Case Series: Prospective Study on the Efficacy of Pregabalin in Managing Opioid Withdrawal Syndrome

Background:
The effective management of opioid addiction poses significant challenges, especially when compounded by co-occurring psychiatric disorders. Pregabalin, an α2δ voltage-gated calcium channel subunit ligand, is used in the management of seizures, neuropathic pain, and anxiety. Previous studies have shown varying results regarding its efficacy in treating opioid withdrawal syndrome, with some indicating promising outcomes (Freynhagen et al., 2016; Krupitsky et al., 2017), and others showing less effectiveness (Kheirabadi et al., 2018).

Methods:
This ongoing prospective study involves five patients aged 27 to 63 years undergoing treatment for opioid withdrawal, who received pregabalin as the primary therapeutic agent. All participants met DSM-V criteria for opiate dependence. The study included patients treated in two different settings: three patients at the Abarbanel Mental Health Center and two at a private addiction therapy center. Comprehensive baseline assessments were conducted, documenting demographics, psychiatric symptoms, and patterns of opioid and other drug use. Pregabalin was administered with dosages ranging from 300 to 600 mg per day, based on clinical judgment. The Clinical Opiate Withdrawal Scale (COWS), an 11-item scale used to rate common signs and symptoms of opiate withdrawal, was assessed at baseline and then again after one day and five days of treatment.

Results:
Pregabalin demonstrated significant improvements across a range of withdrawal symptoms. All five patients experienced alleviation of bone and joint aches. Additionally, four out of five patients reported reduced anxiety and restlessness. These improvements were mirrored in the changes in COWS scores, with notable reductions observed from day one to day five of the treatment period.

Conclusions:
This study underscores the potential benefits of using pregabalin in the treatment of opioid withdrawal syndrome. While the initial results are promising, clinicians should remain cautious due to the potential for pregabalin misuse. Further research is necessary to confirm these findings and refine treatment protocols for opioid withdrawal.