tdsPain improved14Carcinoma of the breastRadiation-induced Brachial plexopathySodium Valproate Carbamazepine Amitriptyline Tramadol300 mg tdsLost balance at 400 mg tds dose maintained at 300 mgPain improved15Carcinoma of the cervixRadicular pain L4 nerve rootAmitriptyline Sodium Valproate Carbamazepine MorphineSodium Valproate Morphine Steroids600 mg tdsDifficult to evaluate efficacy of gabapentin due to concomitant use of other medications16Carcinoma of the breastPostmastectomy pain300 mg tdsDizzyStopped due to dizziness17LeukemiaPostherpetic neuralgiaCarbamazepine Tramadol Amitriptyline300 mg tds increased to 800 mg tdsPain improved significantly at 400 mg tds. Dose increased to 800 mg following pain flare up. No subsequent improvement therefore dose reduced to 400 mg tds18NeurofibromaNeuropathic painDiazepam Amitriptyline CarbamazepineTramadol Naproxen300 mg tdsDizzy and vomitingGabapentin stopped due to side effects19Head and neck tumorMixed nociceptive and neuropathic painCodeine TramadolAmitriptylinestart at 100 mg tdsPain improved, to continue increasing dose20LymphomaPain coccyx ? causeHydromorphone Other opioidsTramadol500 mg tdsDifficult to assess effectiveness - pain continues to be an ongoing problemOverall outcome after gabapentin use (n = 20)Patient numbersPercentageEffective945%Possibly effective525%Discontinued due to side effects624% Open table in a new tab As systematic reviews have shown little difference in the efficacy and side effect profile of antidepressants and anticonvulsants,2McQuay H, Moore A. Anticonvulsant drugs. Antidepressants in neuropathic pain. In: An Evidence Based Resource for Pain Relief. Oxford: Oxford University Press, 1998.Google Scholar good quality studies comparing the efficacy and side effect profile of gabapentin with these neuropathic agents are needed. The findings of these studies will be important because the high cost of gabapentin frequently limits its use in hospital and general practice." @default.
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• W2017809660 title "Gabapentin, an Adjuvant Treatment for Neuropathic Pain in a Cancer Hospital" @default.
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• W2017809660 doi "https://doi.org/10.1016/s0885-3924(00)00166-4" @default.
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