Pregabalin vs placebo to prevent chronic pain after whiplash injury in at-risk individuals: results of a feasibility study for a large randomised controlled trial.

Abstract

ABSTRACT:

There are few effective treatments for acute whiplash-associated disorders (WADs). Early features of central sensitisation predict poor recovery. The effect of pregabalin on central sensitisation might prevent chronic pain after acute whiplash injury. This double blind, placebo-controlled randomised controlled trial examined feasibility and potential effectiveness of pregabalin compared with placebo for people with acute WAD. Twenty-four participants with acute WAD (<48 hours) and at risk of poor recovery (pain ≥5/10) were recruited from hospital emergency departments in Queensland, Australia, and randomly assigned by concealed allocation to either pregabalin (n = 10) or placebo (n = 14). Pregabalin was commenced at 75 mg bd, titrated to 300 mg bd for 4 weeks, and then weaned over 1 week. Participants were assessed at 5 weeks and 3, 6, and 12 months. Feasibility issues included recruitment difficulties and greater attrition in the placebo group. For the primary clinical outcome of neck pain intensity, attrition at 5 weeks was pregabalin: 10% and placebo: 36% and at 12 months was pregabalin: 10% and placebo: 43%. Pregabalin may be more effective than placebo for the primary clinical outcome of neck pain intensity at 3 months (mean difference: -4.0 [95% confidence interval -6.2 to -1.7]) on an 11-point Numerical Rating Scale. Effects were maintained at 6 months but not 12 months. There were no serious adverse events. Minor adverse events were more common in the pregabalin group. A definitive large randomised controlled trial of pregabalin for acute whiplash injury is warranted. Feasibility issues would need to be addressed with modifications to the protocol.

• Authors: Jane Nikles, Gerben Keijzers, Geoffrey Mitchell, Scott F Farrell, Siegfried Perez, Stephan Schug, Robert S Ware, Samuel A McLean, Luke B Connelly, Michele Sterling
• Journal: Pain (Pain) Vol. 163 Issue 2 Pg. e274-e284 (02 01 2022) ISSN: 1872-6623 [Electronic] United States
• PMID: 34108431 (Publication Type: Journal Article, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)
• Copyright: Copyright © 2021 International Association for the Study of Pain.

Chemical References

• Analgesics
• Pregabalin

Topics

• Analgesics
• Chronic Pain (drug therapy, etiology, prevention & control)
• Double-Blind Method
• Feasibility Studies
• Humans
• Pain Measurement
• Pregabalin (therapeutic use)
• Treatment Outcome
• Whiplash Injuries (complications)