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Combination Treatment Found Effective for Neuropathic Pain

Combination of gabapentin and nortriptyline found to relieve pain better than either drug alone

WEDNESDAY, Sept. 30 (HealthDay News) -- A combination treatment of gabapentin and nortriptyline relieve chronic neuropathic pain better than either medication given as monotherapy, according to a study published online Sept. 30 in The Lancet.

Ian Gilron, M.D., of Queen's University in Kingston, Canada, and colleagues randomized 56 patients with chronic neuropathic pain (diabetic polyneuropathy or postherpetic neuralgia) into three groups with each group receiving a different pain treatment regimen (in three six-week treatment periods): gabapentin alone, nortriptyline alone, and a combination of the two medications, all at maximum tolerated dosage. The sequence in which each of the three groups received the treatments varied. The primary study outcome was mean daily pain intensity on a zero to 10 numerical rating scale.

The researchers found that mean daily pain on the numerical rating scale was 5.4 at baseline, 3.2 for gabapentin, 2.9 for nortriptyline, and 2.3 for the combination treatment. At the maximum tolerated dose, the most common side effect was dry mouth, which occurred less in patients on gabapentin than in patients on nortriptyline or combination treatment. There were no serious adverse events reported.

"Combined gabapentin and nortriptyline seems to be more efficacious than either drug given alone for neuropathic pain, therefore we recommend use of this combination in patients who show a partial response to either drug given alone and seek additional pain relief," the authors conclude. "Future trials should compare other combinations to their respective monotherapies for treatment of such pain."

Two study authors reported financial relationships with Pfizer, including receiving honoraria, serving on advisory boards, or receiving research grants.

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