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Audit into the effectiveness of gabapentin in multiple sclerosis pain

Nikki Embrey, MS specialist nurse, North Staffordshire NHS Hospital Trust
Claire Lowndes, MS specialist nurse, North Staffordshire NHS Hospital Trust

Way Ahead 2002;6(1):6-7

Abstract

Gabapentin is increasingly used to treat neuropathic pain in MS and is a well tolerated medication. Previous studies however have been small. We report an audit of the use of gabapentin managed by MS specialist nurses in a larger population of 50 patients

The most common dose was 900mg/day and 86% of patients reported significant benefit in symptom control, compared with 68% in the previous largest study of 25 patients.

We conclude firstly that gabapentin is highly effective in controlling neuropathic pain in MS patients and secondly that MS specialist nurses are a valuable resource in the management of pain in this group.

Introduction

Pain is experienced by 30-65% of people with MS and a variety of pain syndromes are described (1). The specialist nurse will see many patients who describe various types of painful sensations, the most common being neuropathic in nature. Pain associated with MS may be severe and can have multiple causes (2). The MS nurse will ensure appropriate assessment tools are used, implemented and evaluated in the clinical environment in order to provide best practice in the management of MS related pain.

Types of pain described
Type of pain %
Hypersensitivity/parathesias 30
Shooting/stabbing/burning 25
Aching 20
Numbness 14
Cramps 9
Other 2

Neuropathic pain can often profoundly affect a patient's mood, personality and social relationships. People with persistent pain typically experience concomitant depression, sleep disturbance, fatigue and decreased overall physical functioning (3). The role of the MS specialist nurse incorporates provision of information and the promotion of confidence in managing MS related symptoms (4).

Two previous studies highlighted the effects of gabapentin. Houtchens et al (5) found that 68% of patients reported excellent/moderate pain relief in acute and chronic pain syndromes associated with MS. Solero et al (6) found that 78% of patients treated with gabapentin had partial/total resolution of symptoms.

Aims of study

To assess whether gabapentin is as effective in managing pain relief in the authors' local population compared to the Houtchens et al (5) study.

Objectives

  • 1. Explore the types of pain for which gabapentin is reported to be effective.
  • 2. Observe the doses required to adequately control pain.
  • 3. State any side effects experienced.

Design

A retrospective study reviewing patients with MS to audit the effectiveness of gabapentin in relieving pain.

A postal questionnaire was sent to a convenience sample of 50 people with MS who were on gabapentin under the care of the MS specialist nurses at the North Staffordshire Hospital Trust. A 70% response rate was attained and results are detailed below.

Results

  • Gabapentin was effective in controlling 86% of pain in this cohort compared to 68% in the published literature.
  • It was found to be well tolerated by most patients with few side effects.
  • 100% of patients implied they were taking gabapentin for pain. 42% also said it helped with spasms and 33% felt it relieved stiffness.
  • From this study it was found that gabapentin is effective in controlling hypersensitivity and paraesthesia, shooting, stabbing, burning, numbness, aching and cramp type pain in MS.
  • The most common dose of gabapentin in the study was 900mg (12 patients).
  • The mean/average dose in this study was 1,039.4mg per patient per day.
  • Most patients tolerated gabapentin with very few or no side effects (94%).
  • Two patients discontinued treatment due to side effects - dizziness and fatigue.
Effective dose of gabapentin
Dose (mg) No of pts
600 6
900 12
1200 5
1600 4
1800 3
2100 1
2400 1
3600 1

Patient comments

"I have no side effects from taking gabapentin and am thankful that there is at least one way to stop hurting"

"This medication is far more effective in managing symptoms"

"This drug has helped considerably, but the dose has had to be increased"

"The pins and needles have subsided quite a lot since commencing the gabapentin"

Discussion

Gabapentin was found to be effective in controlling pain in 86% of patients and well tolerated.

The nurse specialists have previously used other medications, for example antidepressants and other anti-epilepsy medication, with some effect. However side effects can sometimes be troublesome and will often prevent the patient from being compliant with the medication. Many of the side effects of other drugs will worsen the MS patients' symptoms and can lead to fatigue which is often disabling. The effect of gabapentin was shown in this small cohort of patients to be without intolerable side effects and was in many cases felt to be more beneficial than previously tried medications.

Recommendations

  • Gabapentin is an effective, well-tolerated therapy in the control of MS pain. Further studies need to be carried out in MS patients.
  • It is recommended that written patient information sheets be provided prior to initiation of therapy. This will empower the patient to self manage their MS pain.
  • MS specialist nurses are providing best practice in recommending that patients observe the benefits this treatment has to offer.

References

  • 1. Barnes D. Multiple sclerosis questions and answers. Basingstoke:Merit Publishing International;2000.
  • 2. Maloni H, Schapiro RT. Pain. In: van den Noort S, Holland NJ. Multiple sclerosis in clinical practice. New York:Demos;1999. p.57-66.
  • 3. Ashburn MA, Staats PS. Management of chronic pain. Lancet 1999;353(9167):1865-9.
  • 4. UKMSSNA, Royal College of Nursing, MS Research Trust. Specialist nursing in MS - the way forward - the key elements for developing MS specialist nurse services in the UK. Letchworth:MS Research Trust;2001
  • 5. Houtchens MK, Richert JR, et al. Open label gabapentin treatment for pain in multiple sclerosis. Mult Scler 1997;3(4):250-3.
  • 6. Solaro C, Lunardi GL, et al. An open-label trial of gabapentin treatment of paroxysmal symptoms in multiple sclerosis patients. Neurology 1998;51(2):609-11.

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