Oral Thioctic Acid (a-Lipoic Acid) and Gabapentin as Co-adjuvants in Paraneoplastic Neuropathic Pain
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- Category: Vol. 77, June 2009
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Oral Thioctic Acid (a-Lipoic Acid) and Gabapentin as Co-adjuvants in Paraneoplastic Neuropathic Pain,ABEER H. EL-KHOULY
Abstract
Thioctic acid is a powerful antioxidant. Several studies indicate that oxidative stress play important role in nerve damage and neuropathy. Thioctic acid also controls NMDA receptors activity which are involved in hyperalgesia and allodynia in neuropathic pain. Gabapentin is a potent anticon-vulsant, which was considered as a first choice drug in man-agement of secondary neuropathic pain. This study was designed aiming to evaluate the role of oral thioctic acid or gabapentin or their combination as co-adjuvant to oral mor-phine in neuropathic cancer pain therapy. Forty five patients were randomized to one of three groups (n=15). The gabapentin group received oral gabapentin 1200 mg/day; the thioctic acid group received oral thioctic acid 600 mg 3 times daily and the combined group received both thioctic acid and gabapentin in the same prescribed doses in the previous two groups but together. Pain intensity was measured by Visual Analog Scale of pain (VAS) 10-cm line, allodynia area (in cm2) and severity of allodynia by VAS. Total oral morphine rescue analgesic per day and side effects were recorded. The decrease in VAS pain scores and severity of allodynia were more significant in the combined group than the other two groups at any measurement time (p<0.05). The reduction in allodynia area was up to 40% in the gabapentin group, 25% in thioctic acid group and 45% in the combined group. Patients of the com-bined group showed less daily consumption of morphine on days 14 and 28 (p=0.012, p=0.005) respectively. The incidence of headache and sedation was higher in the thioctic acid group, while the incidence of somnolence was higher in the gabapentin group. Side effects were tolerable in the combined group. We can conclude that thioctic acid and gabapentine as co-adjuvant to oral morphine significantly improved pain scores and allodynia in neuropathic pain.