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PAIN MEDICINE

Gabapentin for the Treatment of Pain in Guillain-Barré Syndrome: A Double-Blinded, Placebo-Controlled, Crossover Study

Chandra K. Pandey, MD^*, Neeta Bose, MD^*, Garima Garg, MD^*, Namita Singh, MD PDCC^*, Arvind Baronia, MD^*, Anil Agarwal, MD^*, Prabhat K. Singh, MD^*, and Uttam Singh, PhD

Departments of *Anaesthesiology and Critical Care Medicine and Bio-statistics, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India

Address correspondence to Chandra Kant Pandey, MD, Department of Anaesthesiology and Critical Care Medicine, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow 226014, India. Address e-mail to ckpandey{at}sgpgi.ac.in Reprints will not be available from the author.

Pain syndromes of Guillain-Barré are neuropathic as well as nociceptive in origin. We aimed to evaluate the therapeutic efficacy of gabapentin in relieving the bimodal nature of pain in Guillain-Barré syndrome in a randomized, double-blinded, placebo-controlled, crossover study in 18 patients admitted to the intensive care unit for ventilatory support. Patients were assigned to receive either gabapentin (15 mg · kg^-1 · d^-1 in 3 divided doses) or matching placebo as initial medication for 7 days. After a 2-day washout period, those who previously received gabapentin received placebo, and those previously receiving placebo received gabapentin as in the initial phase. Fentanyl 2 µg/kg was used as a rescue analgesic on patient demand or when the pain score was >5 on a numeric rating scale of 0–10. The numeric rating score, sedation score, consumption of fentanyl, and adverse effects were noted, and these observed variables were compared. The numeric pain score decreased from 7.22 ± 0.83 to 2.33 ± 1.67 on the second day after initiation of gabapentin therapy and remained low during the period of gabapentin therapy (2.06 ± 0.63) (P < 0.001). There was a significant decrease in the need for fentanyl from Day 1 to Day 7 during the gabapentin therapy period (211.11 ± 21.39 to 65.53 ± 16.17 [µg]) in comparison to the placebo therapy period (319.44 ± 25.08 to 316.67 ± 24.25 [µg]) (P < 0.001).

IMPLICATIONS: Gabapentin, an antiepileptic drug, has been used effectively for different types of pain management. This study demonstrates that gabapentin has minimal side effects and is an alternative to opioids and nonsteroidal antiinflammatory drugs for management of the bimodal nature of pain of Guillain-Barré Syndrome patients.

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Anesthesia & Analgesia® is published for the International Anesthesia Research Society® by Lippincott Williams & Wilkins with the assistance of Stanford University Libraries' HighWire Press®. Copyright 2006 by the International Anesthesia Research Society. Online ISSN: 1526-7598   Print ISSN: 0003-2999