The management of acute, radiotherapy-related nociceptive and neuropathic pain in patients undergoing radiotherapy for head and neck cancers remains an ongoing challenge. Pregabalin, an anticonvulsant drug, has been shown to be efficacious in treating various chronic neuropathic pain conditions. In this randomized controlled trial, investigators randomized 128 patients treated with radiotherapy for head and neck cancer to receive either pregabalin or placebo in order to examine the effect of pregabalin on weekly mean pain intensity. During the study, 35.9% of participants received a maximum daily pregabalin dose of 300 mg, 34.4% received a maximum dose of 450 mg, and 29.7% received a maximum dose of 600 mg. Investigators found that after 16 weeks, 29.7% of patients in the pregabalin group achieved pain relief of 50% or greater, as measured using the 11-point numeric rating scale (NRS), compared to 7.8% for placebo (absolute rate difference 21.88%, 95% CI 7.33% to 36.42%, p=0.003). In the pregabalin group, 59.4% of responders also experienced a pain intensity reduction of 30% or greater at week 16 compared to 32.8% of those in the placebo group (absolute rate difference 26.56%, 95% CI 8.35% to 44.77%, p=0.006). In terms of safety and tolerability, 54.7% of patients in the pregabalin and 45.3% of patients in the placebo group experienced at least one adverse event (p=0.29); adverse events included dizziness and somnolence, which were more common in the pregabalin group (6.3% versus 4.7%), though not statistically significant. The results from this study therefore indicate that pregabalin can be used to reduce pain intensity in patients undergoing radiotherapy for head and neck cancers. This study was limited in that more than half of patients included in this study had nasopharyngeal carcinoma, making generalizability of results difficult without larger, more diverse sample size studies.
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