Abstract
Central post-stroke pain (CPSP) is the most difficult type of central neuropathic pain to control with medical treatment. Pregabalin is recommended as the first-line drug for central neuropathic pain by the medical guidelines of various countries. The mechanism of action for pregabalin is considered to involve binding to α2-δ subunits of voltage-gated calcium channels. Pregabalin has been approved for peripheral neuropathic pain since 2010 and for central neuropathic pain since 2013 in Japan. This study evaluated the efficacy and safety of pregabalin for CPSP.
We retrospectively reviewed 20 cases of CPSP that received pregabalin medication primarily (hemorrhage, n=14 ; infarction, n=6 ; mean age, 63.8±8.8 years). Pain levels were assessed twice as follows using a visual analog scale (VAS) : before pregabalin medication began, and after reaching maintenance dose.
Pregabalin medication showed pain reduction in 11 of 20 cases (55.0%). VAS scores improved from pre-medication (mean, 8.2±1.3) to post-medication (mean, 6.7±2.3) (p=0.018), and the VAS improvement rate was 18.7±25.5%. In the 11 cases with reduced pain, the maintenance dose of pregabalin was 252±127 mg/day, and the dose at the onset of effect was 163±74 mg/day. Side effects were observed in 11 of 20 cases (severe, n=5 ; moderate, n=3 ; mild, n=3). Mean age according to severity of side effects was : severe, 68.2±7.0 years ; moderate, 61.3±14.2 years ; and mild, 56.0±5.3 years.
Pregabalin medication was effective for reducing pain in patients with CPSP. Elderly individuals should start pregabalin medication at a low dose because side effects appear more frequently with increasing age.
