In patients with postherpetic neuralgia, Pregabalin is most effective for relieving pain, while Gabapentin has a better safety profile.

In order to compare the clinical effectiveness of Gabapentin and Pregabalin to treat postherpetic neuralgia, including the variance in pain management and occurrence of adverse events, a meta-analysis of randomized controlled trials (RCTs) was conducted.

Databases such as Web of Science, Cochrane Library, EMBASE, MEDLINE, and PubMed were explored for RCTs contrasting the effectiveness of Gabapentin and Pregabalin in individuals with postherpetic neuralgia. The quality of the incorporated studies was evaluated using the Cochrane Risk of Bias risk assessment tool after data from the studies matching the inclusion criteria was retrieved. The meta-analysis and the detection of publication bias were carried out using Stata17 and Revman 5.3.

Overall, 14 RCTs with 3545 volunteers were included; 926 patients received Pregabalin therapy, 1256 received Gabapentin treatment, and 1363 received a placebo. Pregabalin outperformed Gabapentin in terms of reducing pain and enhancing the global perception of alteration in sleep and pain. Compared to Pregabalin, Gabapentin was linked to a decreased frequency of adverse events. No discernible publication bias was revealed by the funnel plot, and Begg's and Egger's tests.

Compared to Gabapentin, Pregabalin seems to have a more favorable overall therapeutic benefit for individuals with postherpetic neuralgia.  Compared to Pregabalin, Gabapentin has a superior safety profile and a lower frequency of adverse events.