Gabapentin and Pregabalin for Pain — Is Increased Prescribing a Cause for Concern? | NEJM

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Warning – inappropriate use of Gabapentin is following in the wake of the opiate crisis.

“Postmortem toxicology tests detected gabapentin in almost 1 in 10 US overdose deaths between 2019 and 2020.”

“The Food and Drug Administration (FDA) has approved gabapentinoids for the treatment of postherpetic neuralgia (gabapentin and pregabalin), fibromyalgia (pregabalin), and neuropathic pain associated with diabetes or spinal cord injuries (pregabalin). However, while working in inpatient and outpatient settings, we have observed that clinicians in our practice community are increasingly prescribing gabapentin and pregabalin for almost any type of pain.”

“indiscriminate off-label use of gabapentinoids reinforces the tendency to view the treatment of pain through a pharmacologic lens. Clinicians assume (perhaps incorrectly, in some cases) that patients generally expect or demand to be given a drug prescription, and they feel pressure to satisfy these perceived patient expectations. Some clinicians express concern that resisting patients’ demands for opioids might lead to lower scores on patient-satisfaction surveys, poor practice ratings, and even reduced income. However, appropriate management of both acute and chronic pain involves examining how the patient’s pain is affecting activity and function and setting realistic goals that may include coping with or mitigating pain, not necessarily eliminating it. This approach requires time (which is often lacking in rushed outpatient practices), expertise in communicating about a difficult and often emotionally charged symptom, and patient access to timely follow-up and continuity of care. Writing a prescription and moving on is considerably easier and less stressful for clinicians.”

https://www.nejm.org/doi/10.1056/NEJMp1704633

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Gabapentin and Pregabalin for Pain — Is Increased Prescribing a Cause for Concern? | NEJM

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