Consensus on the Clinical Use of Pregabalin in Peripheral Neuropathic Pain

BACKGROUND: Peripheral neuropathic pain (pNP) is a prevalent and complex clinical condition that presents significant therapeutic challenges, with pharmacological options demonstrating variable efficacy and safety. OBJECTIVE: To establish expert consensus recommendations on the clinical use of pregabalin in the management of diverse pNP conditions. METHODS: A multidisciplinary panel of Chinese experts from orthopedics, pain management, neurology, oncology, dermatology, and pharmacy conducted a comprehensive literature review and synthesized clinical evidence to formulate consensus-based recommendations. RESULTS: Pregabalin, a second-generation calcium channel regulator, demonstrated broad efficacy across multiple pNP conditions, including postherpetic neuralgia (PHN), diabetic peripheral neuropathy (DPN), neuropathic cancer pain (NCP), postoperative and post-traumatic neuralgia, and trigeminal neuralgia (TN). In PHN, pregabalin significantly reduced pain intensity and improved sleep quality. In DPN, it provided consistent analgesia with improved pain scores and good tolerability. In NCP, pregabalin effectively alleviated pain, showed no significant drug-drug interactions, and was safely co-administered with chemotherapy. It was also effective in postoperative and post-traumatic neuralgia, although caution is warranted in cases of traumatic neuroma. In TN, pregabalin exhibited favorable low-dose efficacy, particularly in elderly patients, with minimal adverse effects. However, cautious use is advised in patients with nerve compression syndromes, such as carpal tunnel syndrome, and in individuals with a history of substance abuse. CONCLUSIONS: This consensus highlights pregabalin as an effective and generally well-tolerated therapeutic option for a broad range of pNP conditions. These recommendations provide clinically relevant guidance for optimizing pregabalin use, particularly within the Chinese healthcare context.