Extended-Release Gabapentin May Hold Promise for Treatment of Fibromyalgia

[J William M Tweedie]

Jun 12, 2015 | Bill Schu

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Effective treatments for fibromyalgia are notoriously few and far between. A number of studies have shown that gabapentin, developed to treat epilepsy, is effective in treating postherpetic neuralgia and painful diabetic neuropathy. Now, a new—although admittedly limited—study has revealed that gabapentin may hold promise for treating fibromyalgia as well.

This isn’t the first study to measure the effectiveness of gabapentin to treat fibromyalgia pain. A literature review published in PubMed Health in 2014 pointed to the many limitations of current research. That review found that, “The amount of evidence for gabapentin in neuropathic pain conditions except postherpetic neuralgia and painful diabetic neuropathy… is very limited,” and that no top-tier evidence existed that was unequivocally unbiased.The review further noted that there was no obvious difference between standard gabapentin formulations and recently‐introduced extended‐release or gastro‐retentive formulations, or between different doses of gabapentin.

The newer study, which appeared in a recent issue of Pain Practice, assessed the efficacy and safety of extended-release gabapentin in a 15-week, open-label, single-arm, single-center study in patients with fibromyalgia. Patients with autoimmune conditions, and or taking opioids for management of their pain, were excluded from the study. In addition to measuring the impacts of gabapentin on pain, the study looked at its effect in reducing barriers to sleep.

Results were measured using Numeric Pain Rating System (NPRS) scores, and secondary study endpoints were measured with Fibromyalgia Impact Questionnaire (FIQ), Patient’s Global Impression of Change (PGIC), and Medical Outcome Sleep questionnaires (MOS).

A total of 34 subjects were enrolled and 29 subjects completed the starter pack (85%). Patients reported significant pain relief on NPRS by end of 4 weeks. Subjects also reported similar magnitude of improvements in fibromyalgia and its impact on daily life by the end of 4 weeks. MOS results showed subjects reporting improved sleep quantity (on average, 1.2 hours over baseline) with gradual and statistically significant improvement in quality. Improvements in primary and secondary measurements were reflected in PGIC, with significant improvement in patients’ impression of fibromyalgia by week 8.

The study was of a small sample size; other limitations include geographical bias, the fact that it was a single-arm study without a control group, and the relatively short duration of treatment. Duration of treatment is particularly important in measuring FM pain because such pain is typically experienced over long periods. The study found that extended-release gabapentin relieved FM pain symptoms and improved quality-of-life for the FM subjects studied. Subjects reported improvements in both quantity and quality of sleep.
- See more at: http://www.hcplive.com/medical-news...reatment-of-Fibromyalgia#sthash.5XZdilBL.dpuf

 

[Cort]

Pretty good result it looks like..I wonder how it compares to earlier trials of Gabapentin in FM? and to Lyrica - the supposedly more powerful version of the gabapentin.

it's interesting this study got done at all with Lyrica still around but it appears that Gabapentin is still being used regularly enough to warrant a new version of it being produced...

 

[J William M Tweedie]

I was in my very worst period of pain (8-9) when I suggested Gabapentin to my Dr. It was miraculous how it brought immediate relief. I was, however, playing with dosages before long to maintain the effect which wore off relatively quickly (a few weeks). Now I take a low dose at bedtime for the sleep aid effect it seems to have. I've not had an episode of such severe pain since but am looking for an alternative for the steady pain (5-7) I have.

My new Dr may be willing to try Lyrica. Are there studies I can look at to compare Gab and Lyr?

 

[CountingMySpoons]

I've been on gabapentin for the last 5 years and it does help me. The main thing it helps with is neuropathic pain - for me it's that feeling of pins and needles, or feeling like I'm plugged into a wall, or that I can feel the energy coming off those around me. Without Neurontin those pains increase and so does my anxiety. With neurontin I can largely ignore (or just don't feel) those things. Without it I couldn't even be hugged, let alone have someone sitting 6 inches away from me without being on edge or hurting worse.

I did try the extended release recently. I've never had any side effects from the regular gabapentin, except that I can't get over 3x600/day without it making the fatigue worse. Because of another med I was taking my neuropathic pain had spiked and gabapentin wasn't helping as much so I tried the extended release to see if I could get a higher dose with it. Unfortunately, you are supposed to take it about an hour before bed and with food. those two things togehter didn't work well for me - the timing was difficult and so was taking it with food. With or without it seemed to keep me from sleeping and if I didn't eat then my stomach would be upset too (often even if I did eat). So, within a couple of weeks I just went back to taking 1x600 gabapentin in the morning and 2x600 at night. I also stopped taking the other med that was increasing my pain.

