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Gabapentin therapy for diabetic neuropathic pain
Letters to the Editor of a group of proteins associated with tissue remodeling. J Biol Chem. 1995;270: 13076 –13083. 3. Johansen JS, Moller S, Price PA, et al. Plasma YKL-40. A new potential marker of fibrosis in patients with alcoholic cirrhosis? Scand J Gastroenterol. 1997;32:582– 590. 4. Boot RG, van Achterberg TA, van Aken BE, et al. Strong induction of members of the chitinase family of proteins in atherosclerosis: chitotriosidase and human cartilage gp-39 expressed in lesion macrophages. Arterioscleros Thrombos Vasc Biol 1999;19:687– 694.
Table. Characteristics of the Patients Characteristic
Gabapentin (n ⫽ 17)
Placebo (n ⫽ 15)
P Value*
Number (Percent) or Mean ⫾ SD Male sex Age (years) Duration of diabetes (years) Hemoglobin A1c level Baseline At 3 months Pain relief at 1 month†
8 (47) 53 ⫾ 4 13 ⫾ 3
9 (60) 55 ⫾ 3 15 ⫾ 4
0.69 0.12 0.11
9.2 ⫾ 0.9 9.1 ⫾ 1.3 14 (82)
9.1 ⫾ 1.2 9.0 ⫾ 1.1 2 (13)
0.78 0.83 0.00012
* Calculated with Fisher’s exact test or Student’s t test. † Defined as at least 50% reduction in pain score.
GABAPENTIN THERAPY FOR DIABETIC NEUROPATHIC PAIN To the Editor: Neuropathic pain reduces the quality of life of most patients with longstanding diabetes. Tight glycemic control can help prevent the development of neuropathy (1) but may be difficult for many patients to achieve. Opioids, nonopioid agents, tricyclic antidepressant drugs, anticonvulsant agents, antiarrhythmic agents, and topical capsaicin can also provide pain relief (2). Gabapentin is a new oral antiepileptic agent that has been used in the treatment of neuropathic pain (3–5). We conducted a double-blind, controlled trial that compared gabapentin with placebo in the treatment of 32 diabetic patients referred for the management of neuropathic pain (visual pain score ⬎60 on a 100-point scale) after conventional treatment failed. The diagnosis of diabetic neuropathy was made by clinical examination and electrophysiologic study.
All patients had been taking nonopioid analgesic agents, and they continued the therapy at the same doses throughout the study. Our goal was to decrease the self-reported pain score during all examinations by more than half. Patients were started on a dose of gabapentin of 300 mg twice per day, and the dose was adjusted in successive office visits to a maximum of 1,200 mg per day, based on clinical symptoms. Patients were observed for 3 months. There were no significant differences among the patients in demographic characteristics or in glycemic control, as measured by hemoglobin A1c levels, before and after treatment with gabapentin (Table). Fourteen (82%) of the 17 patients in the gabapentin group reported pain relief during the first month of treatment, whereas only 2 (13%) of the 15 patients in the placebo group reported a favorable response (P ⬍0.00012). No major side effects were reported in the gabapentin group.
June 1, 2000
We conclude that gabapentin is a safe and effective therapy for diabetic patients with neuropathic pain. He´ctor Eloy Tamez Pe´rez, MD Gerardo Forsbach Sa´nchez, MD Department of Medicine Division of Endocrinology Hospital de Especialidades No. 25 Instituto Mexicano del Seguro Social Monterrey, Mexico 1. The DCCT Research Group. The effect of intensive treatment of diabetes on development and progression of long term complications in insulin dependent diabetes mellitus. NEJM. 1993;329:977–986. 2. Vinik Al, Holland MT, Le Baeu JM, et al. Diabetic neuropathies. Diabetes Care. 1992;15:1924 –1974. 3. Wetzel CH, Connelly JF. Use of gabapentin in pain management. Ann Pharmacother. 1997;9:1082–1083. 4. Rosenberg JM, Harrell C, Ristic H, et al. The effect of gabapentin on neuropathic pain. Clin J Pain. 1997;3:251–255. 5. Bachouja M, Beydoun A, Eduards KR, et al. Gabapentin for the symptomatic treatment of painful neuropathy in patients with diabetes mellitus. JAMA. 1998;280: 1831–1836.
