Painkiller

Managing Neuropathic Pain: The Role of Pregabalin 300mg in the UK

Neuropathic pain, characterized by a sharp, needle-like sensation, is a relatively common and poorly managed problem impacting 6.9% to 10% of the global population. In the UK, neuropathic pain incidence is 9.2%, making up 18% of cases with chronic pain. 

The problem is significantly greater in people with manual occupations, with a significant impact on their quality of life. 

While there are several options available to manage neuropathic pain, the focus of this article is on Pregabalin 300mg and its role in managing neuropathic pain successfully. 

Types of Neuropathic pain 

Before elucidating the role of neuropathic pain, it is imperative to understand the pathophysiology of the problem. 

Neuropathic pain is a chronic algesic condition caused by a lesion or disease in the neurosensory system, creating an imbalance in excitatory and inhibitory somatosensory signaling receptors managing the pain.

The sensory loss, in turn, damages the nerves corresponding to the brain or the spinal cord region and gives rise to nerve-related pain or neuropathic pain. 

Image Credit: https://journals.physiology.org/doi/full/10.1152/physrev.00045.2019#:~:text=The%20pathophysiology%20involves%20ectopic%20activity,may%20improve%20rational%20pain%20treatment

Neuropathic pain can be either,

Peripheral – in strokes, spinal cord injury and multiple sclerosis 

Central – Trigeminal Neuralgia, Postherpetic neuralgia, peripheral nerve injury pain, painful polyneuropathy 

The pain that results because of the nerve pain results in a stabbing, burning, or stinging sensation with a pins and needles feeling that in turn achieves a chronic situation and impacts sleep and quality of life.

The need of the hour is a treatment option that works on peripheral and central neuropathic pain and is well tolerated. Pregabalin fits the bill. 

A word on Pregabalin 

Pregabalin 

In the United Kingdom, Pregabalin is medically approved for managing neuropathic pain along with an adjunctive option for Generalised Anxiety Disorder and Epilepsy.

Role of Pregabalin in Trigeminal Neuralgia 

Trigeminal neuralgia impacts 8 in every 100000 people in the UK every year and results in severe pain that impacts the quality of life to a significant extent. WHO has declared trigeminal neuralgia a disability because of the impact it has on people’s day-to-day activities and mental health.

While Carbamazepine and Oxcarbazepine are considered the first line of treatments for TN, they have a saturable absorption rate because of which their effect wears off in a short while. Pregabalin, while maintaining the biological activity of Carbamazepine, has improved pharmacological properties because of which it provides effective TN-based analgesic relief. 

Previous Studies have shown the efficacy of Pregabalin in Diabetic Peripheral Neuropathy and proved that it is safe and effective for decreasing DPN pain and improving mood, sleep cycles, and quality of life. 

In a prospective open-label study conducted to evaluate the efficacy of Pregabalin in patients with trigeminal neuralgia, 53 patients diagnosed with the problem were enrolled in a study. 

Out of the 53 subjects, 14 had reported concomitant chronic facial pain because of neuralgic complications. All of the subjects received Pregabalin in strengths of 150-600 mg ( depending on the severity of symptoms ) daily and were reviewed for a year. 

The results were evaluated based on the reduction of pain intensity and researchers recorded the number of patients that went pain free after using Pregabalin or reported a reduction in pain intensity greater than 50% or those with an attack frequency of greater than 50% after eight weeks of using the medication.  

Image Credit: https://journals.sagepub.com/doi/10.1111/j.1468-2982.2007.01483.x

They further recorded pain relief after one year as a secondary outcome. Out of the fifty-three patients, thirty-nine ( 74%)  showed improvement of pain symptoms within eight weeks with a mean dose of 269.8 mg/day. 

Thirteen patients (25%) experienced complete pain relief, and 26 patients ( 49%) reported a pain reduction of greater than 50%. Only 14 patients ( 26%) did not experience any improvement of symptoms. 

32 out of 39 patients without concomitant facial pain showed better response rates in comparison to 7 out of 14 patients with chronic facial pain.

The Study concluded that Pregabalin 300mg is an effective treatment option for trigeminal neuralgia options without chronic facial pain.

Animal studies on the regenerative properties of Pregabalin

Animal studies have shown that other than providing analgesic relief; Pregabalin has the potential to synchronize the regeneration of nerve fibers and accelerate the process of gait recovery. 

In a study conducted to evaluate the role of Pregabalin in Duchenne muscular dystrophy, a genetic disorder resulting in abnormalities of the dystrophin protein resulting in progressive muscle weakness, symptomizing in the form of abnormal gait, frequent falls, and difficulty in getting up or running accompanied by muscle cramps and painful knees- muscular dystrophy strained lab mice with peripheral nerve damage were treated with Pregabalin 30 mg/kg. a day for 28 days. 

After 28 days, their ipsilateral and contralateral sciatic nerves ( responsible for mobility, knee, and hip movement ) were evaluated to understand the expression of proteins, and their cranial with tibial muscles and sciatic nerves were analyzed.

Image Credit: https://www.researchgate.net/figure/Thrombospondin-1-expression-in-reactive-astrocytes-after-stroke-A-mRNA-purification_fig1_362032979

It was observed that treatment with Pregabalin reduced the retrograde cyclic effects of muscle regeneration as observed from the adaptation of nerves for rapid axonal regeneration and regaining of motor function.

Pregabalin was found to be well tolerated and caused a pro-regeneration of proteins in the neurons and Schwann cells. 

Muscular dystrophy impacts 70,000 people in the UK, and Duchenne Muscular Dystrophy is the most common form of Muscular Dystrophy in the UK, with 100 boys born with DMD and 2500 people living with it. 

Loss of ambulation because of DMD, along with the pain arising from it, can significantly impact the quality of life. Pregabalin’s role as an analgesic and potential neuro-regenerator can prove crucial in its use as a first line of treatment for DMD.

Conclusion 

Neuropathic pain is a serious problem in the UK that, left untreated, can progress into chronic debilitating pain and turn into a disability. Pregabalin, while not a first line of treatment for neuropathic pain, has been proven to have a better absorption rate and, thus, longer lasting. It even has the potential to aid in nerve repair other than providing analgesic and anxiolytic relief. That said, Pregabalin should not be used during pregnancy as it can impact the fetus and result in developmental abnormalities. You should use it as per the advice of the physician and taper its use after a certain period to obtain analgesic effects safely.

Reference Links:

https://faseb.onlinelibrary.wiley.com/doi/epdf/10.1096/fj.202200411RR

Muscular dystrophy – NHS

https://pubmed.ncbi.nlm.nih.gov/28509411/

https://pubmed.ncbi.nlm.nih.gov/28114183/

https://journals.sagepub.com/doi/10.1111/j.1468-2982.2007.01483.x

https://pubmed.ncbi.nlm.nih.gov/15288403/

https://pubmed.ncbi.nlm.nih.gov/19299534/

 

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