Low-dose gabapentin as useful adjuvant to opioids for neuropathic cancer pain when combined with low-dose imipramine

Purpose Painful neuropathic conditions of cancer pain often show little response to nonopioid and opioid analgesics but may be eased by antidepressants and anticonvulsants. Although gabapentin is effective in the treatment of neuropathic pain in patients with cancer, some patients experience intoler...

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Bibliographic Details
Published in:Journal of anesthesia 2010-06, Vol.24 (3), p.407-410
Main Authors: Arai, Young-Chang P., Matsubara, Takako, Shimo, Kazuhiro, Suetomi, Katsutoshi, Nishihara, Makoto, Ushida, Takahiro, Kobayashi, Kunio, Suzuki, Chiharu, Kinoshita, Akiko, Kondo, Miki, Matsubara, Satuki, Hayashi, Ruiko, Tohyama, Yukio, Nishida, Kikuyo, Arakawa, Maki
Format: Article
Language:English
Subjects:
Aged
Amines - therapeutic use
Analgesics, Non-Narcotic - therapeutic use
Analgesics, Opioid - therapeutic use
Anesthesiology
Anti-Inflammatory Agents, Non-Steroidal - therapeutic use
Antidepressive Agents, Tricyclic - administration & dosage
Antidepressive Agents, Tricyclic - therapeutic use
Cancer
Cancer pain
Care and treatment
Critical Care Medicine
Cyclohexanecarboxylic Acids - therapeutic use
Dosage and administration
Drug Therapy, Combination
Emergency Medicine
Female
Gabapentin
gamma-Aminobutyric Acid - therapeutic use
Humans
Imipramine
Imipramine - administration & dosage
Imipramine - therapeutic use
Intensive
Male
Medicine
Medicine & Public Health
Middle Aged
Neoplasms - complications
Opioids
Original Article
Pain
Pain - drug therapy
Pain - etiology
Pain Measurement - drug effects
Pain Medicine
Peripheral Nervous System Diseases - drug therapy
Peripheral Nervous System Diseases - etiology
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Summary:Purpose Painful neuropathic conditions of cancer pain often show little response to nonopioid and opioid analgesics but may be eased by antidepressants and anticonvulsants. Although gabapentin is effective in the treatment of neuropathic pain in patients with cancer, some patients experience intolerable side effects sufficient to warrant discontinuation. The aim of this study was to see whether low-dose gabapentin is effective in treating cancer-related neuropathic pain when combined with low-dose imipramine. Methods Fifty-two cancer patients diagnosed as having neuropathic pain were allocated into four groups: G400-I group took gabapentin 200 mg and imipramine 10 mg every 12 h orally; G400 group took gabapentin 200 mg every 12 h orally; G800 group took gabapentin 400 mg every 12 h orally; I group took imipramine 10 mg every 12 h orally. Results Low-dose gabapentin–imipramine significantly decreased the total pain score and daily paroxysmal pain episodes. Several patients developed mild adverse symptoms in the four groups, and three patients discontinued treatment due to severe adverse events in the G800 group. Conclusion Low-dose gabapentin–antidepressant combination with opioids was effective in managing neuropathic cancer pain without severe adverse effects.
ISSN:0913-8668
1438-8359
DOI:10.1007/s00540-010-0913-6