Gabapentin and Pregabalin for the Management of Visceral Hyperalgesia and Pain Manifestations in Children with Severe Neurological Impairment: A Single Centre Retrospective Study

Background: Pain, irritability and feeding intolerance are common symptoms affecting quality of life in children with severe neurological impairment (SNI). Visceral hyperalgesia, an increased response and sensitivity to stimuli within the gastrointestinal tract, is a potential cause of these symptoms, for which there exists few therapeutic options. Hauers` seminal studies have shown some potential benefit of gabapentin treatment in a small number of patients with SNI (1,2).

Objective: This is a retrospective study to investigate the use of gabapentin for symptom control in children with SNI, to see if the results of the seminal studies (1,2) could be replicated in a larger patient cohort. The potential efficacy of pregabalin as a second line agent is also explored.

Methods: This is a retrospective study involving patients currently attending the palliative care and gastroenterology departments of a tertiary level pediatric hospital in Ireland. Children with SNI on treatment with gabapentin for irritability, vomiting and pain of unknown origin were included. Information was gathered from medical and nursing documentation.

Results: A total of 42 patients were included. Irritability was reduced in 71% of patients. There was an overall symptom improvement in 76.3%, with increased gastrointestinal symptoms in only one patient. Pregabalin replaced gabapentin as a second line agent in 12 children. Some degree of benefit was reported in 75% of children while 25% had substantial improvement.

Adverse effects of both medications were rare.

Conclusions: Gabapentin and pregabalin have a role in management of symptoms of pain manifestations in children with SNI.