Article Figures & Data
- Figure 1
Forest plot showing the reduction in mean VAS (Visual Analog Scale) in each treatment arm, comparing gabapentinoids with controls. 95% CI, 95% confidence interval.
- Figure 2
Forest plot showing the reduction in mean VAS (Visual Analog Scale) in each treatment arm, comparing topical doxepin with controls. 95% CI, 95% confidence interval.
- Table 1
Randomized controlled trials of gabapentinoids
Study Year Setting/design Inclusion criteria Patient number Age (years) Intervention groups Gabapentinoid dosing regimen Outcomes Follow-up Zheng et al30 2015 Single center RCT >5% TBSA, second degree burn, >80% healed or healed within 3 months 58 18 to 60 Gabapentin
Cetirizine
Placebo
Gabapentin 300 mg twice daily Pruritus VAS 28 days Ahuja et al22 2013 Single center RCT >5% TBSA, 80% epithelialized or healed within 1 month 80 18 to 60 Four groups: Antihistamine
Pregabalin and antihistamine
Placebo
Pregabalin
Pregabalin varied with severity of pruritus:
Mild—75 mg twice daily
Moderate—75 mg three times a day
Severe—150 mg twice dailyPruritus VAS 28 days Ahuja et al21 2011 Single center RCT >5% TBSA, 80% epithelialized or healed within 1 month 60 12 to 70 Three groups: Cetirizine
Gabapentin
Combination cetirizine and gabapentin
Gabapentin varied with severity of pruritus:
Mild—300 mg once daily
Moderate— 300 mg twice daily
Severe—300 mg three times a dayPruritus VAS 28 days Gray et al24 2011 Single center RCT Admitted to burn unit, >5% TBSA 90 18 to 65 Pregabalin
Placebo
Pregabalin 75 mg twice daily, titrated up to 150 mg twice daily or 300 mg twice daily based on clinical response NPS (includes itch score 0 to 10)
Procedural pain score 0 to 10
4-point side effect scale28 days NPS, Neuropathic Pain Scale; QOL, quality of life; RCT, randomized controlled trial; TBSA, total body surface area.
- Table 2
Observational studies of gabapentinoids
Study Year Setting/design Inclusion criteria Patient number Age (years) Intervention groups Dosing regimen Outcomes Follow-up Kneib et al26 2019 Single center retrospective cohort study Admitted to burn unit, complained of itch 411 >14 Use of neuropathic pain protocol.
Analyzed by group:Gabapentin at <72 hours
Gabapentin >72 hours
No gabapentin
Gabapentin 300 mg once daily increased every 2 days if NRS≥5 to max 900 mg three times a day Morphine equivalent dose
Total gabapentin use
Pain and itch NRS
Short Form-12 survey24 months Nieuwendijk et al28 2018 Single center prospective observational study In burn ward or outpatient clinic, complained of itch 413 <13 Not protocolized. Mixture of no treatment, gabapentin, and antihistamine Gabapentin 5 mg/kg Itch Man Scale 0 to 4
Itch NRS (0 to 10)1 week to 3 months Kaul et al25 2018 Single center retrospective observational study Pruritus or neuropathic pain on gabapentinoid 136 0 to 20 Gabapentin only or in combination with pregabalin Various gabapentin doses used from 50 mg three times a day to 1200 mg three times a day. Pregabalin 50 mg to 100 mg three times a day added if inadequate response to gabapentin. Retrospective review to describe effective dose of drugs Unclear Zachariah et al11 2012 Single center prospective observational study Burn 6 weeks to 2 years old, pruritus with failure of cetirizine and emollients 23 4 to 60 Gabapentin added if cetirizine inadequate Adults—gabapentin 100 mg twice daily, increased to max 300 mg three times a day
Children—5 mg/kg twice daily to max 5 mg/kg three times a dayItch severity scale (7 to 21 points) 6 months Goutos et al14 2010 Single center prospective observational study Within 72 hours of injury, admitted to burn unit, sense of itch and urge to scratch 91 Adults and children Two consecutive protocols. Gabapentin introduced early or late, compared with pre-protocol data. Adult 300 mg once daily titrated to 300 mg three times a day over 3 days
Children 5 mg/kg once daily titrated to 5 mg/kg three times a day over 3 daysItch Man Scale 0 to 4 Unclear. Only inpatient data. Mendham et al27 2004 Single center prospective observational study Itching burn wound, admitted to burns unit 35 Children Gabapentin (no comparator or control) 5 mg/kg three times a day to max 5 mg/kg twice daily plus 10 mg/kg nocte Staff or parent reporting of itch reduction Unclear. Some followed up for 18 months. NRS, Numeric Rating Scale.
- Table 3
Studies of topical doxepin
Study Year Setting/design Inclusion criteria Patient number Intervention Control Outcomes Follow-up Kwa et al33 2020 Multicenter cross-over RCT Healed burn, itch VAS≥3, pruritic area <10% 27 Doxepin cream Placebo cream Pruritus VAS
BIQ at week 2 and week 55 weeks Kwa et al32 2019 Multicenter RCT Healed burn, itch VAS≥3 31 Doxepin cream and placebo tablet Placebo cream and antihistamine tablet Pruritus VAS
BIQ
QOL SF-36
Somnolence
Erythema12 weeks Demling et al34 2003 Single center RCT Healed, <35% TBSA partial thickness burn, pruritic area <20% 31 Doxepin Standard care Pruritus VAS
Erythema (Vancouver Scar Scale)12 weeks Demling et al31 2002 Single center RCT Healed burn, pruritic area <15% 41 Doxepin Standard care Pruritus VAS
Erythema (Vancouver Scar Scale)12 weeks BIQ, Burn Itch Questionnaire; QOL SF-36, Quality of Life Short Form-36 questionnaire; VAS, Visual Analog Scale.
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Neuropathic agents in the management of pruritus in burn injuries: a systematic review and meta-analysis
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