Purpose
Gabapentinoids are commonly prescribed for the treatment of neuropathic pain but are
not recommended for the primary treatment of carpal tunnel syndrome (CTS). We sought
(1) to investigate the preoperative use of gabapentinoids for the treatment of CTS
and (2) to determine whether preoperative exposure is associated with persistent gabapentinoid
and opioid use after carpal tunnel release.
Methods
We performed a retrospective cohort study using IBM MarketScan Research Databases
(2010–2017) of patients who did not fill a gabapentinoid or opioid prescription within
3 months of a new CTS diagnosis undergoing surgical release. Our primary outcomes
included preoperative gabapentinoid prescription fills associated with CTS and persistent
prescription fills of gabapentinoids and opioids at 91 to 180 days after surgery.
Multivariable logistic regression models were used to evaluate the association between
patient-level factors and persistent gabapentinoid and opioid use.
Results
Of the 56,593 patients without a previous gabapentinoid or opioid prescription prior
to diagnosis of CTS, 3,474 patients (6%) filled a gabapentinoid prescription before
carpal tunnel release. Overall, 835 patients (24% of the preoperative users) continued
to fill gabapentinoid prescriptions at 91 to 180 days after surgery. Of the preoperative
gabapentinoid users, 20% (702 patients) continued to fill opioid prescriptions at
91 to 80 days after release. After adjusting for patient characteristics, preoperative
gabapentinoid use was associated with increased odds of persistent postoperative gabapentinoid
use (preoperative gabapentinoid, 22% adjusted probability; 95% confidence interval
[95% CI], 20.3%–23.0%, no preoperative gabapentinoid use, 1%; 95% CI, 1.2%–1.4%) and
persistent postoperative opioid use (preoperative gabapentinoid, 18% adjusted probability;
95% CI, 17%–20%), no preoperative gabapentinoid, 9%; 95% CI, 8.6%–9.1%).
Conclusions
Despite a lack of evidence to support the use of gabapentinoids for CTS, 6% of patients
are prescribed a gabapentinoid prior to surgery, and prolonged use is common. Given
the effectiveness of surgical release and the risks associated with gabapentinoids,
greater attention is needed to ensure that gabapentinoids are prescribed appropriately,
avoided when possible, and stopped after surgery.
Type of study/level of evidence
Prognostic II.
Key words
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References
- Gabapentin, opioids, and the risk of opioid-related death: a population-based nested case-control study.PLoS Med. 2017; 14e1002396
- How addictive are gabapentin and pregabalin? A systematic review.Eur Neuropsychopharmacol. 2017; 27: 1185-1215
- On the addictive power of gabapentinoids: a mini-review.Psychiatr Danub. 2018; 30: 142-149
- Gabapentin use, abuse, and the US opioid epidemic: the case for reclassification as a controlled substance and the need for pharmacovigilance.Risk Manag Healthc Policy. 2018; 11: 109-116
- Important Notice: Gabapentin Becomes a Schedule 5 Controlled Substance in Kentucky.(Available at:)https://pharmacy.ky.gov/Documents/Gabapentin%20-%20Schedule%20V%20Controlled%20Substance.pdfDate accessed: May 14, 2019
- Neurontin (gabapentin).(Available at:)https://www.accessdata.fda.gov/drugsatfda_docs/label/2011/020235s036,020882s022,021129s022lbl.pdfDate accessed: June 16, 2019
- Drug Approval Package: Lyrica (Pregabalin).(Available at:)https://www.accessdata.fda.gov/drugsatfda_docs/nda/2017/209501Orig1s000TOC.cfmDate accessed: June 26, 2019
- A clinical overview of off-label use of gabapentinoid drugs.JAMA Intern Med. 2019; 179: 695-701
- Gabapentin for the symptomatic treatment of painful neuropathy in patients with diabetes mellitus: a randomized controlled trial.JAMA. 1998; 280: 1831-1836
- Gabapentin use in neuropathic pain syndromes.Acta Neurol Scand. 2000; 101: 359-371
- Gabapentin and pregabalin for pain—is increased prescribing a cause for concern?.N Engl J Med. 2017; 377: 411-414
- Carpal tunnel syndrome in Rochester, Minnesota, 1961 to 1980.Neurology. 1988; 38: 134-138
- Prevalence of carpal tunnel syndrome in a general population.JAMA. 1999; 282: 153-158
