Nerve Pain Med Prescriptions Triple Amid Opioid Crisis

By Paul Gaita 01/15/18
One expert believes that the surge is being driven by doctors attempting to use the nerve pain medication as a substitute for opioids.
Pharmacist holding a medicine Lyrica box for treatment neuropathic pain in pharmacy drugstore.

Prescriptions for nerve pain medications, such as Neurontin or Lyrica, have increased in the last decade, but with that elevated number also come concerns that the off-label use of the drugs may have health consequences.

Reuters has reported that a new study suggests that the use of these nerve pain drugs, known as gabapentinoids, among older adults who are already taking opioids or benzodiazepines like Valium, could pose health threats, including dependency and the risk of fatality.

Given the fact that gabapentinoids have been proposed as an alternative to opioid use by the Centers for Disease Control and Prevention (CDC), the study authors suggest that greater research into their interaction with prescription pain medication, as well as more careful monitoring of the medications by doctors and patients alike, may be a necessity.

The study, published on JAMA Internal Medicine by Dr. Michael E. Johansen of the Heritage College of Osteopathic Medicine at Ohio University in Athens, looked at survey data compiled from a nationally representative sample of more than 346,000 adults; included in the data was information on their medical conditions and prescriptions.

The data revealed that the greatest increase in gabapentinoid prescriptions were among older adults and patients already taking opioids or benzodiazepines like Valium or Xanax. 

Four out of five of those prescriptions were for gabapentin, a drug approved for use by the Food and Drug Adminstration (FDA) for treating partial seizures and nerve pain caused by shingles. The increase in use of gabapentinoids among the study subjects reflects elevated prescription on a national level, which rose 3.9% in 2015, up from 1.2% in 2002.

However, the FDA does not allow the drugs' manufacturers to promote their product for conditions for which they are not approved. But doctors are allowed to prescribe gabapentinoids for unapproved usage, which is where Johansen suggests that patients and doctors should be concerned.

"My suspicion is that much of the use is driven by attempting to treat chronic pain with a non-opioid medication," he was quoted as saying in the Reuters story. "We have little data to support much use of this drug class and minimal data to support the long-term safety of the medications." Common side effects of gabapentinoid use include dizziness, vomiting, and memory loss.

Other researchers not involved in Johnasen's study echoed his concerns. "The use of gabapentinoids specifically seems to be outpacing any proven efficacy, and the potential significant harms like addiction and overdose are only beginning to be investigated," said Dr. Christopher Goodman, a researcher at the University of South Carolina School of Medicine.

Reuters also quotes Marissa Seamans, a researcher at the Johns Hopkins Bloomberg School of Public Health, who notes that "gabapentinoids are increasingly prescribed to patients with opioids and benzodiazepines, which increases the risk of respiratory depression and death. Clinicians and patients need to carefully monitor the dosage of these medicines, their interactions, and potentially fatal side effects."

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Paul Gaita lives in Los Angeles. He has contributed to the Los Angeles Times, Variety, LA Weekly, and The Los Angeles Beat, among many other publications and websites.