Randomised clinical trial: pregabalin attenuates experimental visceral pain through sub-cortical mechanisms in patients with painful chronic pancreatitis

Authors

  • S. S. Olesen,

    1. Mech-Sense, Department of Gastroenterology, Aalborg Hospital, Aarhus University Hospital, Denmark.
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  • C. Graversen,

    1. Mech-Sense, Department of Gastroenterology, Aalborg Hospital, Aarhus University Hospital, Denmark.
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  • A. E. Olesen,

    1. Mech-Sense, Department of Gastroenterology, Aalborg Hospital, Aarhus University Hospital, Denmark.
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  • J. B. Frøkjær,

    1. Mech-Sense, Department of Gastroenterology, Aalborg Hospital, Aarhus University Hospital, Denmark.
    2. Department of Radiology, Aalborg Hospital, Aarhus University Hospital, Denmark.
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  • O. Wilder-Smith,

    1. Pain and Nociception Neuroscience Research Group, Department of Anesthesiology, Pain and Palliative Medicine, Radboud University Nijmegen Medical Centre, The Netherlands.
    2. Center for Sensory-Motor Interactions (SMI), Department of Health Science and Technology, Aalborg University, Denmark.
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  • H. van Goor,

    1. Pain and Nociception Neuroscience Research Group, Department of Surgery, Radboud University Nijmegen Medical Center, The Netherlands.
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  • M. Valeriani,

    1. Center for Sensory-Motor Interactions (SMI), Department of Health Science and Technology, Aalborg University, Denmark.
    2. Division of Neurology, Ospedale Pediatrico Bambino Gesù, IRCCS, Rome, Italy.
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  • A. M. Drewes

    1. Mech-Sense, Department of Gastroenterology, Aalborg Hospital, Aarhus University Hospital, Denmark.
    2. Center for Sensory-Motor Interactions (SMI), Department of Health Science and Technology, Aalborg University, Denmark.
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Dr S. S. Olesen, Mech-Sense, Department of Gastroenterology and Hepatology, Aalborg Hospital, Aarhus University Hospital, Mølleparkvej 4, 9000 Aalborg, Denmark.
E-mail: sso@mech-sense.com

Abstract

Aliment Pharmacol Ther 2011; 34: 878–887

Summary

Background  Pregabalin has a broad spectrum of analgesic and antihyperalgesic activity in both basic and clinical studies. However, its mechanisms and sites of action have yet to be determined in humans.

Aims  To assess the antinociceptive effect of pregabalin on experimental gut pain in patients with visceral hyperalgesia due to chronic pancreatitis and to reveal putative changes in corresponding central pain processing as assessed by evoked brain potentials.

Methods  Thirty-one patients were randomly assigned to receive increasing doses of pregabalin or placebo for three consecutive weeks. Perceptual thresholds to electrical stimulation of the sigmoid with recording of corresponding evoked brain potentials were obtained at baseline and study end. The brain source localisations reflecting direct neuronal activity were fitted by a five-dipole model projected to magnetic resonance imaging of the individuals’ brains.

Results  As compared to placebo, pregabalin significantly increased the pain threshold to electrical gut stimulation from baseline (= 0.02). No differences in evoked brain potential characteristics were seen, neither after pregabalin nor placebo treatment (all > 0.05). In agreement with this, brain source locations remained stable during study treatment (all > 0.05).

Conclusion  Pregabalin was superior to placebo for attenuation of experimental visceral pain in chronic pancreatitis patients. We suggest its antinociceptive effects to be mediated primarily through sub-cortical mechanisms. (ClinicalTrials.gov, number NCT 00755573).

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