A Cochrane review [Abstract] 1 included 25 studies with a total of 7 652 subjects. Six studies (649 participants) studied the effects of pregabalin in perioperative situations over about 24 hours, in comparisons with placebo or an active drug (diazepam). Nineteen studies (7 003 participants) studied the effects of pregabalin in post herpetic neuralgia, painful diabetic neuropathy, central neuropathic pain or fibromyalgia. All of these compared pregabalin with placebo. Study duration was mainly between four and 14 weeks.
There was no clear evidence of beneficial effects of pregabalin acute postoperative pain. No studies evaluated pregabalin in chronic nociceptive pain, like arthritis. Pregabalin at doses of 300 to 600 mg daily was effective in patients with neuropathic pain (postherpetic neuralgia, painful diabetic neuropathy or central neuropathic pain), and to a lesser extent fibromyalgia. Pregabalin at 150 mg daily was generally ineffective. Efficacy was demonstrated for moderate or substantial pain relief, alongside lower rates for lack of efficacy discontinuations with increasing dose. The best NNT for each condition for at least 50% pain relief over baseline (substantial benefit) for 600 mg pregabalin daily compared with placebo were 3.9 (95% Cl 3.1 to 5.1) for postherpetic neuralgia, 5.0 (95% Cl 4.0 to 6.6) for painful diabetic neuropathy, 5.6 (95% Cl 3.5 to 14) for central neuropathic pain, and 11 (95% Cl 7.1 to 21) for fibromyalgia. With 600 mg pregabalin daily somnolence typically occurred in 15% to 25% and dizziness occurred in 27% to 46%. Treatment was discontinued due to adverse events in 18 to 28%. Higher rates of substantial benefit were found in postherpetic neuralgia and painful diabetic neuropathy than in central neuropathic pain and fibromyalgia.
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