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Gabapentin for pain : New evidence from hidden data

Therapeutics Initiative (University of British Columbia)

Therapeutics Letter 75 examines new evidence from unpublished trials on the use of gabapentin for pain. Conclusions and recommendations Misleading promotion pushed gabapentin to blockbuster status; scientific evidence suggests gabapentin has a minor role in pain control. Gabapentin reduces neuropathic pain by < 1 point on a 0-10 point scale and benefits about 15% of carefully selected patients (NNT=6-8). A similar proportion of people suffer harm (NNH=8). A test of benefit/harm can be made after 1-2 days at a low dose (100-900 mg/day). Benefit is unlikely to increase with higher doses or longer treatment. Opioids afford greater relief in chronic neuropathic pain, with qualitatively different adverse effects. Use particular caution for people at risk of cognitive impairment, balance disturbance, falls, or when edema is undesirable (e.g. peripheral vascular disease in the elderly). Reassess patients already taking gabapentin at least every 2 months. The short elimination half-life allows reassessment of benefit vs. harm by stopping the drug for 1-2 days (longer if kidney function is impaired). Gabapentin has no role in acute nociceptive pain. Benefits and harms of pregabalin are similar to gabapentin, at higher cost.

Other

eng

2023-06-20

Attribution-NonCommercial-NoDerivatives 4.0 International

http://hdl.handle.net/2429/85064

Reviewed

http://creativecommons.org/licenses/by-nc-nd/4.0/