γ-Aminobutyric Acid and Derivatives Reduce the Incidence of Acute Pain after Herpes Zoster - A Systematic Review and Meta-analysis

Author(s): Wuttapon Sadaeng, Katalin Márta, Péter Mátrai, Péter Hegyi, Barbara Tóth, Balázs Németh, László M. Czumbel, Thanyaporn Sang-Ngoen, Zoltán Gyöngyi, Gábor Varga*, Péter Révész, István Szanyi, Kázmér Karádi, Gábor Gerber

Journal Name: Current Pharmaceutical Design

Volume 26 , Issue 25 , 2020

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Abstract:

Herpes zoster (HZ) causes considerable pain and distress, and γ-Aminobutyric acid (GABA) and its derivatives are assumed to control this, but the available data are inconsistent. This meta-analysis and systematic review aimed to assess the effectiveness of GABA derivatives in the prevention of acute herpetic pain. The metaanalysis was conducted following the PRISMA guidelines using PICO format, registered in PROSPERO number CRD42018095758. PubMed, Web of Science, Ovid, Scopus, and EMBASE databases were searched. Records were included if they were randomized controlled trials of patients undergoing HZ infection, investigating the effect of GABA derivatives versus placebo in the treatment of HZ pain. Eligible trials were evaluated for the risk of bias. Then data were extracted and analysed. The number of patients with observed presence of pain after treatment was used to calculate odds ratio in a random effect model with the DerSimonian-Laird estimator. The I2 statistic was analysed for heterogeneity. The potential risk of bias was measured using Egger’s regression test. The meta-analysis included three randomized controlled trials with a total of 297 patients. The incidence of acute HZ pain events for GABA group was significantly lower compared to placebo group,18/148 vs 44/149, respectively (OR = 0.36; 95% CI = 0.14 to 0.93; Z = 2.11; P = 0.035), Egger’s test yielded P = 0.308. In conclusion, the present meta-analysis demonstrates that GABA derivatives reduce the incidence of acute herpetic pain. However, additional, well-designed randomized clinical trials are needed to determine their dose- and time-dependency regarding this symptom.

Keywords: Acute herpes zoster pain, herpes zoster associated pain, GABA, γ-aminobutyric acid, meta-analysis, Egger’s test.

[1]
Beydoun A. Postherpetic neuralgia: role of gabapentin and other treatment modalities. Epilepsia 1999; 40(Suppl. 6): S51-6.
[http://dx.doi.org/10.1111/j.1528-1157.1999.tb00933.x] [PMID: 10530683]
[2]
Baron R. Post-herpetic neuralgia case study: optimizing pain control. Eur J Neurol 2004; 11(Suppl. 1): 3-11.
[http://dx.doi.org/10.1111/j.1471-0552.2004.00794.x] [PMID: 15061819]
[3]
Gan EY, Tian EA, Tey HL. Management of herpes zoster and post-herpetic neuralgia. Am J Clin Dermatol 2013; 14(2): 77-85.
[http://dx.doi.org/10.1007/s40257-013-0011-2] [PMID: 23456596]
[4]
Kost RG, Straus SE. Postherpetic neuralgia-pathogenesis, treatment, and prevention. N Engl J Med 1996; 335(1): 32-42.
[http://dx.doi.org/10.1056/NEJM199607043350107] [PMID: 8637540]
[5]
Dworkin RH, Schmader KE. Treatment and prevention of postherpetic neuralgia. Clin Infect Dis 2003; 36(7): 877-82.
[http://dx.doi.org/10.1086/368196] [PMID: 12652389]
[6]
Hadley GR, Gayle JA, Ripoll J, et al. Post-herpetic Neuralgia: a Review. Curr Pain Headache Rep 2016; 20(3): 17.
[http://dx.doi.org/10.1007/s11916-016-0548-x] [PMID: 26879875]
[7]
Dworkin RH, Perkins FM, Nagasako EM. Prospects for the prevention of postherpetic neuralgia in herpes zoster patients. Clin J Pain 2000; 16(2)(Suppl.): S90-S100.
