A combination of gabapentin and opioids may not be more effective than opioids alone at alleviating chronic pain, according to results presented at the American Academy of Pain Medicine 2019 annual meeting, held March 6-10, in Denver, Colorado.

Despite the scarcity of robust evidence, the prescribing of gabapentin to treat chronic pain — in particular, chronic low back pain — has increased by 535% over the past 10 years.

The study included participants with chronic pain taking gabapentin in combination with opioids who were matched for propensity with control participants taking opioids only (n=78 in each group). The primary outcome was the safety and efficacy of gabapentin plus opioids compared with opioids alone. The main cause of pain in this cohort was chronic low back pain (60.89%). The average participant age was 59.95±14 years, and the average duration of follow-up was 30.26±11.75 months. The average morphine milligram equivalent in the cohort was 59.22±78. Pain intensity was assessed using a 0 to 10 numeric rating scale.

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Participants in both groups reported improvements in pain intensity compared with baseline (-3.36±1.94; P <.01). Participants taking a gabapentin plus opioid combination had a lower average reduction in numeric rating score (-2.81±1.96) compared with those taking opioids alone (-3.91±1.77; P <.01).

“Our results are in line with recent guidelines for low back pain treatment that reflect the need to assess the recommendation of gabapentinoids for chronic pain in patients already taking opioids to mitigate risk factors of abuse and overdose,” the researchers noted.

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Reference

Knezevic NN, Ortega ARC, Aijaz T, Shamsipour S, Candido KD. Combination of gabapentin and opioids is not superior to opioids alone in pain relief in chronic pain patients. Presented at: American Academy of Pain Medicine 2019 annual meeting; March 6-10, 2019; Denver, CO. Abstract 152.