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Meta-Analysis
. 2023 Jun;45(3):556-565.
doi: 10.1007/s11096-022-01528-y. Epub 2023 Feb 27.

The safety and efficacy of gabapentinoids in the management of neuropathic pain: a systematic review with meta-analysis of randomised controlled trials

Jawza Meaadi  1   2   3 , Ilona Obara  4   5 , Sam Eldabe  6 , Hamde Nazar  1   7
Affiliations
Meta-Analysis

The safety and efficacy of gabapentinoids in the management of neuropathic pain: a systematic review with meta-analysis of randomised controlled trials

Jawza Meaadi et al. Int J Clin Pharm. 2023 Jun.

Abstract

Background: There are increasing concerns regarding the abusive potential of gabapentinoids putting at risk patients with neuropathic pain requiring long-term pain management. The evidence to support this is rather inconcusive.

Aim: This systematic review aimed to evaluate the safety and efficacy of gabapentinoids in the management of neuropathic pain with a focus on randomised controlled trials (RCTs) and categorising the side effects according to the body systems they were affecting.

Method: Searches were conducted in MEDLINE (PubMed), EMBASE, Web of Science, PsycoINFO, and CINAHL (EBSCO), and included RCTs to identify and critically appraise studies investigating safety and therapeutic effects of gabapentionoids in adults with neuropathic pain. Data extraction was conducted using an established Cochrane form and the risk-of-bias tool was used in the assessment of quality.

Results: 50 studies (12,398 participants) were included. The majority of adverse events pertained to the nervous system (7 effects) or psychiatric (3 effects) disorders. There were more adverse effects reported with pregabalin (36 effects) than with gabapentin (22 effects). Six pregabalin studies reported euphoria as a side effect, while no studies reported euphoria with gabapentin. This was the only side effect that may correlate with addictive potential. Gabapentioids were reported to significantly reduce pain compared to placebo.

Conclusion: Despite RCTs documenting the adverse events of gabapentionoids on the nervous system, there was no evidence of gabapentinoid use leading to addiction, suggesting an urgent need to design studies investigating their abusive potential.

Keywords: Gabapentin; Meta-analysis; Neuralgia; Neuropathic pain; Pregabalin; Systematic review.

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Conflict of interest statement

None declared.

Figures

Fig. 1
Fig. 1
The PRISMA flow diagram detailing the search results and subsequent stages of screening
Fig. 2
Fig. 2
Starting dose, dose escalation and maximum daily dose achieved in selected studies for pregabalin. a Presents data collected for starting dose, dose escalation and duration of treatment from 75 mg. b Presents data collected for starting dose, dose escalation and duration of treatment from 150 mg. c Presents data collected for starting dose, dose escalation and duration of treatment from 165, 300, 450 or 600 mg. Superscript number 1, 2 or 3 next to the name refers to the arms in the selected study. mg; milligram
Fig. 3
Fig. 3
Starting dose, dose escalation and maximum daily dose achieved in selected studies for gabapentin. a Presents data collected for starting dose, dose escalation and duration of treatment from 300 mg. b Presents data collected for starting dose, dose escalation and duration of treatment from 400, 600, 900 or 1800 mg. Superscript number 1, 2 or 3 next to the name refers to the arms in the selected study. mg; milligram
See this image and copyright information in PMC

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