[http://dx.doi.org/10.1097/00002508-200006001-00016] [PMID: 10870747]
[8]
Mallick-Searle T, Snodgrass B, Brant JM. Postherpetic neuralgia: epidemiology, pathophysiology, and pain management pharmacology. J Multidiscip Healthc 2016; 9: 447-54.
[http://dx.doi.org/10.2147/JMDH.S106340] [PMID: 27703368]
[9]
Dworkin RH, Portenoy RK. Pain and its persistence in herpes zoster. Pain 1996; 67(2-3): 241-51.
[http://dx.doi.org/10.1016/0304-3959(96)03122-3] [PMID: 8951917]
[10]
Weinberg JM. Herpes zoster: epidemiology, natural history, and common complications. J Am Acad Dermatol 2007; 57(6)(Suppl.): S130-5.
[http://dx.doi.org/10.1016/j.jaad.2007.08.046] [PMID: 18021864]
[11]
Watson PN. Postherpetic neuralgia. BMJ Clin Evid 2010; p. 0905.
[12]
Cappuzzo KA. Treatment of postherpetic neuralgia: focus on pregabalin. Clin Interv Aging 2009; 4: 17-23.
[PMID: 19503762]
[13]
Nicholson BD. Diagnosis and management of neuropathic pain: a balanced approach to treatment. J Am Acad Nurse Pract 2003; 15(12)(Suppl.): 3-9.
[PMID: 15055383]
[14]
Singh D, Kennedy DH. The use of gabapentin for the treatment of postherpetic neuralgia. Clin Ther 2003; 25(3): 852-89.
[http://dx.doi.org/10.1016/S0149-2918(03)80111-X] [PMID: 12852705]
[15]
Wareham DW. Postherpetic neuralgia. BMJ Clin Evid 2007; p. 0905.
[16]
Whitley RJ, Gnann JW. Herpes zoster: focus on treatment in older adults. Antiviral Res 1999; 44(3): 145-54.
[http://dx.doi.org/10.1016/S0166-3542(99)00064-9] [PMID: 10651066]
[17]
Meng FY, Zhang LC, Liu Y, et al. Efficacy and safety of gabapentin for treatment of postherpetic neuralgia: a meta-analysis of randomized controlled trials. Minerva Anestesiol 2014; 80(5): 556-67.
[PMID: 24257149]
[18]
Derry S, Sven-Rice A, Cole P, Tan T, Moore RA. Topical capsaicin (high concentration) for chronic neuropathic pain in adults. Cochrane Database Syst Rev 2013; 2013(2)CD007393
[http://dx.doi.org/10.1002/14651858.CD007393.pub3] [PMID: 23450576]
[19]
Backonja M-MMD, Serra JMD. Pharmacologic Management Part 1: Better-Studied Neuropathic Pain Diseases. Pain Med 2004; 5(Supplement)(1): S28-472.
[20]
Johnson RW, Rice ASC. Clinical practice. Postherpetic neuralgia. N Engl J Med 2014; 371(16): 1526-33.
[http://dx.doi.org/10.1056/NEJMcp1403062] [PMID: 25317872]
[21]
Thakur R, Philip AG. Chronic pain perspectives: Treating herpes zoster and postherpetic neuralgia: an evidence-based approach. J Fam Pract 2012; 61(9)(Suppl.): S9-S15.
[PMID: 23000670]
[22]
Makharita MY, Amr YM, El-Bayoumy Y. Single paravertebral injection for acute thoracic herpes zoster: a randomized controlled trial. Pain Pract 2015; 15(3): 229-35.
[http://dx.doi.org/10.1111/papr.12179] [PMID: 24528531]
[23]
Rose MA, Kam PC. Gabapentin: pharmacology and its use in pain management. Anaesthesia 2002; 57(5): 451-62.
[http://dx.doi.org/10.1046/j.0003-2409.2001.02399.x] [PMID: 11966555]
[24]
Frampton JE, Foster RH. Pregabalin: in the treatment of postherpetic neuralgia. Drugs 2005; 65(1): 111-8.
