Lyrica for neuropathic pain of chemotherapy – pro
Lyrica was designed as a more potent successor to gabapentin. It is indicated for treating neuropathic pain from diabetes or post herpetic neuralgia. There is not enough reported data to state that it should be used in all neuropathic pain. Still, there are guideliens that recommend it for treatment of neuropathic pain other than from diabetes. The NICE guidelines on neuropathic pain (1,2) recommend amitriptyline or pregabalin first line. The Drug and Therapeutics Bulletin (DTB) questions the recommendation in the recent guideline and noted that pregabalin is still a black triangle drug and this too should be considered in any comparison with the much longer established gabapentin. The DTB concludes: “the guideline’s promotion of pregabalin creates a dilemma for those who know from the published data that gabapentin remains an effective treatment option for neuropathic pain. Gabapentin is by far the cheaper of the two drugs and therefore for the same level of investment, the NHS faces the choice of treating more patients with a cheaper but (on indirect evidence) slightly less effective drug, or fewer patients with a more expensive, seemingly more effective one.”
However, other guidelines made the same recommendation. For example, Attal etal says, “Treatments with established efficacy on the basis of class I trials in painful polyneuropathy (PPN) (with the exception of human immunodeficiency virus (HIV)-associated polyneuropathy) are tricyclic antidepressants (TCAs), duloxetine, venlafaxine, gabapentin (GBP), pregabalin, opioids and tramadol (level A).”
REFERENCES
Attal N, Cruccu G, Haanpaa M, Hansson P, Jensen TS, Nurmikko T, Sampaio C, Sindrup S, Wiffen P, EFNS Task Force. EFNS guidelines on pharmacological treatment of neuropathic pain. Eur J Neurol 2006 Nov;13(11):1153-69. [147 references]
J. Mark Wallace Update on pharmacotherapy guidelines for treatment of neuropathic pain Current Pain and Headache Reports Volume 11, Number 3, 208-214
NICE March 2010: CG96 Neuropathic pain – pharmacological management: quick reference guide
MTUS Chronic Pain 2009, o. 16