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Los medicamentos antiepilépticos para el dolor neuropático y la fibromialgia
Andrew Moore1, Philip Wiffen1, Eija Kalso2
1Pain Research and Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, England.
JAMA
|July 10, 2014
Resumen
Los medicamentos antiepilépticos como la gabapentina y la pregabalina ofrecen un modesto alivio del dolor en condiciones de dolor neuropático como la neuropatía diabética y la neuralgia postherpética. La evidencia para otros antiepilépticos en el tratamiento de estas afecciones o fibromialgia es limitada.
Área de la Ciencia:
- Farmacología Farmacología.
- Neurología Neurología.
- Manejo del dolor Manejo del dolor.
Sus antecedentes:
- El dolor neuropático y la fibromialgia son afecciones crónicas con importantes necesidades de tratamiento no cubiertas.
- Los medicamentos antiepilépticos (AED) se usan cada vez más fuera de la etiqueta para el control del dolor.
- La evidencia de la eficacia de los AED en condiciones específicas de dolor requiere una evaluación sistemática.
Objetivo del estudio:
- Evaluar la asociación entre los medicamentos antiepilépticos y la reducción de la intensidad del dolor en pacientes con dolor neuropático o fibromialgia.
- Para sintetizar la evidencia actual sobre la efectividad de los AED para indicaciones específicas de dolor.
Principales métodos:
- Revisión sistemática y metanálisis de ensayos controlados aleatorios.
- Comparación de los AED (gabapentina, pregabalina, otros) frente al placebo.
- Evaluación de la reducción significativa del dolor como resultado primario.
Principales resultados:
- La gabapentina y la pregabalina mostraron un aumento modesto en la reducción significativa del dolor para la neuropatía diabética y la neuralgia postherpética en comparación con el placebo.
- La pregabalina demostró un pequeño aumento en la reducción significativa del dolor para la fibromialgia en comparación con el placebo.
- No existe evidencia suficiente para la eficacia de otros AED en estas condiciones de dolor.
Conclusiones:
- La gabapentina y la pregabalina se asocian con beneficios modestos en condiciones específicas de dolor neuropático y fibromialgia.
- La evidencia actual no apoya el uso de otros DEA para estas indicaciones.
- Se necesita más investigación para aclarar el papel de los AED en el manejo del dolor.
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