Gabapentinoids for neuropathic pain
Level of evidence: B
Gabapentinoids medications likely decrease neuropathic pain.
A systematic review «Soliman N, Moisset X, Ferraro MC, ym. Pharmacotherapy and non-invasive neuromodulation for neuropathic pain: a systematic review and meta-analysis. Lancet Neurol 2025;24(5):413-428 »1 measured effectiveness of Gabapentinoids on neuropathic pain including 56 randomized trials. A reanalysis of these trials suggested mean 0.67 points decrease (95% CI -0.83 to -0.51) in average pain at 4-16 weeks follow up, translating to about 13 % decrease in pain (95% CI -17 % to -10 %).
In a subgroup analysis pregabalin (300-600mg; mean difference -0.70, 95% CI -0.94 to -0.47) had very similar effect compared to gabapentin (1600-3600mg; mean difference -0.67, 95% CI -0.83 to -0.51).
The same systematic review found RD of 3.8 % (2.7 % to 4.9 %) for withdrawals due to side effects.
A Cochrane review «Derry S, Bell RF, Straube S, ym. Pregabalin for neuropathic pain in adults. Cochrane Database Syst Rev 2019;1(1):CD007076 »2measured harms for Pregabalin 300mg and suggested an increase in risk of somnolence (RD 8%; RR 3,.34 [2.62-4.26]) and dizziness (RD 12%, RR 3.53 [2.86-4.35]). Other specific adverse events were not reported. However, another systematic review «Zaccara G, Gangemi P, Perucca P, ym. The adverse event profile of pregabalin: a systematic review and meta-analysis of randomized controlled trials. Epilepsia 2011;52(4):826-36 »3 estimated other adverse events on any condition and found also increased risk of Vertigo (5 %), ataxia (4 %), blurred vision (4 %), peripheral edema (5 %), dry mouth (5 %) and constipation (3 %). The risk of adverse events is likely correlated with the dose.
The quality of evidence was downgraded due to high risk of bias (high dropout rates).
| Reference | Study type | Population | Intervention and comparison | Outcomes | Risk of bias |
|---|---|---|---|---|---|
| RCT=randomized controlled trial; SR=systematic review; MA=meta-analysis | |||||
| «Soliman N, Moisset X, Ferraro MC, ym. Pharmacotherapy and non-invasive neuromodulation for neuropathic pain: a systematic review and meta-analysis. Lancet Neurol 2025;24(5):413-428 »1 | SR/MA | Adult patients with neuropathic pain | Gabapentinoids vs placebo | Decrease in average pain | High |
| Reference | Comments |
|---|---|
| «Soliman N, Moisset X, Ferraro MC, ym. Pharmacotherapy and non-invasive neuromodulation for neuropathic pain: a systematic review and meta-analysis. Lancet Neurol 2025;24(5):413-428 »1 | Most trials were at high risk of bias (mainly due to over 20 % dropout rates). From all trials, 42 tested pregabalin, 23 gabapentin, and 5 mirogabalin. |
Results
| Reference | Number of studies and number of patients (I/C) | Follow-up time | Mean (SD) I | Mean (SD) C | Mean difference (95% CI) |
|---|---|---|---|---|---|
| Level of evidence: Moderate The quality of evidence was downgraded one time due to high risk of bias and inconsistency combined. *We calculated the effect size by using the data provided by the systematic review. We used random effects meta-analysis. We excluded 9 small trials included in the original review due to insufficient data and excluded small doses (under 1600mg for gabapentin and under 300mg for pregabalin). I= intervention; C=comparison; CI=confidence interval | |||||
| «Soliman N, Moisset X, Ferraro MC, ym. Pharmacotherapy and non-invasive neuromodulation for neuropathic pain: a systematic review and meta-analysis. Lancet Neurol 2025;24(5):413-428 »1 | 44 trials, 2699 patients | 4-14 weeks | Not reported | 5.02 | -0.67 (-0.83 to -0.51)* Relative effect: -13 % (-17 % to -10 %) |
References
- Soliman N, Moisset X, Ferraro MC, ym. Pharmacotherapy and non-invasive neuromodulation for neuropathic pain: a systematic review and meta-analysis. Lancet Neurol 2025;24(5):413-428 «PMID: 40252663»PubMed
- Derry S, Bell RF, Straube S, ym. Pregabalin for neuropathic pain in adults. Cochrane Database Syst Rev 2019;1(1):CD007076 «PMID: 30673120»PubMed
- Zaccara G, Gangemi P, Perucca P, ym. The adverse event profile of pregabalin: a systematic review and meta-analysis of randomized controlled trials. Epilepsia 2011;52(4):826-36 «PMID: 21320112»PubMed