USE OF DULOXETINE COMPARED TO PREGABALIN IN THE TREATMENT OF NEUROPATHIC PAIN

Authors

  • Antonio Campos de Sousa Filho Centro Universitário de Patos UNIFP
  • Apolônio Peixoto de Queiroz Centro Universitário de Patos/Faculdade São Francisco da Paraíba https://orcid.org/0000-0002-5598-7389

DOI:

https://doi.org/10.61164/rmnm.v12i2.3166

Keywords:

Antidepressants, Anticonvulsant, Neuralgia

Abstract

Introduction: Neuropathic pain is a challenging clinical condition that significantly impairs patients' quality of life due to a variety of causes, including injuries and diseases affecting the nervous system. With a prevalence of approximately 10% in the general population, this pain presents a complex therapeutic management, often requiring the combined use of several classes of medications, such as antidepressants and anticonvulsants. Objective: To synthesize and compare the main results of the use of antidepressants and anticonvulsants in the treatment of neuropathic pain. Methodology: Systematic review of the literature, using randomized clinical studies published in the last 20 years and available in databases such as the U.S. National Institutes of Health's National Library of Medicine (PubMed), ZB MED Search Portal for Life Sciences (LIVIVO), Virtual Health Library (BVS), Scientific Electronic Library Online (Scielo) and Open Index of Scholarly Works (OpenAlex), using the Health Sciences Descriptors in English “Antidepressive Agents”; “Anticonvulsants” and “Neuropathic Pain” and the term “Neuropathic Pain”, which was not available in the DeCS. Based on the eligibility criteria, randomized clinical trials in English, Portuguese and Spanish from the last 20 years were chosen, with the final sample consisting of eleven articles. Results: Pregabalin was superior in patients with complaints of sexual dysfunction, and improved sleep quality and physical function. Duloxetine was well-regarded for relieving severe pain in individuals with depression and anxiety. The combination of drugs allowed for lower doses, resulting in fewer side effects. Conclusion: Both drugs are effective in controlling neuropathic pain, but choosing between duloxetine and pregabalin requires a personalized approach, considering the individual characteristics of each patient to optimize clinical results.

 

Keywords: Antidepressants; Anticonvulsant; Neuralgia.

References

ANASTASSIOU, E. et al. Impact of pregabalin treatment on pain, pain-related sleep interference and general well-being in patients with neuropathic pain: a non-interventional, multicentre, post-marketing study. Clinical Drug Investigation, v. 31, p. 417-426, 2011. Disponivel em: https://link.springer.com/article/10.2165/11589370-000000000-00000. Acesso em: 10 out de 24.

BACHTIAR, M.; LEE, C. GL. Genetics of population differences in drug response. Current Genetic Medicine Reports, v. 1, p. 162-170, 2013. Disponível em: https://link.springer.com/article/10.1007/s40142-013-0017-3. Acesso em: 14 de out de 24.

BAROHN, R. J. et al. Patient assisted intervention for neuropathy: comparison of treatment in real life situations (PAIN-CONTRoLS): Bayesian adaptive comparative effectiveness randomized trial. JAMA Neurology, v. 78, n. 1, p. 68-76, 2021. Disponível em: https://jamanetwork.com/journals/jamaneurology/fullarticle/2769608. Acesso em: 23 de ago de 24.

BIDARI, A. et al. Comparing duloxetine and pregabalin for treatment of pain and depression in women with fibromyalgia: an open-label randomized clinical trial. DARU Journal of Pharmaceutical Sciences, v. 27, p. 149-158, 2019. Disponivel em: https://link.springer.com/article/10.1007/s40199-019-00257-4. Acesso em: 10 out de 24.

BOUHASSIRA, D. J. R. N. Neuropathic pain: definition, assessment and epidemiology. Revue Neurologique, v. 175, n. 1-2, p. 16-25, 2019. Disponível em: https://pubmed.ncbi.nlm.nih.gov/30385075/. Acesso em: 05 abr de 24.