[http://dx.doi.org/10.2165/00003495-200565010-00011] [PMID: 15610058]
[25]
Bockbrader HN, Burger P, Knapp L, Corrigan BW. Population pharmacokinetics of pregabalin in healthy subjects and patients with chronic pain or partial seizures. Epilepsia 2011; 52(2): 248-57.
[http://dx.doi.org/10.1111/j.1528-1167.2010.02933.x] [PMID: 21269291]
[26]
Scheinfeld N. The role of gabapentin in treating diseases with cutaneous manifestations and pain. Int J Dermatol 2003; 42(6): 491-5.
[http://dx.doi.org/10.1046/j.1365-4362.2003.01831.x] [PMID: 12786883]
[27]
Dakin H, Nuijten M, Liedgens H, Nautrup BP. Cost-effectiveness of a lidocaine 5% medicated plaster relative to gabapentin for postherpetic neuralgia in the United Kingdom. Clin Ther 2007; 29(7): 1491-507.
[http://dx.doi.org/10.1016/j.clinthera.2007.07.006] [PMID: 17825701]
[28]
Attal N, Cruccu G, Haanpää M, et al. EFNS Task Force. EFNS guidelines on pharmacological treatment of neuropathic pain. Eur J Neurol 2006; 13(11): 1153-69.
[http://dx.doi.org/10.1111/j.1468-1331.2006.01511.x] [PMID: 17038030]
[29]
Han Y, Zhang J, Chen N, He L, Zhou M, Zhu C. Corticosteroids for preventing postherpetic neuralgia. Cochrane Database Syst Rev 2013; (3):
[http://dx.doi.org/10.1002/14651858.CD005582.pub4]
[30]
Chen N, Li Q, Yang J, Zhou M, Zhou D, He L. Antiviral treatment for preventing postherpetic neuralgia. Cochrane Database Syst Rev 2014; (2):
[http://dx.doi.org/10.1002/14651858.CD006866.pub3]
[31]
Brody T. Drug SafetyClinical Trials. Boston: Academic Press 2012; pp. 415-69.
[http://dx.doi.org/10.1016/B978-0-12-391911-3.00024-4]
[32]
Higgins J, Green S. Cochrane Handbook for Systematic Reviews of Interventions Version 510.
[33]
Schünemann H, Brożek J, Guyatt G, Oxman A, Eds. Handbook for grading the quality of evidence and the strength of recommendations using the GRADE approach. GRADE Working Group 2013.Available at: https://gdt.gradepro.org/app/handbook/handbook.html
[34]
Czumbel LM, Kerémi B, Gede N, et al. Sandblasting reduces dental implant failure rate but not marginal bone level loss: A systematic review and meta-analysis. PLoS One 2019; 14(5)e0216428
[http://dx.doi.org/10.1371/journal.pone.0216428] [PMID: 31050690]
[35]
Tóth B, Hegyi P, Lantos T, et al. The Efficacy of Saffron in the Treatment of Mild to Moderate Depression: A Meta-analysis. Planta Med 2019; 85(1): 24-31.
[http://dx.doi.org/10.1055/a-0660-9565] [PMID: 30036891]
[36]
Lapolla W, Digiorgio C, Haitz K, et al. Incidence of postherpetic neuralgia after combination treatment with gabapentin and valacyclovir in patients with acute herpes zoster: open-label study. Arch Dermatol 2011; 147(8): 901-7.
[http://dx.doi.org/10.1001/archdermatol.2011.81] [PMID: 21482862]
[37]
Migita T, Maekawa T, Okada K, Kobayashi M, Egi A. Can early administration of pregabalin reduce the incidence of postherpetic neuralgia? Eur J Anaesthesiol 2013; 30: 207.
[http://dx.doi.org/10.1097/00003643-201306001-00646]
[38]
Rullán M, Bulilete O, Leiva A, et al. PHN group. Efficacy of gabapentin for prevention of postherpetic neuralgia: study protocol for a randomized controlled clinical trial. Trials 2017; 18(1): 24.