THE AMERICAN JOURNAL OF MEDICINE威
Volume 108 689
Table. Characteristics of the Patients Characteristic
Gabapentin (n ⫽ 17)
Placebo (n ⫽ 15)
P Value*
Number (Percent) or Mean ⫾ SD Male sex Age (years) Duration of diabetes (years) Hemoglobin A1c level Baseline At 3 months Pain relief at 1 month†
8 (47) 53 ⫾ 4 13 ⫾ 3
9 (60) 55 ⫾ 3 15 ⫾ 4
0.69 0.12 0.11
9.2 ⫾ 0.9 9.1 ⫾ 1.3 14 (82)
9.1 ⫾ 1.2 9.0 ⫾ 1.1 2 (13)
0.78 0.83 0.00012
* Calculated with Fisher’s exact test or Student’s t test. † Defined as at least 50% reduction in pain score.
GABAPENTIN THERAPY FOR DIABETIC NEUROPATHIC PAIN To the Editor: Neuropathic pain reduces the quality of life of most patients with longstanding diabetes. Tight glycemic control can help prevent the development of neuropathy (1) but may be difficult for many patients to achieve. Opioids, nonopioid agents, tricyclic antidepressant drugs, anticonvulsant agents, antiarrhythmic agents, and topical capsaicin can also provide pain relief (2). Gabapentin is a new oral antiepileptic agent that has been used in the treatment of neuropathic pain (3–5). We conducted a double-blind, controlled trial that compared gabapentin with placebo in the treatment of 32 diabetic patients referred for the management of neuropathic pain (visual pain score ⬎60 on a 100-point scale) after conventional treatment failed. The diagnosis of diabetic neuropathy was made by clinical examination and electrophysiologic study.
All patients had been taking nonopioid analgesic agents, and they continued the therapy at the same doses throughout the study. Our goal was to decrease the self-reported pain score during all examinations by more than half. Patients were started on a dose of gabapentin of 300 mg twice per day, and the dose was adjusted in successive office visits to a maximum of 1,200 mg per day, based on clinical symptoms. Patients were observed for 3 months. There were no significant differences among the patients in demographic characteristics or in glycemic control, as measured by hemoglobin A1c levels, before and after treatment with gabapentin (Table). Fourteen (82%) of the 17 patients in the gabapentin group reported pain relief during the first month of treatment, whereas only 2 (13%) of the 15 patients in the placebo group reported a favorable response (P ⬍0.00012). No major side effects were reported in the gabapentin group.
June 1, 2000
We conclude that gabapentin is a safe and effective therapy for diabetic patients with neuropathic pain. He´ctor Eloy Tamez Pe´rez, MD Gerardo Forsbach Sa´nchez, MD Department of Medicine Division of Endocrinology Hospital de Especialidades No. 25 Instituto Mexicano del Seguro Social Monterrey, Mexico 1. The DCCT Research Group. The effect of intensive treatment of diabetes on development and progression of long term complications in insulin dependent diabetes mellitus. NEJM. 1993;329:977–986. 2. Vinik Al, Holland MT, Le Baeu JM, et al. Diabetic neuropathies. Diabetes Care. 1992;15:1924 –1974. 3. Wetzel CH, Connelly JF. Use of gabapentin in pain management. Ann Pharmacother. 1997;9:1082–1083. 4. Rosenberg JM, Harrell C, Ristic H, et al. The effect of gabapentin on neuropathic pain. Clin J Pain. 1997;3:251–255. 5. Bachouja M, Beydoun A, Eduards KR, et al. Gabapentin for the symptomatic treatment of painful neuropathy in patients with diabetes mellitus. JAMA. 1998;280: 1831–1836.
THE AMERICAN JOURNAL OF MEDICINE威
Volume 108 689