Reducing Pain from Chronic Pancreatitis with Pregabalin Kurt J. Isselbacher Opioid-based analgesics often have limited effectiveness, and of course have undesirable side effects. Studies of pancreatic nerves and experimental human pain research suggest that pain processing is abnormal in these patients and, in many, resembles that seen in neuropathic disorders. Nonopioid agents have been suggested, but not tested in randomized studies. These include gabapentoids (gabapentin and pregabalin), which have shown efficacy in neuropathic conditions that seem to resemble the pain that appears in chronic pancreatitis. To investigate the efficacy and safety of pregabalin in reducing pain from chronic pancreatitis, Olesen and colleagues (2011) randomized 64 patients in Europe with chronic pancreatitis and chronic abdominal pain to receive either pregabalin (escalating doses to a maximum of 300 mg twice a day) or placebo for 3 weeks in a double-blind trial. Pain relief as the primary endpoint was measured using a visual analog scale from 0 to 10 (increasing pain). Study groups were well matched for demographic and clinical characteristics. Pain relief was better in the pregabalin group than in the placebo group, with a decrease in average pain score (36% and 24%, respectively; p = .02). More pregabalin recipients than placebo recipients reported "much" or "very much" improvement in the treatment response (44% and 21%, respectively; p = .048). Adverse effects on the central nervous system (e.g., light-headedness) were more common in the pregabalin group, but these seemed to decrease during the course of the trial. This is the first placebo-controlled study to assess the efficacy of gabapentoids in treating the pain of chronic pancreatitis. Although pregabalin did not eliminate pain, the effect of reducing both pain and the need for narcotic analgesics is clinically very valuable. At this point gabapentin as a related drug has not yet been studied. But obviously long-term studies of gabapentenoids will be useful in gauging their effects in these difficult-to-treat patients. In any event, the use of gabapentoids should be strongly considered in patients with painful chronic pancreatitis. [TABLE] [TR] [TD="class: contentReference"] Reference [/TD] [/TR] [TR] [TD="class: contentBody"]Olesen SS et al. Pregabalin reduces pain in patients with chronic pancreatitis in a randomized, controlled trial. Gastroenterology 2011;141:536. [/TD] [/TR] [/TABLE]
