Frequency of Concomitant Use of Gabapentinoids and Opioids among Patients with Cancer-Related Pain at an Outpatient Palliative Care Clinic

Madden, Kevin; Haider, Ali; Moraes, Aline Rozman De; Naqvi, Syed; Enriquez, Parema Alizadeh; Wu, Jimin; Williams, Janet L.; Liu, Diane; Bruera, Éduardo

doi:10.1089/jpm.2019.0614

Cited by 7 publications

(3 citation statements)

References 18 publications

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“…Increasing rates of gabapentinoid prescribing and coprescribing have been documented internationally. 9,20,21 A retrospective study conducted among US patients aged 18–64 years who were enrolled in a commercial insurance plan found that the prevalence of gabapentin prescribing nearly doubled from 2009 to 2016, and the increase was observed in every state (range, 44%–179%). Individuals prescribed gabapentin were also more likely to fill opioid prescriptions (61% versus 17%).…”

Section: Discussionmentioning

confidence: 99%

Gabapentin, Concomitant Prescription of Opioids, and Benzodiazepines among Kidney Transplant Recipients

Chen

Ahn

Bae

et al. 2023

CJASN

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Background Gabapentinoids, commonly used for treating neuropathic pain, may be misused and coprescribed with opioid and benzodiazepine, increasing the risk of mortality and dependency among kidney transplant recipients.Methods We identified adult kidney transplant recipients who enrolled in Medicare Part D in 2006-2017 using the United States Renal Data System/Medicare claims database. We characterized recipients' post-transplant concomitant prescription of gabapentinoids, opioids, and benzodiazepine stratified by transplant year and recipient factors (age, sex, race, and diabetes). We investigated whether concomitant prescriptions were associated with postkidney transplant mortality using Cox regression. Models incorporated inverse probability weighting to adjust for confounders.Results Among 63,359 eligible recipients, 13% of recipients filled at least one gabapentinoid prescription within 1 year after kidney transplant. The prevalence of gabapentinoid prescriptions increased by 70% over the study period (16% in 2017 versus 10% in 2006). Compared with nonusers, gabapentinoids users were more likely to have diabetes (55% versus 37%) and obesity (46% versus 34%). Of the 8509 recipients with gabapentinoid prescriptions, 45% were coprescribed opioids, 7% were coprescribed benzodiazepines, and 3% were coprescribed both opioids and benzodiazepines. Compared with no study prescriptions, gabapentinoid monotherapy (adjusted hazard ratio [aHR]51.25; 95% confidence interval [CI], 1.16 to 1.32) and combination therapy (gabapentinoids and opioids [aHR51.49; 95% CI, 1.39 to 1.60], gabapentinoids and benzodiazepines [aHR51.46; 95% CI, 1.03 to 2.08], and coprescribing all three [aHR51.88; 95% CI, 1.18 to 2.98]) were all associated with a higher risk of postkidney transplant mortality.Conclusions Gabapentinoid coprescription with both benzodiazepines and opioids among kidney transplant recipients increased over time. Kidney transplant recipients prescribed gabapentinoids had a higher risk of posttransplant mortality, and the risk was higher with opioids or benzodiazepine coprescription.

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Section: Discussionmentioning

confidence: 99%

Gabapentin, Concomitant Prescription of Opioids, and Benzodiazepines among Kidney Transplant Recipients

Chen

Ahn

Bae

et al. 2023

CJASN

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“…[46]. For this reason, control of NCP usually requires the concurrent use of opioids and adjuvant analgesics specific for NCP [26,47]. A systematic review and meta-analysis on the combined use of opioids with antidepressants or anticonvulsants indicated a nonsignificant improvement of pain relief in patients with NCP compared with opioid monotherapy, but the heterogeneity of the pain conditions in the studies did not allow the formulation of firm conclusions [48].…”

Section: Opioidsmentioning

confidence: 99%

Treatment of Neuropathic Pain Directly Due to Cancer: An Update

Shkodra

Caraceni

2022

Cancers

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Neuropathic pain can be defined as pain related to abnormal somatosensory processing in either the peripheral or central nervous system. In this review article, with neuropathic cancer pain (NCP), we refer to pain due to nervous tissue lesions caused by the tumor or its metastases. Nervous tissue damage is the cause of cancer pain in approximately 40% of those experiencing cancer pain. Recognizing a neuropathic pathophysiology in these cases may be difficult and requires specific criteria that are not homogenously applied in clinical practice. The management of this type of pain can be challenging, requiring the use of specific non-opioid adjuvant drugs. The majority of the criteria for NCP diagnosis and management have been based mainly on results from the noncancer population, risking the failure of addressing the specific needs of this population of patients. In this review, we summarize current management options available for NCP and provide some insights on new promising treatments.

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“…Due to the difficulties in obtaining effective pain relief, in the treatment of neuropathic pain, combination therapy is frequently used [4]. One of the therapeutic options consists of administering gabapentinoids in combination with opioids [5,6]. The Cochrane Database of Systematic Reviews [4] shows that gabapentin administered with morphine [7] or oxycodone [8] has a better analgesic effect than gabapentin alone.…”

Section: Introductionmentioning

confidence: 99%

Mirogabalin Decreases Pain-like Behaviours and Improves Opioid and Ketamine Antinociception in a Mouse Model of Neuropathic Pain

et al. 2022

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Neuropathic pain remains a difficult clinical challenge due to its diverse aetiology and complex pathomechanisms, which are yet to be fully understood. Despite the variety of available therapies, many patients suffer from ineffective pain relief; hence, the search for more efficacious treatments continues. The new gabapentinoid, mirogabalin has recently been approved for clinical use. Although its main mechanism of action occurs at the α2σ-1 and α2σ-2 subunits of calcium channels and is well documented, how the drug affects the disturbed neuropathic interactions at the spinal cord level has not been clarified, which is crucial information from a clinical perspective. The findings of our study suggest that several indirect mechanisms may be responsible for the beneficial analgesic effect of mirogabalin. This is the first study to report that mirogabalin enhances the mRNA expression of spinal antinociceptive factors, such as IL-10 and IL-18BP, and reduces the concentration of the pronociceptive substance P. Importantly, mirogabalin improves the morphine-, buprenorphine-, oxycodone-, and ketamine-induced antinociceptive effects in a neuropathic pain model. Our findings support the hypothesis that enhancing opioid and ketamine analgesia by combining these drugs with mirogabalin may represent a new strategy for the effective pharmacotherapy of neuropathic pain.

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Frequency of Concomitant Use of Gabapentinoids and Opioids among Patients with Cancer-Related Pain at an Outpatient Palliative Care Clinic

Cited by 7 publications

References 18 publications

Gabapentin, Concomitant Prescription of Opioids, and Benzodiazepines among Kidney Transplant Recipients

Gabapentin, Concomitant Prescription of Opioids, and Benzodiazepines among Kidney Transplant Recipients

Treatment of Neuropathic Pain Directly Due to Cancer: An Update

Mirogabalin Decreases Pain-like Behaviours and Improves Opioid and Ketamine Antinociception in a Mouse Model of Neuropathic Pain

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