Brazilian Journal of Anesthesiology
https://bjan-sba.org/article/doi/10.1016/j.bjane.2018.08.002
Brazilian Journal of Anesthesiology
Scientific Article

Effect of melatonin on the daytime sleepiness side-effect of gabapentin in adults patients with neuropathic pain

Efeito da melatonina sobre o efeito colateral de sonolência diurna da gabapentina em pacientes adultos com dor neuropática

Basak Altiparmak; Hemra Cil; Nalan Celebi

http://dx.doi.org/10.1016/j.bjane.2018.08.002 Braz J Anesthesiol, vol.69, n2, p.137-143, 2019
PDF English
PDF Português
Downloads: 0
Views: 889

Abstract

Abstract Background and objectives: Gabapentin is an antiepileptic drug. Widely used for the management of neuropathic pain. Although it is known to be well tolerated, somnolence and dizziness are the most frequent adverse effects. In this study, we aimed to evaluate the effect of melatonin on daytime sleepiness side effect of gabapentin, sleep quality and pain intensity of patients with neuropathic pain. Methods: Patients suffering from "neuropathic pain" and planed to receive gabapentin therapy were randomly divided into two groups. Group 1 received melatonin 3 mg and gabapentin 900 mg orally, group 2 received matching placebo capsule and gabapentin 900 mg. The Epworth Sleepiness Scale, the Pittsburgh sleep quality index for assessment of sleep quality and Verbal Rating Scale were completed at the 0th, 10th and 30th days of treatment. Additive analgesic drug requirements were recorded. Results: Eighty patients were enrolled to the study; age, gender, ratio of additive analgesic consumption, baseline Epworth Sleepiness Scale, Pittsburg Sleep Quality index and Verbal Rating Scale scores were similar between the groups. Epworth Sleepiness Scale scores, Pittsburgh sleep quality index scores and Verbal Rating Scale scores in Group 1 were significantly lower than group 2 at the 10th day of treatment (p = 0.002, p = 0.003, p = 0.002 respectively). At the 30th day of treatment, Epworth Sleepiness Scale scores and Verbal Rating Scale scores were significantly lower in Group 1 (p = 0.002, p = 0.008 respectively). However, Pittsburgh sleep quality index scores did not significantly differ between the groups (p = 0.0566). Conclusions: Melatonin supplementation rapidly and significantly improved daytime sleepiness side-effect of gabapentin, however sleep quality of the patients with neuropathic pain was similar between groups.

Keywords

Gabapentin, Melatonin, Neuropathic pain, Sleep

Resumo

Resumo Justificativa e objetivos: Gabapentina é um agente antiepiléptico, amplamente utilizado para o tratamento da dor neuropática. Embora conhecida por ser bem-tolerada, sonolência e tontura são os seus efeitos adversos mais frequentes. Neste estudo, nosso objetivo foi avaliar o efeito da melatonina sobre o efeito colateral de sonolência diurna da gabapentina, a qualidade do sono e a intensidade da dor em pacientes com dor neuropática. Métodos: Os pacientes que sofriam de "dor neuropática" e com prescrição para receber terapia com gabapentina foram divididos aleatoriamente em dois grupos. O Grupo 1 recebeu 3 mg de melatonina e 900 mg de gabapentina por via oral, o Grupo 2 recebeu uma cápsula de placebo correspondente e 900 mg de gabapentina. A escala de sonolência de Epworth (ESS), o índice de qualidade do sono de Pittsburgh para avaliação da qualidade do sono (PSQI) e a escala de avaliação verbal (VRS) foram aplicados nos dias 0, 10 e 30 de tratamento. A necessidade de medicamentos analgésicos adicionais foi registrada. Resultados: Oitenta pacientes foram incluídos no estudo; idade, sexo, quantidade de analgésico adicional consumida e os escores basais de ESS, PSQI e VRS foram semelhantes entre os grupos. Os escores ESS, PSQI e VRS do Grupo 1 foram significativamente menores que os do Grupo 2 no décimo dia de tratamento (p = 0,002, p = 0,003, p = 0,002, respectivamente). No trigésimo dia de tratamento, os escores ESS e VRS foram significativamente menores no Grupo 1 (p = 0,002, p = 0,008, respectivamente). No entanto, os escores PSQI não diferiram significativamente entre os grupos (p = 0,0566). Conclusões: A suplementação de melatonina melhorou de forma rápida e significativa o efeito colateral de sonolência diurna da gabapentina, mas a qualidade do sono dos pacientes com dor neuropática foi semelhante entre os grupos.

Palavras-chave

Gabapentina, Melatonina, Dor neuropática, Sono

References

Jensen TS, Baron R, Haanpaa M. A new definition of neuropathic pain. Pain. 2011;152:2204-5.

Wiffen PJ, Derry S, Bell RF. Gabapentin for chronic neuropathic pain in adults. Cochrane Database Syst Rev. 2017;6:CD007938.

Blackburn-Munro G, Blackburn-Munro RE. Chronic pain, chronic stress and depression: coincidence or consequence?. J Neuroendocinol. 2001;13:1009-23.

Castro CM, Lee KA, Bliwise DL. Sleep patterns and sleep-related factors between caregiving and non-caregiving women. Behav Sleep Med. 2009;7:164-79.

