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Abstract
A short cut review was carried out to establish whether pregabalin can reduce acute herpetic pain and reduce post herpetic neuralgia. 48 papers were found using the reported searches, of which one presented the best evidence to answer the clinical question. The author, date and country of publication, patient group studied, study type, relevant outcomes, results and study weaknesses of this best paper are tabulated. It is concluded that pregabalin does not seem to decrease the intensity of pain related to acute herpes zoster. Moreover, it does not decrease the incidence of post herpetic neuralgia. More research is.
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Report by: Eliane Raymond-Dufresne, PGY-3, Emergency Medicine
Search checked by: Katharine Wylie, Senior Informatacist
Institution: Laval University, Québec, Canada
Three-part question
In [patients with new onset of herpes zoster infection], can [pregabalin] be used to [decrease the incidence of post-herpetic neuralgia and to decrease the intensity of acute herpetic pain]?
Clinical scenario
A 62-year-old man comes in with a new vesicular rash on his abdomen that has been present for 24 h. He complains of intense pain and tenderness in the same area as the rash. You diagnose herpes zoster. You start an antiviral medication right away, but you wonder what medication you could use to try to alleviate the patient's pain and reduce the incidence of post-herpetic neuralgia. You have seen your colleagues use pregabalin for that purpose, but wonder if there is good evidence to support this practice.
Search strategy
EMBASE search 20 October 2011: ‘Herpes zoster’ AND ‘Neuralgia’ OR ‘Postherpetic neuralgia’ AND ‘Pregabalin’ Limits: all years, humans, >18-years-old, controlled clinical trials or RCT, English or French, article or article in press:
Pubmed Advanced Search via Search Builder 14 December 2011: (Herpes zoster[MeSH Terms] AND Neuralgia[MeSH Terms] OR Postherpetic neuralgia[MeSH Terms]) AND Pregabalin Limits: Humans, English.
The website http://www.clinicaltrials.gov was searched for an ongoing trial on the topic, and one trial was found.
Search outcome
Twenty-one articles found in Embase and 47 in Medline. One was relevant and of sufficient quality for inclusion (see table 3).
Comment(s)
Herpes zoster is a pathology frequently encountered in the Emergency Department. The acute pain associated to this condition is often debilitating to the patient, as is the less frequent postherpetic neuralgia, which affects 10%–15% after the acute phase. Many patients have an unsatisfactory response to conventional treatment and it would be useful to have other effective drugs available to treat them. Unfortunately, there was no article in the literature that conclusively answered the question posed. The website http://www.clinicaltrials.gov was searched for an ongoing trial on the topic, and one trial was found: ‘Placebo-Controlled Study of Pregabalin for the Pain of Acute Herpes Zoster’. The published results of this trial (2) only included eight patients and it is not included here. A trial of sufficient power studying the effect of the drug at the moment herpes zoster is diagnosed would be useful.
Clinical bottom line
Pregabalin does not seem to decrease the intensity of pain related to acute herpes zoster. Moreover, it does not decrease the incidence of post herpetic neuralgia.
▶ Krcevski Skvarc N, Kamenik M. Effects of pregabalin on acute herpetic pain and postherpetic neuralgia incidence. Wien Klin Wochenschr 2010;122(Suppl 2):49–53.
▶ Jensen-Dahm C, Rowbotham MC, Reda H, et al. Effect of a single dose of pregabalin on herpes zoster pain. Trials 2011;12:55.
Footnotes
Provenance and peer review Commissioned; internally peer reviewed.
Linked Articles
- Best Evidence Topic reports
- Correction