Literature Review

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Literature Review
2.1 Introduction
To support the rational of this PhD project, this chapter will summarise current evidence and identify knowledge gaps. This chapter summarises the evidence regarding increasing gabapentinoid (pregabalin and gabapentin) utilisation for chronic pain management (Neuropathic pain, fibromyalgia, back pain, joint pain, other chronic pain) and will highlight the challenges about lacking evidence-based efficacy and concerns on the safety of gabapentinoid utilisation for patients with chronic pain. Specific contents of this chapter include:
2.2 Overview of Chronic non-cancer pain
2.2.1 Definition of chronic non-cancer pain
2.2.2 Pathophysiology of chronic non-cancer pain
2.2.3 Diagnosis and Severity Grading of chronic non-cancer pain
2.2.4 Epidemiology of chronic non-cancer pain (CNCP)
2.2.5 Risk factors for chronic pain
2.2.5.1 Modifiable factors associated with pain
2.2.5.2 Non-modifiable factors associated with
2.2.6 The Socioeconomic Impact of chronic pain
2.2.7 Management of pain and chronic pain
2.2.7.1 Non-pharmacological treatments
2.2.7.2 Pharmacological treatments

2.3 Overview of pregabalin and gabapentin and their role in chronic pain management

2.3.1 Pregabalin and Gabapentin medications and chronic pain (HISTORICAL PERSPECTIVE)
2.3.2 Pregabalin and Gabapentin mechanism of action in pain management and Pharmacokinetic
2.3.2.1 Mechanism of action
2.3.2.2 Pharmacokinetic
2.3.3 Pregabalin and Gabapentin Dosage and Indications (uses)
2.3.4 Efficacy of Gabapentinoid (Pregabalin and Gabapentin) for managing chronic non-cancer Pain

2.3.4.1 The use of gabapentin and pregabalin in the Management of Neuropathic Pain
2.3.4.2 The use of gabapentin and pregabalin in the Management of Fibromyalgia pain
2.3.4.3 The use of gabapentin and pregabalin in the Management of Back Pain (LBP)
2.3.4.4 The use of gabapentin and pregabalin in Management of musculoskeletal and joint pain
2.3.4.5 The use of gabapentin and pregabalin in the Management of other chronic pain

Note: please summarise all the studies and articles used in this section 2.3.4 and its subsections in a table. An example is listed below

Author,
Year, Country Population (age Inclusion Criteria) and Setting Study Design Number of Patients Exposure
(dosing) Outcome Method of pain management Result
List all the articles related to Musculoskeletal pain
Leveille 2002
USA community-dwelling, women, musculoskeletal pain aged ≥65years Prospective cohort study
940
Pregabalin or gabapentin (1500mg )
1-Mean pain score

2-Pain in walking Pain score / or
Interview / or writing notes …. ect
Pain score = 3; p=0.04
Or

OR (95%CI)
0.79 (0.63–0.98)….

2.3.5 Safety Issues of pregabalin and gabapentin utilisation
2.3.5.1 Gabapentinoid related adverse effects
2.3.5.2 Risk of misuse, overdose, and abuse
Note: please summarise all the studies and articles used in this section 2.3.5 and its subsections in a table. An example is listed below

Author,
Year, Country Population (age Inclusion Criteria) and Setting Study Design Number of Patients Exposure
(dosing) outcome Method of outcome detection Results

2.3.6 Epidemiology of gabapentin and pregabalin for chronic pain
Prevalence and incidence of gabapentin and pregabalin number of prescriptions and number of users for all countries in general and for UK in particular.
2.4 Mortality Associated with gabapentinoids (pregabalin & gabapentin)
2.4.1 Gabapentinoid (pregabalin and gabapentin) related death worldwide (us, EU, middle east, all counties)
2.4.2 Gabapentinoid (pregabalin and gabapentin) overdose related death worldwide (us, EU, middle east, all counties)
2.4.3 Risk factors associated with Gabapentinoid (pregabalin and gabapentin) related to death.
2.4.4 Gabapentinoid (pregabalin and gabapentin) related death in UK.
2.4.5 Gabapentinoid (pregabalin and gabapentin) overdose related death in UK.
2.4.6 Correlation between prescribing other meds (benzodiazepine, opioid, Z-drugs, antidepressant, and other meds ) with Gabapentinoid (pregabalin and gabapentin) and death in UK.
2.4.7 Risk factors associated with Gabapentinoid (pregabalin and gabapentin) related to death in UK.

Note: please summarise all the studies and articles used in this section 2.4.1/2.4.2/2.4.4/2.4.5 An example is listed below

Author,
Year, Country Population (age Inclusion Criteria) and Setting Study Design Number of Patients Outcome Definition of gabpentiond death Exposure Dose Results

2.5 The reclassification of pregabalin (PG) and gabapentin (GB) as controlled drug and the impact of this classification on number of PG & GB users, prescriptions and dose.

2.5.1 Evaluating the impact of gabapentinoid (PG & GB) after reclassification
2.5.2 Limit accessibility of pregabalin and gabapentin
Note: please summarise all the studies and articles used in this section 2.5.1
An example is listed below (the articles related to the reclassification of pregabalin and gabapentin)

Author,
Year, Country Study Design Outcome Time interval (study period) Results

2.6 Summary of Literature Review and Unresolved Issues