Trajectories of pregabalin use and their association with longitudinal changes in opioid and benzodiazepine use.
Journal
Pain
ISSN: 1872-6623
Titre abrégé: Pain
Pays: United States
ID NLM: 7508686
Informations de publication
Date de publication:
01 05 2022
01 05 2022
Historique:
received:
19
03
2021
accepted:
11
07
2021
pubmed:
13
8
2021
medline:
20
4
2022
entrez:
12
8
2021
Statut:
ppublish
Résumé
Concomitant use of pregabalin with opioids and/or benzodiazepines is common, despite the increased risks. However, clinical trials suggest pregabalin can have an opioid-sparing effect when treating acute postoperative pain. We explored how opioid and benzodiazepine use changed over time in people initiating pregabalin, using dispensing claims data for a 10% sample of Australians (2013-19). Among 142,776 people initiating pregabalin (median age = 61 years, 57% female), we used group-based trajectory modelling to identify 6 pregabalin dose trajectories in the first year postinitiation. Two trajectories involved discontinuation: after one dispensing (49%), and after 6 months of treatment (14%). Four trajectories involved persistent use with variable estimated median daily doses of 39 mg (16%), 127 mg (14%), 276 mg (5%), and 541 mg (2%). We quantified opioid and benzodiazepine use in the year before and after pregabalin initiation using generalised linear models. Over the study period, 71% were dispensed opioids and 34% benzodiazepines, with people on the highest pregabalin dose having highest rates of use. Opioid use increased postpregabalin initiation. Among people using both opioids and pregabalin, the geometric mean daily dose in oral morphine equivalents increased after pregabalin initiation in all trajectories, ranging from +5.9% (99% confidence interval 4.8%-7.0%) to +39.8% (99% confidence interval 38.3%-41.5%) in people on the highest daily pregabalin dose. Among people using both pregabalin and benzodiazepines, the dose remained constant over time for people in all trajectories. Notwithstanding its reputation as opioid-sparing, in this outpatient setting, we observed that people using opioids tended to use higher opioid daily doses after pregabalin initiation, especially those on high pregabalin doses.
Identifiants
pubmed: 34382609
doi: 10.1097/j.pain.0000000000002433
pii: 00006396-202205000-00008
doi:
Substances chimiques
Analgesics, Opioid
0
Benzodiazepines
12794-10-4
Pregabalin
55JG375S6M
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
e614-e621Informations de copyright
Copyright © 2021 International Association for the Study of Pain.
Références
Appleyard T, Ashworth J, Bedson J, Yu D, Peat G. Trends in gabapentinoid prescribing in patients with osteoarthritis: a United Kingdom national cohort study in primary care. Osteoarthritis Cartilage 2019;27:1437–44.
Australian Government Department of Health. Pharmaceutical benefits scheme (PBS)|Pregabalin. 2020. Available at: https://www.pbs.gov.au/medicine/item/2335X-2348N-2355Y-2363J . Accessed July 28, 2020.
Australian Government Department of Health. Pregabalin: 24 month predicted versus actual analysis. 2015. Available at: http://www.pbs.gov.au/info/industry/listing/participants/public-release-docs/2015-10/pregabalin-24month-analysis-dusc-prd-10-2015-abstract . Accessed September 4, 2019.
Australian medicines handbook. Pregabalin, 2020. Available at: https://amhonline-amh-net-au/chapters/neurological-drugs/antiepileptics/other-antiepileptics/pregabalin . Accessed July 23, 2020.
Bates D, Schultheis BC, Hanes MC, Jolly SM, Chakravarthy KV, Deer TR, Levy RM, Hunter CW. A comprehensive algorithm for management of neuropathic pain. Pain Med 2019;20:S2–S12.
Brett J, Murnion B. Management of benzodiazepine misuse and dependence. Aust Prescr 2015;38:152–5.
Bykov K, Bateman BT, Franklin JM, Vine SM, Patorno E. Association of gabapentinoids with the risk of opioid-related adverse events in surgical patients in the United States. JAMA Netw Open 2020;3:e2031647.
Cairns R, Schaffer AL, Ryan N, Pearson SA, Buckley NA. Rising pregabalin use and misuse in Australia: trends in utilization and intentional poisonings. Addiction 2019;114:1026–34.
Chen Y, Campbell P, Strauss VY, Foster NE, Jordan KP, Dunn KM. Trajectories and predictors of the long-term course of low back pain: cohort study with 5-year follow-up. PAIN 2018;159:252–60.
Chiu T, Brett J, Pearson S-A, Schaffer AL. Patterns of pregabalin initiation and discontinuation after its subsidy in Australia. Br J Clin Pharmacol 2020;86:1882–7.
