Background & Aims
Background:
•Gabapentinoids, including gabapentin and pregabalin, are commonly prescribed for various types of chronic pain .
•Approved indications are for neuropathic pain, but off-label use is widespread.
•This narrative review explores the reasons for gabapentinoid prescribing behaviors and beliefs despite the potential harms associated with their use, particularly in off-label applications .
Methods
Methods:
•This narrative review is compared to a convenience sample of specialists and general practitioners who responded to an anonymous survey about their reasons and beliefs associated with the prescribing of gabapentinoids for pain.
Results
Results:
•Results demonstrate attitudes and behaviours to prescribing gabapentinoids are often contrary to the evidence base and do not always demonstrate appropriate care. This is comparable to international literature about the prescribing of off-label medications for intractable, long-term conditions such as chronic pain.
Conclusions
Conclusions:
•Gabapentinoids are commonly prescribed off-label for chronic pain, despite limited evidence of their efficacy.
•The increasing nonmedical use and associated harms raise significant concerns.
•Physicians should exercise caution when prescribing gabapentinoids, carefully considering the indication, patient characteristics, and harm-benefit profile.
•Education regarding the use of Gabapentanoids should consider the various psychological needs of both doctor and Patient.
•Deprescribing may be necessary when the indication is unclear, and real-time prescription monitoring programs can aid in identifying ‘at-risk’ prescriptions to reduce potential harms.
Implications for Patient Care:
•This narrative review highlights the need for a balanced approach to gabapentinoid prescriptions, especially when used off-label.
•Clinicians must weigh the potential benefits against the risks.
•Tailored interventions that promote evidence-based practices can enhance patient saf
References
Athavale A, Murnion B. Gabapentinoids: a therapeutic review. Aust Prescr. 2023 Dec;46(4):80-85. doi: 10.18773/austprescr.2023.025. PMID: 38152314; PMCID: PMC10751078
Carvalho AS, Martins Pereira S, Jácomo A, Magalhães S, Araújo J, Hernández-Marrero P, Costa Gomes C, Schatman ME. Ethical decision making in pain management: a conceptual framework. J Pain Res. 2018 May 15;11:967-976. doi: 10.2147/JPR.S162926. PMID: 29844699; PMCID: PMC5962306