The Effect of Pregabalin and Methylcobalamin Combination on the Chronic Postthoracotomy Pain Syndrome

摘要

Background Chronic postthoracotomy pain (CPTP) consists of different types of pain. Some characteristics of CPTP are the same as those of recognized neuropathic pain syndromes. We aimed to determine the safety and efficacy of pregabalin and methylcobalamin combination (PG-B12) in comparison with diclofenac potassium (DP) in patients with CPTP.;Methods One hundred consecutive patients with CPTP after posterolateral/lateral thoracotomy were prospectively randomly assigned and evaluated. Fifty patients were given PG-B12 and another 50 patients were given DP treatment. Visual Analogue Scale (VAS) and the Leeds Assessment of Neuropathic Symptoms and Signs (LANSS) scorings were performed previous to the treatment (day 0) and on the 15th, 30th, 60th, and 90th days. Adverse events were questioned.;Results The mean ages were 58.7 ± 12.2 and 54.6 ± 14.5 years, and the mean durations of pain were 4.01 ± 1.04 and 3.8 ± 1.02 months, respectively. The number of patients with a VAS score less than 5 at the latest follow-up (VAS90 < 5) was 44 (88%) and 18 (36%) in the PG-B12 and DP groups, respectively (p < 0.05). Forty-four patients (88%) in the PG-B12 group and 16 patients (32%) in the DP group had a LANSS score less than 12 at the latest follow-up (p < 0.05). Minor adverse events that did not mandate discontinuation of the treatment were observed in 14 patients (28%) in the PG-B12 group and 2 patients (4%) in the DP group.;Conclusions PB-B12 is safe and effective in the treatment of CPTP with minimal side effects and a high patient compliance. These results should be supported by multidisciplinary studies with larger sample sizes and longer follow-ups.;Chronic postthoracotomy pain (CPTP) or postthoracotomy neuralgia is defined by the International Association for the Study of Pain as pain that recurs or persists along a thoracotomy incision for at least 2 months after the surgical procedure [1][1]. Usually, it is a burning, dysesthetic, and aching feeling in nature, which displays many features of neuropathic pain. It occurs in approximately 50% of patients after thoracotomy; however, in 5% of patients the pain is severe and disabling. The technique of different thoracotomy incisions has been shown to have no difference in reducing the incidence of CPTP [2, 3]. The neurologic mechanisms for the production of neuropathic pain, hyperalgesia, and somatic pain are well described [4, 5, 6, 7]. These conditions are controlled by a variety of drugs that include nonsteroidal anti-inflammatory drugs, parenteral opiates, epidurals,?and paravertebral infusions of local anesthetics, narcotics,?intrapleural analgesia, transcutaneous nerve stimulation, intercostal and phrenic nerve blockades, and cryotherapy [6, 7, 8, 9, 10, 11, 12]. However, the results were variable, and no single strategy was shown to be effective in all patients.We administered pregabalin and vitamin B12 combination (PG-B12), an anticonvulsant and methylcobalamin, to the patients with CPTP and compared its effectiveness with diclofenac potassium (DP), a nonsteroidal anti-inflammatory drug, used in conventional pain treatment. There is only one prospective study and a case report about PG-B12 combination treatment in CPTP.Jump to SectionPatients and MethodsStudy PopulationDrug Admission ProtocolStatistical AnalysisResultsCommentReferences;Jump to SectionPatients and MethodsStudy PopulationDrug Admission ProtocolStatistical AnalysisResultsCommentReferences;One hundred consecutive patients with CPTP were included in the study. After getting approval from the institutional review board, this study was conducted in the Department of Thoracic Surgery, Sureyyapasa Pulmonology and Thoracic Surgery Training and Research Hospital, on 100 consenting patients who underwent thoracotomies. Postoperative pain that did not respond to a conventional treatment of at least 3 months’ duration was accepted as chronic pain. The severity of wound pain was determined using a 10-point Visual Analogue Scale