BOUHASSIRA, D. et al. Neuropathic pain phenotyping as a predictor of treatment response in painful diabetic neuropathy: data from the randomized, double-blind, COMBO-DN study. Pain®, v. 155, n. 10, p. 2171-2179, 2014. Disponível em: https://www.sciencedirect.com/science/article/pii/S0304395914003790. Acesso em: 31 ago de 24.

BOYLE, J. et al. Randomized, placebo-controlled comparison of amitriptyline, duloxetine, and pregabalin in patients with chronic diabetic peripheral neuropathic pain: impact on pain, polysomnographic sleep, daytime functioning, and quality of life. Diabetes Care, v. 35, n. 12, p. 2451-2458, 2012. Disponivel em: https://diabetesjournals.org/care/article/35/12/2451/38523/Randomized-Placebo-Controlled-Comparison-of. Acesso em: 23 de ago de 24.

CÁNOVAS MARTÍNEZ, L. et al. Eficacia analgésica de la asociación duloxetina más pregabalina en el dolor neuropático: experiencia en 60 casos. Revista de la Sociedad Española del Dolor, v. 16, n. 7, p. 381-385, 2009. Disponivel em: https://scielo.isciii.es/pdf/dolor/v16n7/original2.pdf. Acesso em: 23 de ago de 24.

FINNERUP, N. B. et al. Pharmacotherapy for neuropathic pain in adults: a systematic review and meta-analysis. The Lancet Neurology, v. 14, n. 2, p. 162-173, 2015. Disponível em: https://pubmed.ncbi.nlm.nih.gov/25575710/. Acesso em: 05 abr de 24.

FOSTER, E. D.; DEARDORFF, Ariel. Open science framework (OSF). Journal of the Medical Library Association: JMLA, v. 105, n. 2, p. 203, 2017. Disponível em: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5370619/. Acesso em: 25 de ago de 24.

FREEMAN, R. et al. Sensory profiles of patients with neuropathic pain based on the neuropathic pain symptoms and signs. PAIN®, v. 155, n. 2, p. 367-376, 2014. Disponível em: https://www.sciencedirect.com/science/article/abs/pii/S0304395913005678. Acesso em: 10 out de 24.

FREYNHAGEN, R. et al. Efficacy of pregabalin in neuropathic pain evaluated in a 12-week, randomised, double-blind, multicentre, placebo-controlled trial of flexible-and fixed-dose regimens. Pain, v. 115, n. 3, p. 254-263, 2005. Disponível em: https://www.sciencedirect.com/science/article/abs/pii/S0304395905001041. Acesso em: 11 out de 24.

GILRON, I. et al. Pregabalin for peripheral neuropathic pain: a multicenter, enriched enrollment randomized withdrawal placebo-controlled trial. The Clinical journal of Pain, v. 27, n. 3, p. 185-193, 2011. Disponível em: https://journals.lww.com/clinicalpain/abstract/2011/03000/pregabalin_for_peripheral_neuropathic_pain__a.1.aspx. Acesso em: 11 de out de 24.

GILRON, I.; BARON, R.; JENSEN, T. Neuropathic pain: principles of diagnosis and treatment. Mayo Clinic Proceedings. 2015. p. 532-545. 2015. Disponível em: https://pubmed.ncbi.nlm.nih.gov/25841257/. Acesso em: 05 abr de 24.

GÜL, Ş. K.; TEPETAM, H.; GÜL, H. L. Duloxetine and pregabalin in neuropathic pain of lung cancer patients. Brain and Behavior, v. 10, n. 3, p. e01527, 2020. Disponível em: https://onlinelibrary.wiley.com/doi/10.1002/brb3.1527. Acesso em: 23 de ago de 24.

HANSEN, K. B. et al. Structure, function, and allosteric modulation of NMDA receptors. Journal of General Physiology, v. 150, n. 8, p. 1081-1105, 2018. Disponível em: https://pubmed.ncbi.nlm.nih.gov/30037851/. Acesso em: 05 abr de 24.