[http://dx.doi.org/10.1186/s13063-016-1729-y] [PMID: 28088231]
[39]
Lee EG, Lee HJ, Hyun DJ, Min K, Kim DH, Yoon MS. Efficacy of low dose gabapentin in acute herpes zoster for preventing postherpetic neuralgia: a prospective controlled study. Dermatol Ther (Heidelb) 2016; 29(3): 184-90.
[http://dx.doi.org/10.1111/dth.12331] [PMID: 26799145]
[40]
Krcevski Skvarc N, Kamenik M. Effects of pregabalin on acute herpetic pain and postherpetic neuralgia incidence. Wien Klin Wochenschr 2010; 122(Suppl. 2): 49-53.
[http://dx.doi.org/10.1007/s00508-010-1345-x] [PMID: 20517672]
[41]
Wang Q, Cui W, Song T. The Effectiveness of Gabapentin for the Prevention of Postherpetic Neuralgia in Patients with Acute Herpes Zoster. J Pharmacol Sci 2013; 121: 194.
[42]
Varga G, Papp M, Hársing LG Jr, et al. Neuroeffector transmission of the hepatic and pancreatico-duodenal isolated arteries of the dog. Gastroenterology 1984; 87(5): 1056-63.
[http://dx.doi.org/10.1016/S0016-5085(84)80065-7] [PMID: 6090257]
[43]
Borbély Z, Csomó BK, Kittel Á, Gerber G, Varga G, Vizi ES. Effect of rat spinal cord injury (hemisection) on the ex vivo uptake and release of [3H]noradrenaline from a slice preparation. Brain Res Bull 2017; 131: 150-5.
[http://dx.doi.org/10.1016/j.brainresbull.2017.04.007] [PMID: 28434993]
[44]
Kordás KS, Sperlágh B, Tihanyi T, et al. ATP and ATPase secretion by exocrine pancreas in rat, guinea pig, and human. Pancreas 2004; 29(1): 53-60.
[http://dx.doi.org/10.1097/00006676-200407000-00056] [PMID: 15211112]
[45]
Lohinai Z, Burghardt B, Zelles T, Varga G. Nitric oxide modulates salivary amylase and fluid, but not epidermal growth factor secretion in conscious rats. Life Sci 1999; 64(11): 953-63.
[http://dx.doi.org/10.1016/S0024-3205(99)00021-1] [PMID: 10201644]
[46]
Lau BK, Vaughan CW. Descending modulation of pain: the GABA disinhibition hypothesis of analgesia. Curr Opin Neurobiol 2014; 29: 159-64.
[http://dx.doi.org/10.1016/j.conb.2014.07.010] [PMID: 25064178]
[47]
Varga G, Kisfalvi K, Pelosini I, D’Amato M, Scarpignato C. Different actions of CCK on pancreatic and gastric growth in the rat: effect of CCK(A) receptor blockade. Br J Pharmacol 1998; 124(3): 435-40.
[http://dx.doi.org/10.1038/sj.bjp.0701811] [PMID: 9647465]
[48]
Varga G, Campbell DR, Bussjaeger LJ, Solomon TE. Role of gastrin and cholecystokinin receptors in regulation of peptone-stimulated gastric acid secretion in conscious rats. Eur J Pharmacol 1993; 250(1): 37-42.
[http://dx.doi.org/10.1016/0014-2999(93)90618-R] [PMID: 8119323]
[49]
Burghardt B, Wenger C, Barabás K, et al. GRP-receptor-mediated signal transduction, gene expression and DNA synthesis in the human pancreatic adenocarcinoma cell line HPAF. Peptides 2001; 22(7): 1119-28.
[http://dx.doi.org/10.1016/S0196-9781(01)00433-8] [PMID: 11445243]
[50]
Kortezova N, Mizhorkova Z, Milusheva E, Varga G, Vizi ES, Papasova M. Non-adrenergic non-cholinergic neuron stimulation in the cat lower esophageal sphincter. Eur J Pharmacol 1996; 304(1-3): 109-15.
