Abstract

A PROSPECTIVE OBSERVATIONAL STUDY ON THE CLINICAL SAFETY AND EFFICACY OF ANALGESICS USED IN THE TREATMENT OF NEUROPATHIC PAIN

Dr. Velpukonda Anudeep, Putta Saiteja*, Jawahar Chowdary Sushma Swaraj, Podili Vaishnavi, Kasaramoni Swetha, Dr. Suresh Reddy Challamalla

ABSTRACT

Back ground: Neuropathic pain is a distressing condition characterized by shooting or burning sensations resulting from damage or lesions in the somatosensory nervous system. Allodynia, an increased sensitivity to touch, often accompanies this condition. Various medical conditions, including diabetes, viral infections, autoimmune disorders, spinal cord injury, post-stroke complications, and chemotherapy-induced neuropathy, contribute to the development of neuropathic pain. Commonly prescribed analgesics for managing neuropathic pain include GABA analogues (e.g., Pregabalin, Gabapentin), SNRIs (e.g., Duloxetine), and anticonvulsants (e.g., Carbamazepine). Aim: The aim of the study is to determine the clinical safety and efficacy of the analgesic’s medications used in the neuropathic pain. Results: In this prospective observational study conducted over a six-month period at Aware Gleneagles Global Hospital, 60 patients (52% female, 48% male) were enrolled. Hypertension (40%) and diabetes (30%) were the predominant comorbidities among the patients. Sciatica (18.33%), radiculopathy (23%), and PDN (8%) were the most commonly diagnosed neuropathic pain conditions. The treatment course resulted in a significant reduction in Visual Analog Scale (VAS) pain scores, with 42% of patients reporting a score of 0 and 44% reporting a score of 1. The loss of neuropathic component was evaluated using the painDetect questionnaire. Gabapentin (48%), Pregabalin (47%), Duloxetine (13%), Nortriptyline (18%), and Carbamazepine (7%) were the most frequently prescribed analgesics, administered in various regimens including monotherapy (58%), dual therapy (28%), triple therapy (8%), and multiple therapy (6%). Patient feedback indicated excellent cure in response to therapy, a good response in cases of infrequent pain, and no response when there was no change in pain. Monotherapy showed a good response in 68% of cases and an excellent response in 29%, while dual therapy showed a good response in 53% and an excellent response in 41%, with 8% experiencing frequent pain. Triple therapy demonstrated an excellent response with no reported pain. Among the prescribed analgesics, Pregabalin (71%) and Gabapentin (59%) showed the highest efficacy as monotherapy. However, Pregabalin and Duloxetine had a slightly higher incidence of adverse events (10%) compared to Gabapentin and Carbamazepine (8%). Constipation (12%), weight changes (15%), insomnia (5%), and dry mouth (4%) were the most common adverse events reported, with a higher incidence observed in older and overweight patients. Although two patients showed non-compliance with Duloxetine due to lack of pain relief, no drugs were discontinued due to adverse effects. Conclusion: Pregabalin and Gabapentin were found to be widely used and effective analgesics for treating neuropathic pain, with reasonable safety profiles. Mild adverse effects such as dry mouth, constipation, and insomnia were reported. Monotherapy was the preferred approach for managing paraesthesia, pain, numbness, and weakness, while dual therapy was utilized for severe neuropathic pain. Neuropathic pain with severe comorbidities was preferably treated with multiple therapies.

Keywords: Neuropathic pain, Analgesics, GABA Analogues, Pregabalin, Gabapentin, Efficacy, Safety.