 

[Cort]

I was in my very worst period of pain (8-9) when I suggested Gabapentin to my Dr. It was miraculous how it brought immediate relief. I was, however, playing with dosages before long to maintain the effect which wore off relatively quickly (a few weeks). Now I take a low dose at bedtime for the sleep aid effect it seems to have. I've not had an episode of such severe pain since but am looking for an alternative for the steady pain (5-7) I have.

My new Dr may be willing to try Lyrica. Are there studies I can look at to compare Gab and Lyr?

Here is one. Lyrica is better in some ways and not in others. Theoretically it should be more powerful - it was built off of gabapentin to deliver better results....

Clin Ther. 2010 Jul;32(7):1357-70. doi: 10.1016/j.clinthera.2010.07.014. Pregabalin and gabapentin in matched patients with peripheral neuropathic pain in routine medical practice in a primary care setting: Findings from a cost-consequences analysis in a nested case-control study. Pérez C1, Navarro A, Saldaña MT, Masramón X, Rejas J.

BACKGROUND:

Pregabalin and gabapentin are marketed to treat peripheral neuropathic pain, but head-to-head comparison is lacking.
OBJECTIVES:

The aims of this work were to compare the effects of pregabalin and gabapentin on different patient-reported health outcomes and to analyze health care and nonhealth-care resource consumption and their related costs among patients treated for peripheral neuropathic pain in primary medical care.
METHODS:

A cost-consequences comparison in subjects with refractory (suboptimal response to > or =1 previous analgesic treatment for >6 months) chronic peripheral neuropathic pain was carried out using data extracted from two 12-week, observational, prospective studies in primary medical care. Patients were eligible if they were aged > or =18 years, had a score of > or =4 on the Douleur Neuropathique 4 questionnaire, and were able to complete health questionnaires written in Spanish. A nested-paired case-control design was chosen to perform the comparison with 2 controls (pregabalin) per case (gabapentin) matched by age, sex, peripheral neuropathic pain condition, time since diagnosis, number of previous treatments, pain intensity, depressive and anxiety symptom scores, and health state. Adult subjects with refractory chronic pain because of diabetic neuropathy, postherpetic or trigeminal neuralgias, or cervical or lumbosacral radiculopathies were included. Epidemiologic statistical methods were applied for comparing health effects (pain intensity, sleep, anxiety and depressive symptoms, disability, and health state), resources utilization, and related cost variations after 12 weeks. Indirect costs were measured by means of lost-workday equivalent calculations multiplied by the mean national daily salary.
RESULTS:

Analysis included 44 patients treated with gabapentin (cases) and 88 patients treated with pregabalin (controls) who were matched for age, sex, and other parameters. The mean (SD) gabapentin and pregabalin doses were 1263 (540) and 202 (119) mg/d, respectively. Although there was a greater reduction in last-week mean pain intensity with pregabalin (visual analog scale: 39.1 [22.5] vs 28.0 [22.2] mm; P = 0.008), as well as more patients with a > or =50% reduction in pain rate (60.9% vs 40.5%; P = 0.029), there were no significant differences between groups for sensory, affective, total, or present pain intensity.

The significantly higher drug cost associated with pregabalin was offset by a greater reduction in productivity costs compared with gabapentin, yielding similar cost reduction (-euro1254 [1479] vs -euro1384 [2874], respectively; P = NS).
CONCLUSION:

Pregabalin appeared to be associated with greater reduction in mean weekly intensity of pain, but there were no significant differences in cost.

 

[Cort]

I've been on gabapentin for the last 5 years and it does help me. The main thing it helps with is neuropathic pain - for me it's that feeling of pins and needles, or feeling like I'm plugged into a wall, or that I can feel the energy coming off those around me. Without Neurontin those pains increase and so does my anxiety. With neurontin I can largely ignore (or just don't feel) those things. Without it I couldn't even be hugged, let alone have someone sitting 6 inches away from me without being on edge or hurting worse.

I did try the extended release recently. I've never had any side effects from the regular gabapentin, except that I can't get over 3x600/day without it making the fatigue worse. Because of another med I was taking my neuropathic pain had spiked and gabapentin wasn't helping as much so I tried the extended release to see if I could get a higher dose with it. Unfortunately, you are supposed to take it about an hour before bed and with food. those two things togehter didn't work well for me - the timing was difficult and so was taking it with food. With or without it seemed to keep me from sleeping and if I didn't eat then my stomach would be upset too (often even if I did eat). So, within a couple of weeks I just went back to taking 1x600 gabapentin in the morning and 2x600 at night. I also stopped taking the other med that was increasing my pain.

Interesting that pain and anxiety are linked. If I overexercise my pain levels - burning feeling skin sensations go up - and so does my anxiety...I get very jittery...My attention span goes down as well. I think they're all linked together for me.