Characterization of Outpatient Gabapentinoid Prescribing for Pain.

Two statements from national organizations outline recommended minimum effective doses of gabapentin and pregabalin for the treatment of diabetic peripheral neuropathy (DPN). However, studies of real-world gabapentinoid dosing demonstrate that the recommended dose targets are frequently not met and do not consider renal insufficiency. This study aimed to characterize gabapentinoid prescribing patterns in patients receiving primary care at two internal medicine clinics within an academic medical center. This retrospective chart review included adult outpatients who were newly initiated on gabapentin or pregabalin between October 1, 2017 and October 1, 2020 and reviewed for 12 months. A total of 1,221 patients were included in the study with 1,079 (88.4%) prescribed gabapentin and 142 (11.6%) prescribed pregabalin. Only 22.4% of patients prescribed gabapentin and 33.3% of patients prescribed pregabalin with adequate renal function met the minimum effective dosing of gabapentin 1800 mg per day and pregabalin 300 mg per day provided by the American Diabetes Association (ADA) and American Academy of Neurology (AAN). This study supports the need for optimization of gabapentinoid dosing to ensure an adequate trial at the minimum effective dose is completed.

Osteoarthritis in Older Adults: Nonsteroidal Anti-Inflammatory Drugs Versus Opioids.

Persistent pain in older adults as a result of osteoarthritis (OA) has various treatment options, and all of them have significant risks. An oral nonsteroidal anti-inflammatory drug (NSAID) or an opioid can be considered as a treatment option when persistent pain is not controlled by nonpharmacological interventions and regularly scheduled doses of acetaminophen. However, NSAIDs are nephrotoxic and may cause upper gastrointestinal bleeding. These risks can be mitigated through the initiation of a proton-pump inhibitor and careful monitoring of renal function and serum electrolytes. A low-dose opioid taken as needed can be considered as a treatment option if the pain is not controlled by NSAIDs as long as the risks associated with central nervous system depression and dose escalation as a result of tolerance are monitored closely. The complete patient profile must be taken into consideration when determining the best option.