Resumen

CANOVAS MARTINEZ, L. et al. Analgesic efficacy of the association of duloxetine plus pregabalin in neuropathic pain: experience in 60 patients. Rev. Soc. Esp. Dolor [online]. 2009, vol.16, n.7, pp.381-385. ISSN 1134-8046.

Objective: The efficacy of duloxetine and pregabalin has been demonstrated separately and both drugs are approved by the Food and Drug Administration for the treatment of specific types of neuropathic pain. Our objective was to determine whether the association of both drugs improves their analgesic effectiveness and the effect of this association on patients' quality of life. Material and methods: We studied 60 patients with severe neuropathic pain (visual analog scale [VAS] > 6) over a 3-month period. The patients were randomized to three groups (n = 20): group A (duloxetine 30 mg/24 h the first 3 days followed by 60 mg/24 h at breakfast, with progressive increases of 30 mg every 3 days until pain relief was achieved). Group B (pregabalin 75 mg/night for the first 3 days, with increases of 75 mg every 3 days until pain relief was achieved. Group C (A+B). The variables studied were age, sex, diagnosis, VAS; stabbing pain, dull pain and allodynia (VAS); the dose required for pain relief > 50%, and subjective feeling of overall symptom improvement in patients and their sleep quality (0-3: 0 = none; 1 = mild; 2 = moderate; 3 = excellent). Patients were evaluated weekly in the first month, every 15 days in the second month and then once a month. Results: No significant differences were found in age or diagnosis among the three groups. The most common diagnoses were cervical and lumbar radiculopathy (68%), fibrosis after lumbar disc surgery (17%), lumbar canal stenosis (12%) and postherpetic neuralgia (8%). There were more women, except in group A, with equal distribution of men and women (50% F/M). Pain relief > 50% was achieved with 96.2 ± 24.1 mg of duloxetine in 60% of patients in group A, 532 ± 63mg of pregabalin in 68% of patients in group B, and 298.5 ± 56 mg of pregabalin plus 65.2 ± 31.1 mg of duloxetine in 73% of patients in group C (p > 0.05). Dull and stabbing pain was also reduced by > 50% with these doses but not allodynia (< 50%). Improvement in sleep quality was excellent in 71% of group C and in 67% of group B and was moderate in 59% of group A. The patients' subjective feeling of overall symptom improvement was correlated with pain relief. Conclusions: The association of duloxetine and pregabalin improved the analgesic efficacy of both drugs, achieving more effective pain control with lower doses in a greater percentage of patients compared with other studies.

Palabras clave : Duloxetine; Pregabalin; Pain relief; Neuropathic pain.

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