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Role of Pregabalin therapy in pain associated with chronic pancreatitis

Diabnerve PM / Mynerve PM (Pregabalin/methylcobalamin)

Role of pregabalin therapy in pain associated with chronic pancreatitis

Management of pain in patients with chronic pancreatitis continues to be a conundrum as the mechanisms underlying analgesic treatment remain obscure. The present study was thus conducted to assess the differences in pain sensitivity and modulation in these patients, depending on their clinical response (responders vs non- responders) to placebo or pregabalin therapy. This study was part of a randomized, double-blind, placebo-controlled trial analyzing the analgesic effects of pregabalin and placebo in
chronic pancreatitis.

Post hoc, patients were randomly allocated into four groups; responders and non-responders to pregabalin (n=16; n=15) or placebo (n=12; n=17) treatment. Patients with > 30% pain reduction after 3 weeks of treatment were considered as the responders. Changes in pain sensitivity pre- and post- treatment were determined with electric pain detection thresholds (ePDT) in dermatomes C5 (generalized effects) and Ventral T10 (segmental effects). Descending endogenous pain modulation was quantified by conditioned pain modulation (CPM) paradigm.

"Pain relieving mechanism of pregabalin is associated with anti-hyperalgesic effects and increased endogenous inhibitory modulation"

The outcomes of the study were:

  • A total of 60 patients were analyzed in a per-protocol analysis
  • Electric pain detection thresholds change in C5 was remarkable, and comparatively higher in pregabalin (1.3 mA) than placebo responders (-0.1 mA), while this was not observed for ePDT in Ventral T10
  • Increase in CPM was greater in pregabalin than placebo responders (9% vs -17%)
  • Changes in CPM were considerable vs baseline only for pregabalin responders.

This trial serves as the first evidence that indicates that pain relieving mechanism of pregabalin is associated with anti-hyperalgesic effects and increased endogenous inhibitory modulation, as these effects were observed only in patients treated with pregabalin and not with placebo.

Source: Bouwense SA, Olesen SS, Drewes AM, van Goor H, Wilder-Smith OH. Pregabalin and placebo responders show different effects on central pain processing in chronic pancreatitis patients. Journal of Pain Research. 2015 Jul 10;8:375-86.