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Crossover randomised controlled trial
Study finds that the combination gabapentin plus nortriptyline reduces neuropathic pain more than either drug alone
  1. Alec B O'Connor
  1. Correspondence to Alec B O'Connor
    University of Rochester School of Medicine and Dentistry, Box HMD, 601 Elmwood Avenue, Rochester, NY 14642, USA; alec_oconnor{at}urmc.rochester.edu

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Neuropathic pain is common, debilitating and expensive to manage.1 Several drugs have demonstrated efficacy relative to placebo, but many patients continue to experience substantial pain despite some pain relief from medication.2 Unfortunately, few clinical trials have compared treatments, and even fewer have assessed the efficacy and tolerability of combination therapy.2

In their government-sponsored three-period crossover trial, Gilron and colleagues elegantly compared two first-line neuropathic pain treatments2 with each other and with their combination, finding greater pain relief with the combination than with either drug alone.

This is a high-quality study, but some design compromises were made. Most importantly, treatment duration was compressed, with rapid titration, a short period at the maximum tolerated dose and a short washout period. The primary outcome measure (numeric pain score change) was adequately responsive within the compressed time frame, …

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