Gabapentin for Pain
Dr. Bruno’s Original Post: Gabapentin, et al: Do they even provide a placebo effect? This article is an interesting read.
"In many well-controlled studies, they found there was less than a one-point difference on the 10-point pain scale between patients taking the drug versus a placebo, a difference often clinically meaningless. Despite the limited evidence of benefit, Dr. Johansen found that the number of people taking gabapentin more than tripled from 2002 to 2015."
Millions Take Gabapentin for Pain but There’s Scant Evidence It Works.
“There is very little data to justify how these drugs are being used and why they should be in the top 10 in sales.”
By Jane E. Brody N.Y. Times May 20, 2019
Article Summary:
“One of the most widely prescribed prescription drugs, gabapentin, is being taken by millions of patients despite little or no evidence that it can relieve their pain. In 2006, I wrote about gabapentin after discovering accidentally that it could counter hot flashes. The drug was initially approved 25 years ago to treat seizure disorders, but it is now commonly prescribed off-label to treat all kinds of pain, acute and chronic, in addition to hot flashes, chronic cough and a host of other medical problems. The F.D.A. approves a drug for specific uses and doses if the company demonstrates it is safe and effective for its intended uses, and its benefits outweigh any potential risks. Off-label means that a medical provider can legally prescribe any drug that has been approved by the Food and Drug Administration for any condition, not just the ones for which it was approved. This can leave patients at the mercy of what their doctors think is helpful.”
“Thus, it can become a patient’s job to try to determine whether a medication prescribed off-label is both safe and effective for their particular condition. This is no easy task even for well-educated doctors, let alone for desperate patients in pain.”
“Two doctors recently reviewed published evidence for the benefits and risks of off-label use of gabapentin (originally sold under the trade name Neurontin) and its brand-name cousin Lyrica (pregabalin) for treating all kinds of pain. (There is now also a third drug, gabapentin encarbil, sold as Horizant, approved only for restless leg syndrome and postherpetic neuralgia, which can follow a shingles outbreak.)”
“It’s not that there are no other alternatives to opioids to treat chronic pain, among them physical therapy, cognitive behavioral therapy, hypnosis and mindfulness training. But practicing clinicians may be unaware of the options, most of which require more effort for the doctor than writing a drug prescription and are not as easy or accessible for patients as swallowing a pill.”
“Contributing to the frequent misuse of gabapentinoids is how doctors interpret the term “neuropathic pain” for which the drugs are commonly prescribed. It is defined as pain caused by a lesion or disease of the nervous system, leading clinicians to assume that if a drug is effective for one type of neuropathic pain, it is effective for all types, regardless of the underlying cause, Drs. Goodman and Brett suggested.”
“Dr. Johansen pointed out that “there is no recipe book” for treating pain with gabapentinoids.” “Doctors need to work with one patient at a time and figure out what works and what doesn’t work,” he said. He noted that many times pain resolves with “the tincture of time” but patients and doctors may attribute improvement to the prescribed drug. For those taking a gabapentinoid, he suggested that patients’ doctors readdress its use after two or three months. But, Dr. Goodman cautioned against going off the drug cold turkey because there can be unpleasant withdrawal symptoms.”