Gabapentin and pregabalin in the pain setting: All you need to know

Abstract

The last decade has seen a marked increase in the use of gabapentinoid drugs for pain management. This, in part, reflects the shift from some non-steroidal anti-inflammatory drugs (NSAIDs), as well as issues arising from the protracted use of opioids. More extensive use of gabapentin and pregabalin, has seen the clinical role widen to incorporate a range of unlicensed pain scenarios, as well as increased medicines' costs. The evidence for efficacy in some pain conditions, namely postherpetic neuralgia and diabetic neuropathic pain, is stronger than for non-neuropathic pain conditions, such as fibromyalgia. Anxiolytic properties, as well as widespread availability, have encouraged recreational misuse, which is associated with doses outside the therapeutic range. Safe use for neuropathic pain (central and peripheral), complex pain, migraine, and the evidence for some non-neuropathic pain conditions will be discussed, as well as the emerging abuse issues. Anti-convulsant interventions will not be covered in this article, nor will use in children.

Gabapentinoid prescriptions for neuropathic and musculoskeletal pain in Lebanon

“…In the USA, prescriptions for these molecules have more than tripled in the last 10 years, as described by Johansen et al and Montastruc et al [ 12 , 13 ]. Although, the explanation for this significant increase is not really clear, some doctors, such as Rees et al and Enke et al , justify it by the search for opioids and NSAIDs alternatives because of their side effects [ 14 , 15 ]. Goodman et al advise physicians on the minimal evidence of efficacy for non-approved indications, and insist on warning patients that the benefits are not yet certain [ 16 ].…”