[http://dx.doi.org/10.1016/0014-2999(96)00093-3] [PMID: 8813591]
[51]
Kisfalvi I Jr, Burghardt B, Bálint A, Zelles T, Vizi ES, Varga G. Antisecretory effects of galanin and its putative antagonists M15, M35 and C7 in the rat stomach. J Physiol Paris 2000; 94(1): 37-42.
[http://dx.doi.org/10.1016/S0928-4257(99)00105-9] [PMID: 10761687]
[52]
Milusheva EA, Kortezova NI, Mizhorkova ZN, et al. Role of different bombesin receptor subtypes mediating contractile activity in cat upper gastrointestinal tract. Peptides 1998; 19(3): 549-56.
[http://dx.doi.org/10.1016/S0196-9781(97)00467-1] [PMID: 9533644]
[53]
Keremi B, Lohinai Z, Komora P, et al. Antiinflammatory effect of BPC 157 on experimental periodontitis in rats. J Physiol Pharmacol 2009; 60(Suppl. 7): 115-22.
[PMID: 20388954]
[54]
Argoff CE, Katz N, Backonja M. Treatment of postherpetic neuralgia: a review of therapeutic options. J Pain Symptom Manage 2004; 28(4): 396-411.
[http://dx.doi.org/10.1016/j.jpainsymman.2004.01.014] [PMID: 15471658]
[55]
Head H, Cambell AW. The pathology of herpes zoster and its bearing on sensory localisation. Brain 1900; 23(3): 353-62.
[http://dx.doi.org/10.1093/brain/23.3.353]
[56]
Woolf CJ, Max MB. Mechanism-based pain diagnosis: issues for analgesic drug development. Anesthesiology 2001; 95(1): 241-9.
[http://dx.doi.org/10.1097/00000542-200107000-00034] [PMID: 11465563]
[57]
Baron R, Binder A, Wasner G. Neuropathic pain: diagnosis, pathophysiological mechanisms, and treatment. Lancet Neurol 2010; 9(8): 807-19.
[http://dx.doi.org/10.1016/S1474-4422(10)70143-5] [PMID: 20650402]
[58]
Garry EM, Delaney A, Anderson HA, et al. Varicella zoster virus induces neuropathic changes in rat dorsal root ganglia and behavioral reflex sensitisation that is attenuated by gabapentin or sodium channel blocking drugs. Pain 2005; 118(1-2): 97-111.
[http://dx.doi.org/10.1016/j.pain.2005.08.003] [PMID: 16213091]
[59]
Irving G, Jensen M, Cramer M, et al. Efficacy and tolerability of gastric-retentive gabapentin for the treatment of postherpetic neuralgia: results of a double-blind, randomized, placebo-controlled clinical trial. Clin J Pain 2009; 25(3): 185-92.
[http://dx.doi.org/10.1097/AJP.0b013e3181934276] [PMID: 19333167]
[60]
Wallace MS, Irving G, Cowles VE. Gabapentin extended-release tablets for the treatment of patients with postherpetic neuralgia: a randomized, double-blind, placebo-controlled, multicentre study. Clin Drug Investig 2010; 30(11): 765-76.
[http://dx.doi.org/10.2165/11539520-000000000-00000] [PMID: 20818838]
[61]
Rauck RL, Irving GA, Wallace MS, Vanhove GF, Sweeney M. Once-daily gastroretentive gabapentin for postherpetic neuralgia: integrated efficacy, time to onset of pain relief and safety analyses of data from two phase 3, multicenter, randomized, double-blind, placebo-controlled studies. J Pain Symptom Manage 2013; 46(2): 219-28.
[http://dx.doi.org/10.1016/j.jpainsymman.2012.07.011] [PMID: 23149085]
[62]
Rowbotham M, Harden N, Stacey B, Bernstein P, Magnus-Miller L. Gabapentin for the treatment of postherpetic neuralgia: a randomized controlled trial. JAMA 1998; 280(21): 1837-42.
[http://dx.doi.org/10.1001/jama.280.21.1837] [PMID: 9846778]
[63]
Rice AS, Maton S. Postherpetic Neuralgia Study Group. Gabapentin in postherpetic neuralgia: a randomised, double blind, placebo controlled study. Pain 2001; 94(2): 215-24.
[http://dx.doi.org/10.1016/S0304-3959(01)00407-9] [PMID: 11690735]
[64]
Backonja M, Glanzman RL. Gabapentin dosing for neuropathic pain: evidence from randomized, placebo-controlled clinical trials. Clin Ther 2003; 25(1): 81-104.
[http://dx.doi.org/10.1016/S0149-2918(03)90011-7] [PMID: 12637113]
[65]
Freynhagen R, Strojek K, Griesing T, Whalen E, Balkenohl M. Efficacy of pregabalin in neuropathic pain evaluated in a 12-week, randomised, double-blind, multicentre, placebo-controlled trial of flexible- and fixed-dose regimens. Pain 2005; 115(3): 254-63.
[http://dx.doi.org/10.1016/j.pain.2005.02.032] [PMID: 15911152]
[66]
van Seventer R, Feister HA, Young JP Jr, Stoker M, Versavel M, Rigaudy L. Efficacy and tolerability of twice-daily pregabalin for treating pain and related sleep interference in postherpetic neuralgia: a 13-week, randomized trial. Curr Med Res Opin 2006; 22(2): 375-84.
[http://dx.doi.org/10.1185/030079906X80404] [PMID: 16466610]
[67]
Sabatowski R, Gálvez R, Cherry DA, et al. 1008-045 Study Group. Pregabalin reduces pain and improves sleep and mood disturbances in patients with post-herpetic neuralgia: results of a randomised, placebo-controlled clinical trial. Pain 2004; 109(1-2): 26-35.
[http://dx.doi.org/10.1016/j.pain.2004.01.001] [PMID: 15082123]
[68]
Jensen-Dahm C, Rowbotham MC, Reda H, Petersen KL. Effect of a single dose of pregabalin on herpes zoster pain. Trials 2011; 12: 55.
[http://dx.doi.org/10.1186/1745-6215-12-55] [PMID: 21356040]
[69]
Achar A, Chakraborty PP, Bisai S, Biswas A, Guharay T. Comparative study of clinical efficacy of amitriptyline and pregabalin in postherpetic neuralgia. Acta Dermatovenerol Croat 2012; 20(2): 89-94.
[PMID: 22726281]
[70]
Dworkin RH, Barbano RL, Tyring SK, et al. A randomized, placebo-controlled trial of oxycodone and of gabapentin for acute pain in herpes zoster. Pain 2009; 142(3): 209-17.
[http://dx.doi.org/10.1016/j.pain.2008.12.022] [PMID: 19195785]
[71]
Parsons B, Tive L, Huang S. Gabapentin: a pooled analysis of adverse events from three clinical trials in patients with postherpetic neuralgia. Am J Geriatr Pharmacother 2004; 2(3): 157-62.
[http://dx.doi.org/10.1016/j.amjopharm.2004.09.004] [PMID: 15561647]
[72]
Quintero GC. Review about gabapentin misuse, interactions, contraindications and side effects. J Exp Pharmacol 2017; 9: 13-21.
[http://dx.doi.org/10.2147/JEP.S124391] [PMID: 28223849]
[73]
Zhang M, Gao C-X, Ma K-T, et al. A Meta-Analysis of Therapeutic Efficacy and Safety of Gabapentin in the Treatment of Postherpetic Neuralgia from Randomized Controlled Trials. BioMed Res Int 2018; 20187474207
[http://dx.doi.org/10.1155/2018/7474207] [PMID: 30069477]
[74]
Zaccara G, Gangemi P, Perucca P, Specchio L. The adverse event profile of pregabalin: a systematic review and meta-analysis of randomized controlled trials. Epilepsia 2011; 52(4): 826-36.
[http://dx.doi.org/10.1111/j.1528-1167.2010.02966.x] [PMID: 21320112]


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VOLUME: 26
ISSUE: 25
Year: 2020
Page: [3026 - 3038]
Pages: 13
DOI: 10.2174/1381612826666200605120242

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