α(2)δ Modulators for Management of Compression Neuropathic Pain: A Review of Three Case Series

CONTEXT: The α(2)δ modulators gabapentin and pregabalin are effective against neuropathic pain. Numerous brands of α(2)δ modulators are available in India, and are expected to have equivalent clinical effects. They are routinely used for management of neuropathic pain associated with radiculopathy. AIM: To describe clinical outcomes in three series of cases of neuropathic pain treated with three available brands of α(2)δ modulators. SETTINGS AND DESIGN: Retrospective analysis of clinical outcomes in patients attending an interventional pain clinic PATIENTS AND METHODS: One hundred and ninety-four consecutive patients with neuropathic pain secondary to Magnetic Resonance Imaging (MRI)-documented compression radiculopathy received either LYRICA (LYR), a locally available generic brand of pregabalin (PGN), or a locally available generic brand of gabapentin (GBN), respectively. Drug treatment was continued till adequate pain relief was achieved. In each of the three groups, mean pain scores were analyzed at Days 0, 15, 60 and 90, and daytime sedation scores at Days 1, 15, 60 and 90. STATISTICAL ANALYSIS USED: Analysis of variance (ANOVA) followed by pair-wise comparison using two-tailed unpaired t-test (if P value was significant). RESULTS: Mean pain score was significantly lower in the LYR series as compared to the PGN and GBN series at Days 15, 60 and 90. As compared to the PGN and GBN series, a greater proportion of patients in the LYR series could discontinue drug therapy following adequate pain relief, by Day 90. Daytime sedation scores were significantly lower in the LYR series as compared to the PGN and GBN series at Days 1, 15 and 60, and as compared to the PGN series at Day 90. CONCLUSION: These results indicate the effectiveness of α(2)δ modulators for management of neuropathic pain secondary to compression radiculopathy. The results also suggest a possible therapeutic superiority of LYRICA over locally available generic brands of pregabalin and gabapentin. These findings need to be further examined in randomized, controlled trials.