Finnerup NB, Sindrup SH, Jensen TS. The evidence for pharmacological treatment of neuropathic pain. Pain. 2010;150:573-81.

Chadwick D. The evidence for pharmacological treatment of neuropathic pain. Lancet. 1994;343:89-91.

Claustrat B, Brun J, Chazot G. The basic physiology and pathophysiology of melatonin. Sleep Med. 2005;9:11-24.

Rahman SA, Kayumov L, Shapiro CM. Antidepressant action of melatonin in the treatment of delayed sleep phase syndrome. Sleep Med. 2010;11:131-6.

Srinivasan V, Pandi-Perumal SR, Spence DW. Potential use of melatonergic drugs in analgesia: mechanisms of action. Brain Res Bull. 2010;81:362-71.

Seabra ML, Bignotto M, Pinto LR. Randomized, double-blind clinical trial, controlled with placebo, of the toxicology of chronic melatonin treatment. J Pineal Res. 2000;29:193-200.

Hussain SA, Al-Khalifa II, Jasim NA. Adjuvant use of melatonin for treatment of fibromyalgia. J Pineal Res. 2011;50:267-71.

Gitto E, Romeo C, Reiter RJ. Melatonin reduces oxidative stress in surgical neonates. J Pediatr Surg. 2004;39:184-9.

Izci B, Ardic S, Firat H. Reliability and validity studies of the Turkish version of the Epworth Sleepiness Scale. Sleep Breath. 2008;12:161-8.

Aslan O, Sanisoglu Y, Akyol M. Subjective sleep quality of cancer patients. J BUON. 2010;15:708-14.

O'Connor AB. Neuropathic pain: quality-of-life impact, costs and cost effectiveness of therapy. Pharmacoeconomics. 2009;27:95-112.

Argoff CE. The coexistence of neuropathic pain, sleep, and psychiatric disorders: a novel treatment approach. Clin J Pain. 2007;23:15-22.

Biyik Z, Solak Y, Atalay H. Gabapentin versus pregabalin in improving sleep quality and depression in hemodialysis patients with peripheral neuropathy: a randomized prospective crossover trial. Int Urol Nephrol. 2013;45:831-7.

Narita M, Niikura K, Nanjo-Niikura K. Sleep disturbances in a neuropathic pain-like condition in the mouse are associated with altered GABAergic transmission in the cingulate cortex. Pain. 2011;152:1358-72.

Roth T, van Seventer R, Murphy TK. The effect of pregabalin on pain-related sleep interference in diabetic peripheral neuropathy or postherpetic neuralgia: a review of nine clinical trials. Curr Med Res Opin. 2010;26:2411-9.

Melikoglu MA, Celik A. Does neuropathic pain affect the quality of sleep?. Eurasian J Med. 2017;49:40-3.

Gringras P, Nir T, Breddy J. Efficacy and safety of pediatric prolonged-release melatonin for insomnia in children with autism spectrum disorder. J Am Acad Child Adolesc Psychiatry. 2017;56:948-57.

Scheer FA, Morris CJ, Garcia JI. Repeated melatonin supplementation improves sleep in hypertensive patients treated with beta-blockers: a randomized controlled trial. Sleep. 2012;35:1395-402.

Beydoun A, Uthman BM, Sackellares JC. Gabapentin: pharmacokinetics, efficacy, and safety. Clin Neuropharmacol. 1995;18:469-81.

Zhang W, Chen XY, Su SW. Exogenous melatonin for sleep disorders in neurodegenerative diseases: a meta-analysis of randomized clinical trials. Neurol Sci. 2016;37:57-65.

Borsani E, Buffoli B, Bonazze V. Single administration of melatonin modulates the nitroxidergic system at the peripheral level and reduces thermal nociceptive hypersensitivity in neuropathic rats. Int J Mol Sci. 2017;18:2143-60.

Wang YS, Li YY, Cui W. Melatonin Attenuates Pain Hypersensitivity and decreases astrocyte-mediated spinal neuroinflammation in a rat model of oxaliplatin-induced pain. Inflammation. 2017;40:2052-61.

Bourne RS, Mills GH, Minelli C. Melatonin therapy to improve nocturnal sleep in critically ill patients: encouraging results from a small randomised controlled trial. Crit Care. 2008;12:R52.

Wade A, Downie S. Prolonged release melatonin in the treatment of primary insomnia: evaluation of the age cut-off for short- and long-term response. Curr Med Res Opin. 2011;17:1567-72.

Liu J, Zhong R, Xiong W. Melatonin increases reactive aggression in humans. Psychopharmacology (Berl). 2017;234:2971-8.

Ulugol A, Dokmeci D, Guray G. Antihyperalgesic, but not antiallodynic, effect of melatonin in nerve-injured neuropathic mice: Possible involvements of the L-arginine-NO pathway and opioid system. Life Sci. 2006;78:1592-7.

5dcb02760e8825325003b87b rba Articles
Links & Downloads
2352-2291 (Electronic) 0104-0014 (Printed)
Braz J Anesthesiol ©2024 All rights reserved.

Braz J Anesthesiol

Share this page
Page Sections