Things We Do for No Reason™: Prescribing gabapentinoids for pain - PubMed
5 days ago
- #off-label use
- #pain management
- #gabapentinoids
- Gabapentin and pregabalin are among the most frequently prescribed medications in the US, with gabapentin in the top 10 and pregabalin in the top 100.
- Most use of gabapentinoids is for off-label pain indications despite FDA approval only for select neuropathic conditions.
- Randomized trials show minimal or clinically insignificant benefit for most off-label pain syndromes.
- Gabapentinoids are associated with adverse effects like sedation, falls, delirium, respiratory depression, misuse, and hospitalization, especially when combined with opioids or in cases of renal impairment.
- Given limited efficacy and potential harms, gabapentinoids should not routinely substitute for opioids.
- Clinicians should reassess indications, deprescribe when appropriate, and prioritize nonpharmacologic strategies for pain management.