my personal edition > back pain > news


  E-Mail this DGDispatch to a colleague

DGDispatch

Gabapentin Effective for Severe Back Pain and Restless Leg Syndrome Associated with Rapid Opioid Detoxification: Presented at WCP

By Peggy Peck
Special to DG News

SAN DIEGO, CA -- August 21, 2002 -- Rapid opioid detoxification is associated with a number of neurological symptoms including intense back pain and restless leg syndrome (RLS), but new research suggests that administering gabapentin following rapid opioid detoxification (ROD) can eliminate these symptoms.

Enno Freye, MD, of the University of Düsseldorf, Düsseldorf, Germany and colleagues from the Department of Anesthesia, Jewish Hospital Berlin, Berlin, Germany, and the Department of Anesthesia and Pain Therapy, Nordwest Hospital, Frankfurt/Main, Germany, presented findings from a study of 21 patients who received gabapentin following ROD. The results were presented August 20^th at the 10^th World Congress on Pain.

In an interview, Dr. Freye said that ROD patients are "often very difficult to handle. They are coming out of the fog and all types of stimuli are hitting them at once. These are not easy patients to handle, and when they experience back pain or RLS, they are usually thrashing about and very, very difficult." These symptoms do not respond to standard treatment.

He also said that in addition to using gabapentin for symptom control, "these patients need to be closely watched for at least 24 hours. Some centers do ROD and then just send the patients home. That is a mistake."

The 21 patients underwent ROD using naltrexone and simultaneous administration of clonidine and somatostatin. Aside from amplitude height of late SSEPs (somatosensory-evoked potentials) (SSEPs >100ms), individual tolerance to an increase in electrical stimuli (mA) to the forearm was measured when the patients were awake, during anesthesia, and before and after receiving 1200 mg of gabapentin.

Data was analyzed using Friedman's test for repeated measures of variance on ranks, and the Student-Newman-Keuls test for multiple comparison.

Following ROD, amplitude in the SSEP increased (8.4±2.5 to 12.3±3.3 µV; p< 0.01) which dropped below control (3.5±1.5 µV; p <0.01) after gabapentin. Simultaneously, tolerance to electrical stimuli decreased from 10.2±1.2 mA to 4.4±1.2 mA. After gabapentin, tolerance increased to 19.5±4.8 mA.

There was an inverse linear correlation of amplitude height of SSEP and tolerance to electrical stimuli (r2=0.88), but inverse linear correlation of tolerance to electrical stimuli and latency of SSEP was less. (r2= 0.61).

E-Mail this DGDispatch to a colleague

To print, use this version