ILLEEZ, O. G. et al. Comparison of the effects of duloxetine and pregabalin on pain and associated factors in patients with knee osteoarthritis. Revista da Associação Médica Brasileira, v. 68, p. 377-383, 2022. Disponível em: https://www.scielo.br/j/ramb/a/cV4z55ts4Hpf7mnXDwtCmNs/?lang=en. Acesso em: 23 de ago de 24.

IRVING, G. et al. Comparative safety and tolerability of duloxetine vs. pregabalin vs. duloxetine plus gabapentin in patients with diabetic peripheral neuropathic pain. International Journal of Clinical Practice, v. 68, n. 9, p. 1130-1140, 2014. Disponível em: https://onlinelibrary.wiley.com/doi/abs/10.1111/ijcp.12452. Acesso em: 31 ago de 24.

JADAD, A. R. et al. Assessing the quality of reports of randomized clinical trials: is blinding necessary? Controlled Clinical Trials, v. 17, n. 1, p. 1–12, fev. 1996. Disponível em: https://pubmed.ncbi.nlm.nih.gov/8721797/. Acesso em: 25 de ago de 24.

JENSEN, T. S. et al. A new definition of neuropathic pain. Pain, v. 152, n. 10, p. 2204-2205, 2011. Disponível em: https://pubmed.ncbi.nlm.nih.gov/21764514/. Acesso em: 05 abr de 24.

JENSEN, T. S.; FINNERUP, N. B. Allodynia and hyperalgesia in neuropathic pain: clinical manifestations and mechanisms. The Lancet Neurology, v. 13, n. 9, p. 924-935, 2014. Disponível em: https://pubmed.ncbi.nlm.nih.gov/25142459/. Acesso em: 31 ago de 24.

JULIAN, T. et al. B12 as a treatment for peripheral neuropathic pain: a systematic review. Nutrients, v. 12, n. 8, p. 2221, 2020. Disponível em: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7468922/. Acesso em: 05 abr de 24.

MOISSET, X. et al. Pharmacological and non-pharmacological treatments for neuropathic pain: Systematic review and French recommendations. Revue Neurologique, v. 176, n. 5, p. 325-352, 2020. Disponível em: https://pubmed.ncbi.nlm.nih.gov/32276788/. Acesso em: 05 abr de 24.

MÜCKE, M. et al. Cannabis‐based medicines for chronic neuropathic pain in adults. Cochrane Database of Systematic Reviews, n. 3, 2018. Disponível em: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6494210/. Acesso em: 05 abr de 24.

PAGE, M. J. et al. A declaração PRISMA 2020: diretriz atualizada para relatar revisões sistemáticas. Revista Panamericana de Salud Pública, v. 46, p. e112, 2023. Disponível em: https://www.scielosp.org/article/rpsp/2022.v46/e112/pt/. Acesso em: 25 de ago de 24.

PRITCHETT, Y. L. et al. Duloxetine for the management of diabetic peripheral neuropathic pain: response profile. Pain Medicine, v. 8, n. 5, p. 397-409, 2007. Disponível em: https://academic.oup.com/painmedicine/article/8/5/397/1847738?login=false. Acesso em: 11 out de 24.

QUILICI, S. et al. Meta-analysis of duloxetine vs. pregabalin and gabapentin in the treatment of diabetic peripheral neuropathic pain. BMC Neurology, v. 9, p. 1-14, 2009. Disponivel em: https://bmcneurol.biomedcentral.com/articles/10.1186/1471-2377-9-6. Acesso em: 10 out de 24.

RAJA, S. N. et al. The revised International Association for the Study of Pain definition of pain: concepts, challenges, and compromises. Pain, v. 161, n. 9, p. 1976-1982, 2020. Disponível em: https://pubmed.ncbi.nlm.nih.gov/32694387/. Acesso em: 05 abr de 24.

RASKIN, J. et al. Duloxetine versus routine care in the long-term management of diabetic peripheral neuropathic pain. Journal of Palliative Medicine, v. 9, n. 1, p. 29-40, 2006. Disponível em: https://www.liebertpub.com/doi/abs/10.1089/jpm.2006.9.29. Acesso em: 11 de out de 24.

