Efficacy of pregabalin versus nortriptyline in the treatment of chronic low backache with radiculopathy: an open label observational study

Background: The efficacy and safety of Pregabalin and Nortriptyline have been proved individually in low backache with radicular pain. However, there are limited number of studies comparing the efficacy of Pregabalin and Nortriptyline in Chronic Low Backache (CLBA) with radicular pain. Hence the present study was designed to determine the efficacy as well as tolerability of Pregabalin in comparison with that of Nortriptyline for reduction of pain in CLBA. The present study was an open label prospective observational study.Methods: Patients with CLBA, 15-60 years of age without specific cause and significant neurological deficit were included in the study. Severity of pain was assessed by Visual Analogue Scale (VAS). Patients were followed up at 2 and 4 weeks and their VAS scores and side effects were noted.Results: Both Pregabalin and Nortriptyline were effective in reducing pain, from baseline to 2 weeks and up to 4 weeks of treatment in chronic low backache with radicular pain, but there was no statistically significant difference between the two treatment groups. The incidences of side effects were less in the Nortriptyline treatment group as compared to Pregabalin.Conclusions: From the results of the present study it can be concluded that both Pregabalin and Nortriptyline were equally effective in the treatment of chronic low backache with radicular pain, but the incidence of adverse effects were more with Pregabalin as compared to Nortriptyline.

Neurosteroids: current perspective in therapy of neuropsychiatric disorders

Neurosteroids are natural or synthetic steroid derivatives which act locally in brain by modulating neuronal excitability. The objective of this study is to analyze available literature on classification, biosynthesis and mechanism of action, and therapeutic potential of neurosteroids. A review of literature pertaining to neurosteroids published from inception to 2018 was carried on data bases like PUBMED, Google Scholar and Science Direct. The search terms used were neurosteroids, neuro-active steroids, ganaxolone and GABA-A receptor modulators. Review of literature suggests neurosteroids are powerful neuro-modulators, involving rapid non-genomic and non-hormone receptor mechanisms. They are classified based on structure as pregnane, androstane and sulphated neurosteroids, and based on function as excitatory or inhibitory neurosteroids. They act via GABAA receptor (primarily), rho- GABA (?GABA), NMDA-glutamate and sigma receptor modulation. The inhibitory neurosteroids demonstrate sedative, anxiolytic and anticonvulsant actions, whereas the excitatory agents produce memory enhancing and anxiogenic effects. They show efficacy in various CNS and psychiatric conditions like epilepsy, anxiety, depression, learning and memory disorders and substance abuse. Endogenous neurosteroids have limited clinical use due to low bioavailability, lack of specificity and unwanted effects. Hence, synthetic agents like alphaxalone, ganaxolone, sepranolone and brexanolone which have better bioavailability and specificity, are being investigated in various phases of clinical trials. Neurosteroids are novel endogenous compounds with neuro-modulatory function and show promising effects in therapy of various neurological and psychiatric conditions. Further studies that prove their long term efficacy and safety may revolutionize the clinical approach to therapy of these conditions.