Elizabeth Briand
Gabapentinoid use has continued to climb in the United States, despite a lack of strong evidence for its effectiveness in pain management and other uses, according to a recent study published in the January 2024 issue of the Annals of Family Medicine.
Researchers analyzed data from the 2002–2021 Medical Expenditure Panel Survey (MEPS) and showed that the proportion of the population reporting use of a gabapentinoid medication increased from 1.2% in 2002 to 4.7% in 2021. A probability increase was seen for nearly all age groups, with the probability of gabapentinoid use among individuals aged 70 and older at 9%.
An ongoing trend
Michael Johansen, MD, a family medicine physician with OhioHealth who led the study, said he was unsurprised by the results of this analysis, noting that it was “consistent with what I see in clinical practice.”
Mark Garofoli, PharmD, clinical assistant professor at West Virginia University School of Pharmacy in Morgantown, WV, agreed. The results were “completely expected given the tightening of the reins on other pain management medication options such as prescription opioids.”
Individuals coping with musculoskeletal pain and diabetes accounted for the highest proportion of the population using gabapentinoids, but patients with other conditions, including polyneuropathies, fibromyalgia, seizure disorder, anxiety disorder, and migraine, were also prescribed the medications.
“We lack effective treatment for many of these chronic pain conditions,” Johansen said. “Clinicians strive to avoid opioids and these medications give us a potential alternative, non-opioid treatment.”
The study, which is a continuation of a previous MEPS data analysis by Johansen through 2015, noted that gabapentinoids “continue to be commonly used in conjunction with other sedating medications, which is concerning in light of FDA’s 2019 warning about co-prescribing of gabapentinoids with other central nervous system depressants.”
In assessing the root cause of that finding, Johansen said, “My guess is that it is a function of trying to avoid increasing opioid doses. It is likely akin to using it as an adjunctive medication to opioids. To my knowledge there isn’t much evidence to support its use in situations such as this in terms of efficacy or decreasing adverse effects.”
Garofoli noted that these medications are typically added within a diverse pain management treatment plan. “In the realm of pain management, various gabapentin formulations are FDA-approved for the treatment of post-herpetic neuralgia, while pregabalin is FDA-approved for treatment of neuropathic pain associated with diabetic peripheral neuropathy and postherpetic neuralgia, fibromyalgia, and neuropathic pain associated with spinal cord injury.”
Gabapentinoids, however, also “have been utilized off-label for a variety of indications beyond those FDA approvals,” he said.
The study also sought to examine the likelihood of individuals starting, stopping, or continuing gabapentinoids. The longitudinal analysis looked at the percentage of people still using the medications after 1 year and found that the probability increased until 2016 to 2017, when it plateaued at just over 3%. The data also showed that new use of the medications was more prevalent than discontinuation, especially in the earlier years of the data, but showed the difference declining more recently.
Providing added support for patients
As the use of gabapentinoids continues, it remains important for physicians and pharmacists to work with patients and reassess the necessity of these medications on a routine basis, said Johansen. He said it’s crucial for clinicians to recognize that these medications are rarely a solution to chronic pain conditions and carry the potential for a number of adverse effects.
The ongoing trends in gabapentinoid use can serve as a reminder that “pain management guidelines need to look at the whole picture and not just one type of medication,” said Garofoli. “In other words, if we recommend reserving, or actually limit, one pain medication (opioids), another will take its place.”
Garofoli said the observed increase in gabapentinoid prescription medications utilization propels pharmacists to another opportunity for providing patient care in the form of patient counseling. “Although OBRA ’90 requires the offering of patient counseling, the core of our being as pharmacists should propel an automatic conversation, always,” he said. ■