Comparison of gabapentine and amitryptiline in the treatment of chronic postthoracotomy pain

Aim: Chronic postthoracotomy pain (CPTP) seems to be a combination of both nociceptive and neuropathic pain. The mechanism of CPTP based on neuropathic, origin results in amitryptiline and gabapentine to be regarded attractive adjuvant analgesics. Aim of this trial is to compare the efficacy of gabapentine and amitryptiline in CPTP. Material and Method: 40 patients with chronic nonmalignant postthoracotomy pain (burning, stabbing and shooting pain) received gabapentine or amitryptiline as a single drug therapy. Study drugs were increased to effective and tolerable doses gradually throughout the study (4 weeks). Assessment variables were the intensity of burning, stabbing and shooting pain (assessed on VAS), side effects and patients' satisfaction (assessed with 7-points Likert's scale). The assessments were done before the study drugs treatments, at one and 4 weeks of study. Results: The burning, stabbing and shooting pain scores mean VAS values were lower in gabapentine group compared with amitryptiline group (p<0,05). Side effects were also high (55 %) in amitryptiline group (p<0,001). Patients satisfaction measured with Likert's scale was statistically significantly high in gabapentine grup (6,35±0,7; 50 % improvements) compared with amitryptiline group (4,55±0,9; 25 %). Conclusion: Gabapentin appears safe and well tolerated when used for chronic postthoracotomy pain. Gabapentin as one of the first line agents used in neuropathic pain are preferable in postthoracotomy pain.