The Effect of Pregabalin and Metformin on Subacute and Chronic Radiculopathy

Document Type : Original Article


Department of Neurology, Faculty of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran


Background: Radicular pain is one of the most common forms of chronic pain in the world, which has challenges about effective medical therapy. The aim of this study was to evaluate the effect of pregabalin (PGB) and metformin (Met) on subacute and chronic radiculopathy. Materials and Methods: This double-blind prospective clinical trial was performed on 71 patients with subacute and chronic cervical and lumbosacral radiculopathy. Group A was treated with PGB 75 mg daily while Group B was treated with PGB 75 mg daily and Met 500 mg daily for 3 months. Finally, the pain score in both groups was evaluated based on visual analog scale (VAS) and numerical scale pain. Results: The results showed a significant reduction in VAS and pain severity in both groups but this reduction in the terms of VAS (47.79% vs. 46.48%, P = 0.125) and pain severity (47.1% vs. 39.2%, P = 0.264) was more in treated patients with PGB and Met as compared to PGB group while total pain experience (53.5% vs. 49.1%, P = 0.464) and interference with daily function (57.1% vs. 50.61%, P = 0.726) were more in patients treated with PGB alone. Conclusion: Our results showed that PGB and PGB + Met reduced pain intensity and interference with daily function while we did not observe significant differences between two groups. PGB alone would have the potentiality to become a simple and economic means to decrease radicular pain.


Furlan AD, Giraldo M, Baskwill A, Irvin E, Imamura M. Massage for low-back pain. Cochrane Database Syst Rev 2015;(9):CD001929.  Back to cited text no. 1
Anderson DG, Tannoury C. Molecular pathogenic factors in symptomatic disc degeneration. Spine J 2005;5 6 Suppl: 260S-6S.  Back to cited text no. 2
Jarvik JG, Hollingworth W, Heagerty PJ, Haynor DR, Boyko EJ, Deyo RA. Three-year incidence of low back pain in an initially asymptomatic cohort: Clinical and imaging risk factors. Spine (Phila Pa 1976) 2005;30:1541-8.  Back to cited text no. 3
Pinto RZ, Maher CG, Ferreira ML, Ferreira PH, Hancock M, Oliveira VC, et al. Drugs for relief of pain in patients with sciatica: Systematic review and meta-analysis. BMJ 2012;344:e497.  Back to cited text no. 4
Nightingale S. The neuropathic pain market. Nat Rev Drug Discov 2012;11:101-2.  Back to cited text no. 5
Tassone DM, Boyce E, Guyer J, Nuzum D. Pregabalin: A novel gamma-aminobutyric acid analogue in the treatment of neuropathic pain, partial-onset seizures, and anxiety disorders. Clin Ther 2007;29:26-48.  Back to cited text no. 6
Richter RW, Portenoy R, Sharma U, Lamoreaux L, Bockbrader H, Knapp LE. Relief of painful diabetic peripheral neuropathy with pregabalin: A randomized, placebo-controlled trial. J Pain 2005;6:253-60.  Back to cited text no. 7
Freynhagen R, Strojek K, Griesing T, Whalen E, Balkenohl M. Efficacy of pregabalin in neuropathic pain evaluated in a 12-week, randomised, double-blind, multicentre, placebo-controlled trial of flexible- and fixed-dose regimens. Pain 2005;115:254-63.  Back to cited text no. 8
van Seventer R, Feister HA, Young JP Jr., Stoker M, Versavel M, Rigaudy L. Efficacy and tolerability of twice-daily pregabalin for treating pain and related sleep interference in postherpetic neuralgia: A 13-week, randomized trial. Curr Med Res Opin 2006;22:375-84.  Back to cited text no. 9
Kruszewski SP, Shane JA. Pregabalin in central neuropathic pain associated with spinal cord injury: A placebo-controlled trial. Neurology 2007;68:2158-9.  Back to cited text no. 10
Ma J, Yu H, Liu J, Chen Y, Wang Q, Xiang L. Metformin attenuates hyperalgesia and allodynia in rats with painful diabetic neuropathy induced by streptozotocin. Eur J Pharmacol 2015;764:599-606.  Back to cited text no. 11
Steinberg GR, Kemp BE. AMPK in health and disease. Physiol Rev 2009;89:1025-78.  Back to cited text no. 12
Chakraborty A, Chowdhury S, Bhattacharyya M. Effect of metformin on oxidative stress, nitrosative stress and inflammatory biomarkers in type 2 diabetes patients. Diabetes Res Clin Pract 2011;93:56-62.  Back to cited text no. 13
Salminen A, Hyttinen JM, Kaarniranta K. AMP-activated protein kinase inhibits NF-kappaB signaling and inflammation: Impact on healthspan and lifespan. J Mol Med (Berl) 2011;89:667-76.  Back to cited text no. 14
Taylor A, Westveld AH, Szkudlinska M, Guruguri P, Annabi E, Patwardhan A, et al. The use of metformin is associated with decreased lumbar radiculopathy pain. J Pain Res 2013;6:755-63.  Back to cited text no. 15
Staal JB, Nelemans PJ, de Bie RA. Spinal injection therapy for low back pain. JAMA 2013;309:2439-40.  Back to cited text no. 16
Sabatowski R, Gálvez R, Cherry DA, Jacquot F, Vincent E, Maisonobe P, et al. Pregabalin reduces pain and improves sleep and mood disturbances in patients with post-herpetic neuralgia: Results of a randomised, placebo-controlled clinical trial. Pain 2004;109:26-35.  Back to cited text no. 17
Achar A, Chakraborty PP, Bisai S, Biswas A, Guharay T. Comparative study of clinical efficacy of amitriptyline and pregabalin in postherpetic neuralgia. Acta Dermatovenerol Croat 2012;20:89-94.  Back to cited text no. 18
Siddall PJ, Cousins MJ, Otte A, Griesing T, Chambers R, Murphy TK. Pregabalin in central neuropathic pain associated with spinal cord injury: A placebo-controlled trial. Neurology 2006;67:1792-800.  Back to cited text no. 19
Argoff CE. The coexistence of neuropathic pain, sleep, and psychiatric disorders: A novel treatment approach. Clin J Pain 2007;23:15-22.  Back to cited text no. 20
Price TJ, Dussor G. AMPK: An emerging target for modification of injury-induced pain plasticity. Neurosci Lett 2013;557(Pt A):9-18.  Back to cited text no. 21
Melemedjian OK, Yassine HN, Shy A, Price TJ. Proteomic and functional annotation analysis of injured peripheral nerves reveals ApoE as a protein upregulated by injury that is modulated by metformin treatment. Mol Pain 2013;9:14.  Back to cited text no. 22
Labuzek K, Liber S, Marcol W, Okopien B. Controlling newly diagnosed type 2 diabetes mellitus with metformin managed pain symptoms in a patient affected with Dercum's disease. Pain Med 2012;13:1526-7.  Back to cited text no. 23