Randomized Double-Blind Trial of Pregabalin Versus Placebo in Conjunction with Palliative Radiotherapy for Cancer-Induced Bone Pain

Randomized Double-Blind Trial of Pregabalin Versus Placebo in Conjunction with Palliative Radiotherapy for Cancer-Induced Bone Pain
Fallon, M, (2016) Journal of Clinical Oncology (Link to abstract)

 

Pregabalin is a Calcium-channel blocker which is used for neuropathic pain treatment. This RCT in adults compared pregabalin vs placebo in the treatment of bone pain. Patients were also allowed to receive palliative radiotherapy. All patients were adults and most had breast, lung, or prostate cancer. All patients had at least 4/10 bone pain at the time of enrollment. A total of 233 patients were randomly allocated and although there were withdrawals in each arm, an intention-to-treat analysis was used. There was no difference between the groups in time to decreased pain scores, lower pain overall, lower opioid requirement, or in functional ability.


* This is a well designed trial that strongly argues against using pregabalin to treat pain related to bone metastases. It is mostly in adult patients with carcinoma but unless there is a model showing that the pathophysiology of cancer bone pain is different in sarcomas, embryonal tumors, or hematological malignancies there is not a strong argument to redo this expensive trial in children nor to use pregabalin for this indication.