The Efficacy And Safety Of Pregabalin In The Treatment Of Central Post-stroke Pain: A Meta-analysis

Objective:We aimed to conduct a meta-analysis to evaluate the efficacy and safety of pregabalin(PGB)in the treatment of central post-stroke pain(CPSP).Methods:We conducted a comprehensive literature review of the CBM,CNKI database,Wanfang database,VIP Chinese Journal Database,PubMed,Embase,Web of Science and Cochrane Library from inception to February 2020.We identified randomized controlled trials(RCTs)according to the inclusion and exclusion criteria.Two authors independently assessed the quality of the selected studies and extracted the data using data extraction forms.Statistical analysis was performed using Review Manager 5.3 by the Cochrane collaboration.Results:A total of 1036 patients were enrolled in 13 articles that described 15 studies,including 488 in the experimental group and 548 in the control group.The quality assessment of included studies,11 were of medium quality and 4 were of high quality.The mean changes in the NRS score : comparison of PGB with gabapentin,SMD=-1.81,95%CI[-2.59,-1.03],P<0.00001;comparison of PGB with carbamazepine,SMD=-2.38,95%CI[-3.35,-1.42],P<0.00001.The mean change in the VAS score:comparison of PGB with carbamazepine,SMD=-1.16,95%CI[-2.11,-0.21],P=0.02.The mean change in the HAMD-17 score:comparison of PGB with gabapentin,SMD=-1.17,95%CI[-1.41,-0.93],P<0.00001.The mean change in the HAMA score:comparison of PGB with gabapentin,SMD=-1.25,95%CI[-1.55,-0.94],P<0.00001.The total effective rate:comparison of PGB with gabapentin,RR=1.14,95%CI[0.96,1.36],P=0.14;comparison of PGB with carbamazepine,RR=1.30,95%CI[1.15,1.47],P<0.0001.Dizziness rate:comparison of PGB with gabapentin,RR=0.69,95%CI[0.43,1.12],P=0.14;comparison of PGB with carbamazepine,RR=0.47,95%CI[0.31,0.73],P=0.0007;comparison of PGB with lamotrigine,RR=0.50,95%CI[0.26,0.98],P=0.04.Somnolence rate:comparison of PGB with gabapentin,RR=0.66,95%CI[0.38,1.15],P=0.14;comparison of PGB with carbamazepine,RR=0.38,95%CI[0.21,0.68],P=0.001;comparison of PGB with lamotrigine,RR=0.46,95%CI[0.25,0.86],P=0.01.Dry mouth rate:comparison of PGB with gabapentin,RR=0.55,95%CI[0.19,1.58],P=0.27;comparison of PGB with carbamazepine,RR=0.25,95%CI[0.12,0.52],P=0.0002.Ataxia rate:comparison of PGB with gabapentin,RR=0.33,95%CI[0.09,1.18],P=0.09;comparison of PGB with carbamazepine,RR=0.20,95%CI[0.04,1.11],P=0.06.Edema peripheral rate:comparison of PGB with gabapentin,RR=0.52,95%CI[0.19,1.39],P=0.19;comparison of PGB with lamotrigine,RR=0.25,95%CI[0.07,0.85],P=0.03.Blurred vision rate:comparison of PGB with gabapentin,RR=0.98,95%CI[0.20,4.74],P=0.98.Conclusions:Compared with gabapentin,PGB is better than gabapentin in reducing the degree of pain,relieving depression and anxiety,but the total effective rate in clinical treatment and the incidence of dizziness,somnolence,dry mouth,ataxia,edema peripheral and blurred vision in the adverse events is similar.Compared with carbamazepine,PGB is better than carbamazepine in reducing the degree of pain,in the clinical efficacy of the total effective rate is higher than carbamazepine,the incidence of dizziness,somnolence and dry mouth is lower than carbamazepine,the incidence of ataxia is similar.Compared with lamotrigine,the incidence of dizziness,somnolence and edema peripheral in the adverse events of PGB is lower than lamotrigine.