Letters to the Editor

Pregabalin for the Treatment of Trigeminal Neuralgia

Am Fam Physician. 2008 Oct 1;78(7):808.

Original Article: Trigeminal Neuralgia

Issue Date: May 1, 2008

Available at: http://www.aafp.org/afp/20080501/1291.html

to the editor: The article on trigeminal neuralgia came at a perfect time as I had just been discussing a refractory case with some family medicine and neurology colleagues. This particular patient's pain is made more intolerable by underlying anxiety, as is common with pain syndromes. I would like to add a suggestion from my recent experience. The author of the article briefly discussed “a variety of other medications and modalities” but omitted pregabalin (Lyrica). Although the evidence is scant, this is a potentially useful drug for some patients because it may be beneficial for both the neuropathic pain and comorbid anxiety.14

Author disclosure: Nothing to disclose.

REFERENCES

1. Obermann M, Yoon MS, Sensen K, Maschke M, Diener HC, Katsarava Z. Efficacy of pregabalin in the treatment of trigeminal neuralgia. Cephalalgia. 2008;28(2):174–181.

2. Feltner DE, Crockatt JG, Dubovsky SJ, et al. A randomized, double-blind, placebo-controlled, fixed-dose, multicenter study of pregabalin in patients with generalized anxiety disorder. J Clin Psychopharmacol. 2003;23(3):240–249.

3. Pande AC, Feltner DE, Jefferson JW, et al. Efficacy of the novel anxiolytic pregabalin in social anxiety disorder: a placebo-controlled, multicenter study. J Clin Psychopharmacol. 2004;24(2):141–149.

4. Pohl RB, Feltner DE, Fieve RR, Pande AC. Efficacy of pregabalin in the treatment of generalized anxiety disorder: double-blind, placebo-controlled comparison of BID versus TID dosing. J Clin Psychopharmacol. 2005;25(2):151–158.

In Reply: I appreciate the comments from Dr. Viel about trigeminal neuralgia. Many medications and modalities have been tried for the treatment of trigeminal neuralgia, but the evidence is very limited regarding the effectiveness of most, with the exception of carbamazepine (Tegretol). The article Dr. Viel references regarding the use of pregabalin (Lyrica)1 was published after the preparation of my manuscript, but it offers another option for patients intolerant or refractory to carbamazepine. Unfortunately, the open-label format and lack of a control group make it difficult to fully evaluate the efficacy of pregabalin for this condition and relegate it to a position with other potentially effective treatments. An argument can be made that the choice of one of these treatments might be properly influenced by coexisting conditions, as was the case in Dr. Viel's patient with anxiety disorder.

Author disclosure: Nothing to disclose.

REFERENCES

1. Obermann M, Yoon MS, Sensen K, Maschke M, Diener HC, Katsarava Z. Efficacy of pregabalin in the treatment of trigeminal neuralgia. Cephalalgia. 2008;28(2):174–181.

Send letters to Kenneth W. Lin, MD, MPH, Associate Deputy Editor for AFP Online, e-mail: afplet@aafp.org, or 11400 Tomahawk Creek Pkwy., Leawood, KS 66211-2680.

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