In this episode, I’ll discuss the continuation of newly prescribed gabapentin for acute pain management after hospital discharge.
The frequency of gabapentin use for the treatment of inpatient postoperative pain has increased due to the promotion of multimodal analgesia with the goal of reducing the use of opioids.
A group of authors recently published a retrospective cohort study characterizing the use of newly prescribed gabapentin in hospital inpatients.
Just under 500 patients were analyzed in a randomly generated sample from a single center. The ratio of surgical to medical patients was roughly 2:1.
The top 3 indications for starting gabapentin in the overall cohort were:
1. Multimodal analgesia (~46%)
2. Neuropathic pain (~21%)
3. Postoperative pain (~12%)
The mean daily dose of gabapentin given was roughly 600 mg for both groups. Almost all of the surgical patients and about two-thirds of the medical patients were co-prescribed opioids.
About half of the surgical patients and about four-fifths of the medical patients had their gabapentin continued at discharge. These rates of continuation are significantly higher than the percentage of patients in each cohort that had chronic pain conditions like neuropathic pain where gabapentin might be used long term. Very few patients in the cohort – about 2% – were referred to a pain management specialist on discharge.
This raises the question: What exactly is happening to these many patients who start gabapentin for an acute inpatient pain regimen and are then discharged on gabapentin? Is the gabapentin really intended for chronic use in these patients with acute pain conditions? Are these patients receiving both gabapentin and opioids and therefore at greater risk of respiratory depression?
Gabapentin is not a risk-free alternative to opioids, and the risks of long-term continuation in outpatients for the treatment of acute pain is not well characterized.
As the authors of the study emphasize, incorporating gabapentin into existing opioid stewardship programs makes sense because otherwise, high numbers of patients may continue gabapentin in the outpatient setting unnecessarily which could place them at risk of respiratory depression or other side effects.
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