Concern for Nerve Pain Prescriptions and Addiction

According to a recent article in the New England Journal of Medicine (NEJM), the treatment of noncancer pain has become a challenge for physicians and clinicians. While nonsteroidal antiinflammatory drugs, and acetaminophen are prescribed as a first-line, pain-relieving options, they often don’t serve the patients well enough for the reduction of pain. Clinicians, in their search and response for safe alternatives to opioids during the addiction crisis, are prescribing gabapentin.

The Food and Drug Administration (FDA) approved gabapentinoids for the treatment of neuralgia, fibromyalgia and neuropathic pain, associated with diabetes and other injuries such as those of the spinal cord. What has been observed, however, is the upswing and prescribing rates of these drugs for practically any kind of pain. In the CDC guidelines, gabapentinoids (gabapentin or pregabalin) are also recommended as first-line agents for neuropathic pain.

Christopher W. Goodman, M.D., and Allan S. Brett, M.D from the University of North Carolina, stated in their 2016 NEJM article that gabapentin was the 10th most commonly prescribed medication in the United States with 64 million prescriptions dispensed. This rate has substantially increased since 2012 when there were 39 million prescriptions. The authors were concerned that many of the drug trials for gabapentin were uncontrolled or inadequately controlled and their duration too short. They also felt brand marketing and off label outcomes could be misleading.

Side effects like sedation and dizziness frequently occur while taking gabapentin. Some patients, considered current or past users of opioids, misuse or abuse the drug. Of major concern is the possibility that the high number of gabapentin prescriptions could expand the drug crisis. The use of  patient-satisfaction surveys and poor practice ratings, weigh heavily on some clinicians minds. If they resist demands for opioids, their scores might be lower. In response to this, there is a fear their income could be reduced.

With all that said, the authors state that gabapentinoids offer an alternative that is potentially safer than opioid. While they are supportive of the efforts to limit opioid prescribing, they contend that clinicians must not assume gabapentinoids are an effective approach for most pain occurrences or a routine and appropriate substitute for opioids. They conclude that more research is needed to on the subject of pain management.

“You may be the only person left who believes in you, but it’s enough. It takes just one star to pierce a universe of darkness. Never give up.”—Richelle E. Goodrich

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