Crossin R, Scott D, Arunogiri S, Smith K, Dietze PM, Lubman DI. Pregabalin misuse-related ambulance attendances in Victoria, 2012–2017: characteristics of patients and attendances. Med J Aust 2019;210:75–9.
Deyo RA, Bryan M, Comstock BA, Turner JA, Heagerty P, Friedly J, Avins AL, Nedeljkovic SS, Nerenz DR, Jarvik JG. Trajectories of symptoms and function in older adults with low back disorders. Spine (Phila Pa 1976) 2015;40:1352–62.
Dixon WJ. Simplified estimation from censored normal samples. Ann Math Stat 1960;31:385–91.
Driot D, Jouanjus E, Oustric S, Dupouy J, Lapeyre‐Mestre M. Patterns of gabapentin and pregabalin use and misuse: results of a population‐based cohort study in France. Br J Clin Pharmacol 2019;85:1260–1269.
Dunn KM, Jordan K, Croft PR. Characterizing the course of low back pain: a latent class analysis. Am J Epidemiol 2006;163:754–61.
Enke O, New HA, New CH, Mathieson S, McLachlan AJ, Latimer J, Maher CG, Lin CC. Anticonvulsants in the treatment of low back pain and lumbar radicular pain: a systematic review and meta-analysis. CMAJ 2018;190:E786–93.
Federico CA, Wang T, Doussau A, Mogil JS, Fergusson D, Kimmelman J. Assessment of pregabalin postapproval trials and the suggestion of efficacy for new indications: a systematic review. JAMA Intern Med 2019;179:90–7.
Finnerup NB, Attal N, Haroutounian S, McNicol E, Baron R, Dworkin RH, Gilron I, Haanpää M, Hansson P, Jensen TS, Kamerman PR, Lund K, Moore A, Raja SN, Rice AS, Rowbotham M, Sena E, Siddall P, Smith BH, Wallace M. Pharmacotherapy for neuropathic pain in adults: a systematic review and meta-analysis. Lancet Neurol 2015;14:162–73.
Giummarra MJ, Gibson SJ, Allen AR, Pichler AS, Arnold CA. Polypharmacy and chronic pain: harm exposure is not all about the opioids. Pain Med 2015;16:472–9.
Gomes T, Juurlink DN, Antoniou T, Mamdani MM, Paterson JM, van den Brink W. Gabapentin, opioids, and the risk of opioid-related death: a population-based nested case–control study. PLOS Med 2017;14:e1002396.
Goodman CW, Brett AS. Gabapentin and pregabalin for pain—is increased prescribing a cause for concern? N Engl J Med 2017;377:411–14.
Iacobucci G. UK government to reclassify pregabalin and gabapentin after rise in deaths. BMJ 2017;358:j4441.
Isoardi KZ, Polkinghorne G, Harris K, Isbister GK. Pregabalin poisoning and rising recreational use: a retrospective observational series. Br J Clin Pharmacol 2020;86:2435–40.
Johansen ME. Gabapentinoid use in the United States 2002 through 2015. JAMA Intern Med 2018;178:292–4.
Jones BL, Nagin DS, Roeder K. A SAS procedure based on mixture models for estimating developmental trajectories. Sociol Methods Res 2001;29:374–93.
Knezevic NN, Aijaz T, Ortega-Camacho A, Candido KD. A retrospective analysis of gabapentinoid and opioids to opioid monotherapy for pain relief in patients with chronic neck and low back pain. Pain Med 2021;6:1760–66.
Kwok H, Khuu W, Fernandes K, Martins D, Tadrous M, Singh S, Juurlink DN, Gomes T. Impact of unrestricted access to pregabalin on the use of opioids and other CNS-active medications: a cross-sectional time series analysis. Pain Med 2017;18:1019–26.
Lynn E, Cousins G, Lyons S, Bennett KE. A repeated cross-sectional study of factors associated with pregabalin-positive poisoning deaths in Ireland. Drug Alcohol Depend 2020;206:107741.
Mathieson S, Lin CC, Underwood M, Eldabe S. Pregabalin and gabapentin for pain. BMJ 2020;369:m1315.
Maust DT, Strominger J, Kim HM, Langa KM, Bynum JPW, Chang C-H, Kales HC, Zivin K, Solway E, Marcus SC. Prevalence of central nervous system–active polypharmacy among older adults with dementia in the US. JAMA 2021;325:952–61.
Mealing NM, Dobbins TA, Pearson SA. Validation and application of a death proxy in adult cancer patients. Pharmacoepidemiol Drug Saf 2012;21:742–8.
Montastruc F, Loo SY, Renoux C. Trends in first gabapentin and pregabalin prescriptions in primary care in the United Kingdom, 1993-2017. JAMA 2018;320:2149–51.
