Current common treatments of laryngeal sensory neuropathy include the use of gabapentin and amitriptyline, but those treatments tend to be limited due to sedation and tolerance to the medication, he said.
Explore This IssueOctober 2008
Details of Pregabalin Study
In the study, doctors collected data on patient demographics, their chief complaint and precipitating factors, treatment, and response. Patients rated their symptoms on a scale of 0 to 5 before and after treatment, Dr. Sycamore explained. We compared the pre- and post-treatment scores of only their chief complaint-globus sensation, throat discomfort, chronic throat clearing, or chronic cough-for this study. We also tracked adverse side effects, drug tolerance, and the ability to wean off the treatment.
The mean age of the patients was 53 years. All patients had acute onset of globus sensation or cough or throat clearing.
Dr. Sycamore said that in four of the patients, the incident of laryngeal sensory neuropathy followed an upper respiratory infection; in another four patients, symptoms followed surgical intervention and intubation. The severity of the patients’ chief complaint was tracked before and after treatments. Of the 10 patients who responded to pregabalin, the pretreatment complaint score was 4.4. After treatment of at least one month, the mean score was 2.1.
In our study we did not find evidence of drug tolerance with pregabalin, Dr. Sycamore said. Sedation was severe enough in two cases to cause patients to discontinue therapy.
Six patients reported improvement at a dose of 150 mg twice a day. Two of these patients required increased their dosing from an initial dose of 75 mg twice a day. The rest of the patients who responded reported improvement on either 75 mg twice a day or 75 mg three times a day. Eight patients continued to take pregabalin for symptom management throughout the 15-month duration of the study, he said.
Our results indicate that pregabalin is highly effective in treatment of laryngeal sensory neuropathy, improving the chief complaint of globus discomfort, cough, or throat clearing, Dr. Sycamore said. Effective symptom control can be obtained with 75 mg twice a day; however, at least 20 percent of patients required 150 mg twice a day.
Among patients who can tolerate pregabalin, treatment of neuropathy has been shown to be effective for at least 15 months, said Suzan Streichenwein, MD, a private practice psychiatrist in West Palm Beach, FL. Several of these antiepileptic drugs appear to have effectiveness in treatment of various other neuropathies as well.