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Gabapentinoid Use Has More Than Tripled in the U.S. Since 2002

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This is an interesting article for our readers who treat pain.

 Johansen ME. JAMA Intern Med 2018 Jan 2.

Much of the increased use is in patients who also are using opioids and benzodiazepines for chronic conditions.

Gabapentin and pregabalin are approved for treating patients with several specific neurological and neuropathic conditions (e.g., gabapentin and pregabalin for partial seizures and postherpetic neuralgia; pregabalin for diabetic peripheral neuropathy and fibromyalgia). Off-label use of these gabapentinoids has risen markedly, with unclear benefit (N Engl J Med 2017; 377:411). In this study, a national health and medical care survey database was used to examine chronic conditions and prescription medication use in about 350,000 community-living adults from 2002 through 2015.

The proportion of participants who used gabapentinoids rose from 1.2% in 2002 to 3.9% in 2015. Increases in use occurred mostly after 2008 and were attributable mainly to gabapentin. Use increased among diabetics and older participants (age, ≥65), but it rose even more in patients with five or more chronic conditions and in those who reported more than two opioid prescriptions, particularly those who also reported at least one benzodiazepine prescription. In 2014 through 2015, 11% of participants reported more than two opioid prescriptions or at least one benzodiazepine prescription and accounted for 53% of gabapentinoid users.

COMMENT

These data suggest — although they don’t prove — that much of the marked increase in gabapentinoid use is associated with chronic pain related to conditions for which these drugs are not FDA-approved. We have no evidence of benefits for gabapentinoid use in patients with most chronic pain conditions (e.g., back pain), and some potential exists for drug–drug interactions with opioids and benzodiazepines.

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