- Management of Carpal Tunnel Syndrome Evidence-Based Clinical Practice Guideline. February 29, 2016.(Available at:)
- Gabapentin for the treatment of carpal tunnel syndrome: a randomized controlled trial.Eur J Neurol. 2011; 18: 726-730
- IBM MarketScan Research Databases for Life Sciences Researchers. 2019.(Available at:)https://www.ibm.com/products/marketscan-research-databasesDate accessed: March 12, 2020
- IASP Task Force for the Classification of Chronic Pain in ICD-11 Prepares New Criteria on Postsurgical And Posttraumatic Pain.(Available at:)http://www.iasp-pain.org/PublicationsNews/NewsDetail.aspx?ItemNumber=5134&navItemNumber=643Date accessed: June 11, 2019
- Rates and risk factors for prolonged opioid use after major surgery: population based cohort study.BMJ. 2014; 348: g1251
- New persistent opioid use after minor and major surgical procedures in US adults.JAMA Surg. 2017; 152e170504
- Risk of prolonged opioid use among opioid-naive patients following common hand surgery procedures.J Hand Surg Am. 2016; 41: 947-957.e3
- Effect of perioperative gabapentin on postoperative pain resolution and opioid cessation in a mixed surgical cohort: a randomized clinical trial.JAMA Surg. 2018; 153: 303-311
- Effects of gabapentin on pain and opioid consumption after abdominal hysterectomy.Pain Res Manag. 2013; 18: 94-96
- A new method of classifying prognostic comorbidity in longitudinal studies: development and validation.J Chron Dis. 1987; 40: 373-383
- Adapting a clinical comorbidity index for use with ICD-9-CM administrative databases.J Clin Epidemiol. 1992; 45: 613-619
- CDC guideline for prescribing opioids for chronic pain—United States, 2016.JAMA. 2016; 315: 1624-1645
- Gabapentin misuse, abuse and diversion: a systematic review.Addiction. 2016; 111: 1160-1174
- Prevalence of gabapentin abuse: comparison with agents with known abuse potential in a commercially insured US population.Clin Drug Investig. 2017; 37: 763-773
- The analgesic effects of perioperative gabapentin on postoperative pain: a meta-analysis.Reg Anesth Pain Med. 2006; 31: 237-247
- Postoperative multimodal analgesia pain management with nonopioid analgesics and techniques: a review.JAMA Surg. 2017; 152: 691-697
- Impact of pregabalin on acute and persistent postoperative pain: a systematic review and meta-analysis.Br J Anaesth. 2015; 114: 10-31
- Gabapentinoid use in the United States 2002 through 2015.JAMA Intern Med. 2018; 178: 292-294
- Abuse and misuse of pregabalin and gabapentin.Drugs. 2017; 77: 403-426
- Fibromyalgia survey criteria are associated with increased postoperative opioid consumption in women undergoing hysterectomy.Anesthesiology. 2015; 122: 1103-1111
- Heritability of the fibromyalgia phenotype varies by age.Arthritis Rheumatol. 2020; 72: 815-823
- Preliminary validation of the Michigan Body Map.Pain. 2016; 157: 1205-1212
- Characteristics of fibromyalgia independently predict poorer long-term analgesic outcomes following total knee and hip arthroplasty.Arthritis Rheumatol. 2015; 67: 1386-1394
- Association between the 2011 fibromyalgia survey criteria and multisite pain sensitivity in knee osteoarthritis.Clin J Pain. 2018; 34: 909-917
- Pregabalin's abuse potential: a mini review focusing on the pharmacological profile.Int J Clin Pharmacol Ther. 2014; 52: 709-716
- Schedules of controlled substances: placement of pregabalin into schedule V. Final rule.Fed Regist. 2005; 70: 43633-43635
- House Bill 1832.(Available at:)http://wapp.capitol.tn.gov/apps/BillInfo/default.aspx?BillNumber=HB1832&GA=110Date accessed: May 14, 2019
- Gabapentin Scheduled as Controlled Substance to Help with State's Opioid Epidemic.(Available at:)https://www.michigan.gov/lara/0,4601,7-154-11472-487050--,00.htmlDate accessed: June 11, 2019
Article info
Publication history
Published online: May 30, 2020
Accepted:
April 15,
2020
Received:
September 4,
2019
Footnotes
No benefits in any form have been received or will be received related directly or indirectly to the subject of this article.
This article does not necessarily represent the views of the U.S. Government or Department of Veterans Affairs.
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© 2020 by the American Society for Surgery of the Hand. All rights reserved.
