From the Guidelines
The recommended treatment for allodynia is a multimodal approach, with first-line medications including anticonvulsants such as pregabalin (starting at 75mg twice daily, increasing to 300-600mg daily) or gabapentin (starting at 300mg daily and gradually increasing to 1800-3600mg daily in divided doses), as these have shown significant efficacy in reducing pain and allodynia in clinical trials 1.
Treatment Options
- Anticonvulsants:
- Tricyclic antidepressants:
- Amitriptyline: 10-25mg at bedtime, gradually increasing to 25-150mg
- SNRIs:
- Duloxetine: 30-60mg daily
- Topical treatments:
- Lidocaine patches (5%) applied to painful areas for up to 12 hours daily
Non-Pharmacological Approaches
- Physical therapy
- Cognitive behavioral therapy
- Stress reduction techniques
- Cardio-exercise: at least 30 minutes twice weekly 1
- Nutritional intervention: increasing the ratio of omega-3 to omega-6 fatty acids, and considering gluten-free diet 1
- Meditation and mindfulness: to contribute positively to pain management and overlapping co-morbidities such as depression and anxiety 1
Important Considerations
- Treatment should be individualized based on the specific cause of allodynia, patient comorbidities, and medication tolerability.
- Regular follow-up is essential to monitor effectiveness and adjust treatment as needed, with the goal of improving function and quality of life rather than complete pain elimination.
- The most recent and highest quality study 1 supports the use of pregabalin and gabapentin as first-line treatments for allodynia, due to their efficacy and relatively favorable side effect profiles.
From the FDA Drug Label
The recommended dose of pregabalin for fibromyalgia is 300 to 450 mg/day. Begin dosing at 75 mg two times a day (150 mg/day). The dose may be increased to 150 mg two times a day (300 mg/day) within 1 week based on efficacy and tolerability Patients who do not experience sufficient benefit with 300 mg/day may be further increased to 225 mg two times a day (450 mg/day).
Allodynia is a symptom of fibromyalgia. The recommended treatment for allodynia with pregabalin is to start with a dose of 75 mg two times a day (150 mg/day) and increase to 300-450 mg/day based on efficacy and tolerability 2.
- Key points:
- Start with 75 mg two times a day (150 mg/day)
- Increase to 300 mg/day within 1 week if necessary
- Further increase to 450 mg/day if no sufficient benefit is seen with 300 mg/day
- Important consideration: Doses above 450 mg/day are not recommended due to dose-dependent adverse reactions 2.
From the Research
Treatment Options for Allodynia
The recommended treatment for allodynia includes:
- Tricyclic antidepressants, gabapentin, and pregabalin, which have been shown to effectively reduce pain and decrease allodynia 3
- Opioids, which have demonstrated pain relief in some cases 3
- Capsaicin and the lidocaine 5% patch, which can relieve pain and decrease allodynia 3
- Topical gabapentin gel, which has been shown to alleviate allodynia and hyperalgesia in animal models 4
Gabapentin for Allodynia
Gabapentin is considered an effective treatment for allodynia, with studies showing that it:
- Relieves symptoms of allodynia, burning pain, shooting pain, and hyperesthesia 5
- Is effective in the treatment of painful diabetic neuropathy, postherpetic neuralgia, and other neuropathic pain syndromes 5
- Can be started at a dose of 900 mg/d and titrated up to 1800 mg/d for greater efficacy 5
Comparison of Treatments
Comparative studies have shown that:
- Capsaicin 8% patch is superior to pregabalin in reducing the intensity and area of dynamic mechanical allodynia, and in the number of patients with complete resolution of allodynia 6
- Topical gabapentin gel is effective in alleviating allodynia and hyperalgesia in animal models, without the systemic side effects associated with oral gabapentin 4
Animal Studies
Animal studies have demonstrated that: