A recent randomized, double-blind, placebo-controlled study3 compared the efficacy of a combination of gabapentin and morphine with that of each as a single agent in patients with painful diabetic neuropathy or post-herpetic neuralgia. Patients received daily active placebo, sustained-release morphine, gabapentin, or a combination of gabapentin and morphine—each given orally for five weeks. Of 57 patients who underwent randomization (35 with diabetic neuropathy and 22 with post-herpetic neuralgia), 41 completed the trial. Mean daily pain (on a scale from 0 to 10, with higher numbers indicating more severe pain) was rated as follows: 5.72 at baseline, 4.49 with placebo, 4.15 with gabapentin, 3.70 with morphine, and 3.06 with the gabapentin-morphine combination (P <0.05). Total scores on the Pain Questionnaire (on a scale from 0 to 45, with higher numbers indicating more severe pain) at a maximal tolerated dose were 14.4 with placebo, 10.7 with gabapentin, 10.7 with morphine, and 7.5 with the gabapentin-morphine combination (P <0.05). Gabapentin and morphine combined achieved better analgesia at lower doses of each drug than either as a single agent, with constipation, sedation and dry mouth as the most frequent adverse effects.
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