Pathos (May 2005)
Gabapentin and Pregabalin in chronic neuropathic pain: cost efficacy evaluation
Abstract
Pain caused by injury of the nervous system is in almost all cases a chronic condition difficult to treat. In 1998 the first clinical trial on the efficacy of gabapentin to treat pain in diabetic neuropathy appeared. Gabapentin is also effective in treating post herpetic neuralgia, chronic regional pain syndrome, neuropathic pain in cancer, in immunodeficiency syndrome, and also in mix conditions of neuropathic pain. Gabapentin is well tolerated and at medium doses the drop out from clinical trials due to side effects equates placebo. Recently pregabalin, also approved for the treatment of neuropathic pain, has been introduced on the Italian market. The drug has been studied in diabetic painful polyneuropathy and in postherpetic neuralgia. Thus far, there are no studies available comparing the two drugs and comparison on the effective doses may only be estimated, relying on the comparison with placebo. One animal study might indicate that the ratio between effective doses of intravenous gabapentin and pregabalin should be about 3 to 1. Even comparing the drug with a ratio of 6 to 1, gabapentin remains much more advantageous, with an average inferior monthly cost of about 25 euro for italian NHS and remains the gold standard and first line treatment for neuropathic pain.