Nagin DS, Odgers CL. Group-based trajectory modeling in clinical research. Annu Rev Clin Psychol 2010;6:109–38.
Nielsen S, Degenhardt L, Hoban B, Gisev N. A synthesis of oral morphine equivalents (OME) for opioid utilisation studies. Pharmacoepidemiol Drug Saf 2016;25:733–7.
Nielsen S, Gisev N, Leung J, Clare P, Bruno R, Lintzeris N, Larance B, Blyth F, Hall W, Cohen M, Degenhardt L, Farrell M, Campbell G. Clinical correlates and outcomes associated with pregabalin use among people prescribed opioids for chronic non-cancer pain: a five-year prospective cohort study. Br J Clin Pharmacol 2021;87:3092–104.
Nielsen S, Lintzeris N, Bruno R, Campbell G, Larance B, Hall W, Hoban B, Cohen ML, Degenhardt L. Benzodiazepine use among chronic pain patients prescribed opioids: associations with pain, physical and mental health, and health service utilization. Pain Med 2015;16:356–66.
Ohnuma T, Raghunathan K, Moore S, Setoguchi S, Ellis AR, Fuller M, Whittle J, Pyati S, Bryan WE, Pepin MJ, Bartz RR, Haines KL, Krishnamoorthy V. Dose-dependent association of gabapentinoids with pulmonary complications after total hip and knee arthroplasties. J Bone Joint Surg Am 2020;102:221–9.
Rahman A, Kane J, Montastruc F, Renoux C. Trends in new prescription of gabapentinoids and of coprescription with opioids in the four nations of the United Kingdom, 1993-2017. Br J Clin Pharmacol 2021;87:3349–53.
Royal Australian College of General Practitioners. Prescribing drugs of dependence in general practice. 2019. Available at: https://www.racgp.org.au/clinical-resources/clinical-guidelines/key-racgp-guidelines/view-all-racgp-guidelines/drugs-of-dependence/part-b/contraindications-and-precautions-in-special-group . Accessed November 2, 2020.
Rundell SD, Phelan EA, Patel KV, Jones BL, Marcum ZA. Longitudinal patterns of pain reporting among community-dwelling older adults. Clin J Pain 2020;36:912–22.
Schaffer AL, Busingye D, Chidwick K, Brett J, Blogg S. Pregabalin prescribing patterns in Australian general practice, 2012-2018: a cross-sectional study. BJGP Open 2021;5:5.
Schaffer AL, Zoega H, Tran DT, Buckley NA, Pearson S, Havard A. Trajectories of antipsychotic use before and during pregnancy and associated maternal and birth characteristics. Aust N Z J Psychiatry 2019;53:1208–21.
Serpell M, Latymer M, Almas M, Ortiz M, Parsons B, Prieto R. Neuropathic pain responds better to increased doses of pregabalin: an in-depth analysis of flexible-dose clinical trials. J Pain Res 2017;10:1769–76.
Clair CO St., Golub NI, Ma Y, Song J, Winiecki SK, Menschik DL. Characteristics associated with U.S. Outpatient opioid analgesic prescribing and gabapentinoid Co-prescribing. Am J Prev Med 2020;58:e11–19.
Therapeutic Guidelines Limited. Neuropathic pain. eTG, 2019. Available at: https://tgldcdp.tg.org.au/viewTopic?topicfile=neuropathic-pain&guideline . Accessed October 3, 2019.
Tiippana EM, Hamunen K, Kontinen VK, Kalso E. Do surgical patients benefit from perioperative gabapentin/pregabalin? A systematic review of efficacy and safety. Anesth Analg 2007;104:1545–56, table of contents.
Torrance N, Veluchamy A, Zhou Y, Fletcher EH, Moir E, Hebert HL, Donnan PT, Watson J, Colvin LA, Smith BH. Trends in gabapentinoid prescribing, co-prescribing of opioids and benzodiazepines, and associated deaths in Scotland. Br J Anaesth 2020;125:159–67.
Votrubec M, Thong I. Neuropathic pain—a management update. Aust Fam Physician 2013;42:92–7.
Yu D, Appleyard T, Cottrell E, Peat G. Co-prescription of gabapentinoids and opioids among adults with and without osteoarthritis in the United Kingdom between 1995 and 2017. Rheumatology (Oxford) 2021;60:1942–50.
Zhou L, Bhattacharjee S, Kwoh CK, Tighe PJ, Reisfield GM, Malone DC, Slack M, Wilson DL, Chang CY, Lo-Ciganic WH. Dual-trajectories of opioid and gabapentinoid use and risk of subsequent drug overdose among Medicare beneficiaries in the United States: a retrospective cohort study. Addiction 2021;116:819–30.