Gabapentinoids for Neuropathic Pain Management: A Systematic Umbrella Review

This umbrella review aimed to evaluate the effectiveness of gabapentinoids, including dosing and risk profile, for the management of neuropathic pain.

Eligibility criteria were restricted exclusively to systematic reviews and meta-analyses conducted under PRISMA reporting standards. Methodological quality was evaluated using the Assessment of Multiple Systematic Reviews 2 (AMSTAR 2) instrument. The scope of the review comprised six distinct pain conditions: spinal cord injury, post-herpetic neuralgia, cancer-related neuropathic pain, diabetic peripheral neuropathic pain, refractory neuropathic pain, and sciatica.

22 systematic reviews and meta-analyses were included, and 19 out of 22 studies were of critically low quality. Mirogabalin reduced lower limb neuropathic pain better than pregabalin. Drugs other than gabapentinoids were better in pain reduction among post-herpetic neuralgia patients. Pregabalin had a higher short-term pain-reducing effect compared to gabapentin. Dizziness and somnolence were more closely linked to gabapentin and pregabalin.

The limitations of this review included the small number of studies, limited variability in the study populations and locations, and small sample sizes.

Gabapentinoids showed efficacy in diabetic peripheral neuropathic pain, cancerrelated neuropathic pain, and spinal cord injury. Gabapentinoids also showed efficacy in patients with the following types of refractory neuropathic pain, including refractory diabetic peripheral neuropathic pain, trigeminal neuralgia, complex regional pain syndrome, and lower back pain. However, in the case of post-herpetic neuralgia, the results were controversial. Most of the included studies were of critically low quality, which reduces confidence in the efficacy of gabapentinoids. Their use was highly associated with drowsiness, somnolence, peripheral edema, and weight gain.