Comparison of the effect of topiramate versus gabapentin on neuropathic pain in patients with polyneuropathy: A randomized clinical trial

Background Neuropathic pain is one of the most common complaints of neurologic clinics. Neuropathic pain is common and important and has inappropriate complications, and despite their importance, there is no effective treatment for them. Objective Because of the importance of neuropathic pain and safe and effective treatment, in this study, we determined the effect of topiramate versus gabapentin in patients with neuropathic pain. Methods In this randomized clinical trial, 30 patients with pain attributed to neuropathy who had at least one month of neuropathic pain in one area, were randomized to receive either gabapentin, titrated from 300 mg/day to a maximum of 900 mg/day or topiramate, titrated from 50 mg/day to a maximum of 100 mg/day after a 4-week period in the neurology clinic of Imam Khomeini Hospital of Urmia city, Iran in 2015. Complication, drug tolerance rate and pain were investigated. The pain was measured on visual analog scale (VAS). The data were analyzed by SPSS version 18, and using descriptive statistics, t-test, and ANOVA. Results In patients treated by gabapentin, the primary pain score was 74.33±10.29, this score decreased to 49.46±11.41 and 29.93±11.92 in the second and fourth week after intervention with gabapentin. In topiramate treated patients, the primary score was 76.00±9.69. It decreased to 54.33±10.31 and 34.20±6.09 at the same time. There were no significant differences between both groups in terms of average reduction of pain intensity [gabapentin group (59.73%) compared with topiramate (55%) (p=0.48)]. In the present study, the only complication reported in patients treated by gabapentin was drowsiness, but other uncommon side effects were nausea and dizziness. Conclusion This study showed that both gabapentin and topiramate reduce pain. Topiramate can also be a good alternative choice, if gabapentin has side effects for patients and it cannot be tolerated, topiramate can be a good replacement. Trial registration The trial was registered at the Thai Registry of Clinical Trials (http://www.clinicaltrials.in.th) with the TCTR ID: TCTR20170615001. Funding This research has been financially supported by Research Council of Urmia University of Medical Sciences.