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TOPLINE: 

Use of gabapentinoids by adults in the United States has increased from 4% of the population in 2015 to 4.7% in 2021, according to a study published online on January 22 in Annals of Family Medicine. In many cases, the drugs may be prescribed off label for chronic pain conditions, for which "minimal evidence supporting use" exists, the researchers said.

METHODOLOGY: 

• Researchers analyzed data from the 2002-2021 Medical Expenditure Panel Survey to examine how many adults use gabapentinoids, including gabapentin and pregabalin.
• The study included cross-sectional data from 488,348 individuals and longitudinal data from 196,589 individuals.

TAKEAWAY:

• Use of gabapentin has increased since 2008; use of pregabalin has remained steady.
• Between 2017 and 2021, most patients using gabapentinoids reported having musculoskeletal pain and diabetes. Other relatively common conditions included anxiety, insomnia, and low back pain. 
• Gabapentin and pregabalin are approved to treat postherpetic neuralgia and epilepsy. In addition, pregabalin is approved to treat fibromyalgia as well as neuropathic pain associated with diabetic peripheral neuropathy or spinal cord injury.
• Use of the medications is more common among patients taking other classes of medications that act on the central nervous system, and gabapentinoids commonly are used with "sedating medications, which is concerning in light of the US Food and Drug Administration's 2019 warning about co-prescribing of gabapentinoids with other central nervous system depressants," the study authors wrote. 
• Such combinations can cause life-threatening breathing difficulties.

IN PRACTICE: 

"Gabapentinoid users continued to increase following our 2015 publication despite a dearth of evidence supporting use in many cases; while these clinical scenarios can be challenging, continuation should be reconsidered at regular intervals," the researchers wrote. 

SOURCE: 

The study was conducted by Michael E. Johansen, MD, MS, with Grant Family Medicine, OhioHealth, in Columbus, and Donovan T. Maust, MD, MS, with the Ann Arbor VA Center for Clinical Management Research and the University of Michigan in Ann Arbor. 

LIMITATIONS: 

The researchers were unable to directly link a patient's use of a gabapentinoid to a particular medical condition. The Medical Expenditure Panel Survey changed its data collection procedures in 2020 and 2021 in response to the COVID-19 pandemic. Patients' use of opioids and muscle relaxants may be underreported.

DISCLOSURES: 

Maust receives funding from the National Institute on Drug Abuse.