Vermindert duloxetine de neuropathische pijn bij patiënten met het centrale pijnsyndroom?
Een dubbelblind gerandomiseerd onderzoek.

Central neuropathic pain (pain associated with lesions of the central nervous system) has been estimated to occur in up to 8% of patients after a stroke, and about 10% to 30% of patients with spinal cord injury are affected during the course of their illness.

(1) The mechanisms underlying central neuropathic pain are not completely understood. A dominating feature of central pain, however, is an abnormal spinothalamic function with altered sensitivity to temperature and pinprick.

(2) Disruption of the spinothalamic pathways may contribute to neuronal hyperexcitability, loss of descending inhibitory control mechanisms in the spinal cord, and alterations in the processing of incoming noxious and non-noxious stimuli resulting in an abnormal pain perception (1; 3). In addition, loss of balance between noxious and non-noxious sensory inputs gives rise to neuronal reorganization in the thalamus contributing to the onward flow of nociceptive information to the postcentral gyrus of the cortex (4). Despite recent advances in identification of peripheral and central sensitization mechanisms related to central nervous system injury, the effective treatment of patients suffering from central pain remains a clinical challenge. Nevertheless the numerous treatment options available (including opioids, anticonvulsants, antidepressant, baclofen, á-adrenergic agonists, and ketamine), some of these patients still experience severe neuropathic pain. In addition, the use of these agents is often limited by significant side effects. Recently, duloxetine was reported to possess antihyperalgesic and antiallodynic properties in a wide range of animal models, and to be effective in randomized clinical trials of nonmalignant chronic neuropathic pain (including fibromyalgia and diabetic peripheral neuropathy). Although recent trials confirm the effectiveness of duloxetine in peripheral neuropathic pain, the role of pregabalin in the treatment of central neuropathic pain remains unknown. Given the absence of other effective pharmacological treatments for central pain, any medication providing some benefits in terms of symptom amelioration and quality of life improvement in patients with neuropathic pain have to be evaluated.

We tested, in a randomized, double-blind, placebo-controlled trial, the effects of duloxetine on pain relief, tolerability, health status, and quality of life in patients with central neuropathic pain.

Each week, pain intensity score is used as a guide to evaluate treatment.

Duloxetine versus placebo.