Adequate management of refractory pain developed in chronic diabetic neuropathic pain is one of the most difficult and debatable problem in the modern palliative care. The goal of our study was management of chronic diabetic neuropathic pain.
An experimental study on refractory pain was conducted in a number of palliative clinics on 81 randomly selected patients with diabetic neuralgia, 59% of which participated in the previous double-blind randomized controlled trial in which Pregabalin was used in different dosage regimen. Short-Form McGill Pain Ques–tionnaire (SF-MPQ) along with VAS were employed. The patients were enrolled based on the screening criteria – chronic pain intensity minimum 40 mm by VAS. 90% of the study subjects were classified as refractory to Gabapentin and Tricyclic Antidepressants. 63% suffered with severe pain. Pregabalin was used in a fixed dose of 150-600 mg/day, that was changing by necessity.
Study findings showed effectiveness of Pregabalin in the treatment of neuropathic refractory pain. It was more effective, then combination of Gabapentin and Tricyclic Antidepressants. Effectiveness of Pregabalin was similar in patients, receiving and non-receiving concomitant gabapentin. In 1/3 of patients pain was relieved by > 50% and it was stable during 17 month-observation period. After 17 month-duration treatment with Pregabalin proportion of patients with severe pain significantly reduced (from 63% to 23%).
Based on our study effectiveness of Pregabalin in the treatment of neuropathic refractory pain is reliably high