PubMed · 13660977
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E LEDO DUNIPE, A LEDO POZUETA. [On the minimum shingles].. https://pubmed.ncbi.nlm.nih.gov/13660977/
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Pregabalin, the pharmacologically active S-enantiomer of 3-aminomethyl-5-methyl-hexanoic acid, has a similar pharmacological profile to that of its developmental predecessor gabapentin, but showed greater analgesic activity in rodent models of neuropathic pain. The exact mechanism of action of pregabalin is unclear, although it may reduce excitatory neurotransmitter release by binding to the alpha2-delta protein subunit of voltage-gated calcium channels. Oral pregabalin 150-600 mg/day, administered twice or three times daily, was superior to placebo in relieving pain and improving pain-related sleep interference in three randomised, double-blind, placebo-controlled, multicentre studies of 8-13 weeks' duration in a total of 776 evaluable patients with postherpetic neuralgia (PHN). Weekly mean pain scores (primary endpoint; assessed in all three studies) and weekly mean sleep interference scores (assessed in two studies) were significantly improved at 1 week. In two studies, significant improvements in daily mean pain scores were apparent on the first or second day of treatment with pregabalin administered three times daily. Pregabalin was generally well tolerated when force-titrated over 1 week to fixed dosages (maximum 600 mg/day) in clinical trials that enrolled most elderly PHN patients. Dizziness, somnolence and peripheral oedema of mild-to-moderate intensity were the most common adverse events.
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In postherpetic neuralgia, as in all types of neuropathic pain, it is generally accepted that outcome can be affected early management with specific analgesics. However, when one looks at the diagnostic criteria appearing in the literature, there is no consensus. Authors use the notion of latency to situate the onset of postherpetic neuralgia within the continuum of herpetic pain. Depending on the Author, this latency period ranges from one to six Months after the skin eruption. This latency is poorly compatible with early intervention and not well-adapted to everyday practice. With the aim of finding ways to improve the management of pain, the Neuropathic Pain Expert Group agreed upon a new definition. Postherpetic neuralgia is pain in the involved site after the skin eruption has healed and which displays the features of neuropathic pain. This definition, which does away with the latency criterion, is based on the identification of one or more clinical features of neuropathic pain in a situation of treatment failure, namely: presence of chronic unsolicited pain (burning, tightness, pressure) and/or paroxysmal pain (tingling, stabbing pain) and/or mechanical hyperalgia/allodynia (to friction or pressure) and/or temperature sensitivity (to heat and/or cold). Such pain occurs in circumscribed neurologic zones in which a sensory deficit can be demonstrated and is usually associated with dysesthesia and/or paresthesia.