The combination of gabapentin and morphine appears to be an effective treatment for neuropathic pain. These results were published in The New England Journal of Medicine.
Historically, neuropathic pain has been difficult to treat due to dose-limiting side effects, and medications available for the treatment of neuropathic pain are not effective. A recent study compared the drugs morphine and gabapentin, as well as a combination of the two drugs for the treatment of patients with painful diabetic neuropathy or post herpetic neuralgia.
Researchers enrolled 57 patients in this randomized, double blind, controlled trial. Of the 57 patients, 35 suffered with diabetic neuropathy, and 22 with post-herpetic neuralgia. Participants received daily doses of one of the following medication regimens: sustained release morphine, gabapentin, a combination of gabapentin and morphine or an active placebo (lorazepam) for a total of 5 weeks. The researchers compared the patients’ average daily pain intensity after receiving the maximum tolerated dose for each treatment group. Also evaluated were side effects, mood quality of life, overall pain based on a 0-10 scale (10 being the greatest amount of pain), and maximum tolerated doses.
Results of the study revealed that only 41 patients completed the trial. The average daily pain experienced at the maximum tolerated dose at beginning of trial was 5.72, 4.49 among the placebo treated group, 4.15 with gabapentin, 3.70 with the morphine treatment, and 3.06 among the gabapentin/morphine combination group.
Patients who received the combination were not able to tolerate the highest doses. Side effects at the highest doses included constipation and dry mouth. These were more frequent among the patients who received gabapentin/morphine compared to patients treated with gabapentin or morphine alone. Sedation was also reported as a frequent side effect of treatment.
Overall, the combination of gabapentin and morphine produced better pain relief at lower doses than either of the drugs as a single agent, despite the side effects of constipation, dry mouth and sedation.
Reference: Gilron I, Bailey J, Tu D, et al. Morphine, Gabapentin or Their Combination for Neuropathic Pain. New England Journal of Medicine. 2005; 352:1324-1334.
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