ROY, M. K. et al. A study on comparative efficacy and cost effectiveness of Pregabalin and Duloxetine used in diabetic neuropathic pain. Diabetes & Metabolic Syndrome: Clinical Research & Reviews, v. 11, n. 1, p. 31-35, 2017. Disponível em: https://www.sciencedirect.com/science/article/abs/pii/S1871402116301771. Acesso em: 31 ago de 24.

SALEHIFAR, E. et al. Comparison of the Efficacy and Safety of Pregabalin and Duloxetine in Taxane-Induced Sensory Neuropathy: A Randomized Controlled Trial. Clinical Drug Investigation, v. 40, n. 3, p. 249-257, 2020. Disponível em: https://link.springer.com/article/10.1007/s40261-019-00882-6. Acesso em: 31 ago de 24.

SHIMOZUMA, K. et al. Feasibility and validity of the Patient Neurotoxicity Questionnaire during taxane chemotherapy in a phase III randomized trial in patients with breast cancer: N-SAS BC 02. Supportive Care in Cancer, v. 17, p. 1483-1491, 2009. Disponível em: https://link.springer.com/article/10.1007/s00520-009-0613-7. Acesso em: 11 de out de 24.

SIDDAWAY, A. P.; WOOD, A. M.; HEDGES, L. V. How to do a systematic review: a best practice guide for conducting and reporting narrative reviews, meta-analyses, and meta-syntheses. Annual Review of Psychology, v. 70, n. 1, p. 747-770, 2019. Disponível em: https://www.annualreviews.org/content/journals/10.1146/annurev-psych-010418-102803. Acesso em: 20 ago de 24.

TANENBERG, R. J. et al. Duloxetine, pregabalin, and duloxetine plus gabapentin for diabetic peripheral neuropathic pain management in patients with inadequate pain response to gabapentin: an open-label, randomized, noninferiority comparison. In: Mayo Clinic Proceedings. Elsevier, 2011. p. 615-626. Disponível em: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3127557/. Acesso em: 23 de ago de 24.

TESFAYE, S. et al. Duloxetine and pregabalin: high-dose monotherapy or their combination? The “COMBO-DN study”–a multinational, randomized, double-blind, parallel-group study in patients with diabetic peripheral neuropathic pain. PAIN®, v. 154, n. 12, p. 2616-2625, 2013. Disponível em: https://www.sciencedirect.com/science/article/pii/S0304395913002856. Acesso em: 01 sete de 24.

VALADARES, J. V.; ROSA, L. V.; PRETO, S. M. L. R. Uso de Antidepressivos em Adolescentes: uma Revisão Sistemática da Literatura. Revista Cereus, v. 14, n. 1, p. 288-303, 2022. Disponível em: http://www.ojs.unirg.edu.br/index.php/1/article/view/3696. Acesso em: 31 ago de 24.

VAN HECKE, O. et al. Neuropathic pain in the general population: a systematic review of epidemiological studies. PAIN, v. 155, n. 4, p. 654-662, 2014. Disponível em: https://pubmed.ncbi.nlm.nih.gov/24291734/. Acesso em: 05 abr de 24.

WU, Chung-Sheng et al. Efficacy and safety of duloxetine in painful diabetic peripheral neuropathy: a systematic review and meta-analysis of randomized controlled trials. Systematic Reviews, v. 12, n. 1, p. 53, 2023. Disponível em: https://systematicreviewsjournal.biomedcentral.com/articles/10.1186/s13643-023-02185-6. Acesso em: 10 out de 24.

Published

2024-11-13

How to Cite

Campos de Sousa Filho, A., & Peixoto de Queiroz, A. . (2024). USE OF DULOXETINE COMPARED TO PREGABALIN IN THE TREATMENT OF NEUROPATHIC PAIN. Revista Multidisciplinar Do Nordeste Mineiro, 12(2). https://doi.org/10.61164/rmnm.v12i2.3166