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Taking gabapentin, a medication known to help fight pain in some people, before and after surgery can help reduce the need for opioid painkillers.
So concluded a study published today in JAMA by a team of researchers at Stanford University. The study compared about 200 surgical patients given placebo v. 200 surgical patients given gabapentin.
Surgeries performed on patients participating in the study included breast lumpectomies, total knee replacements, shoulder surgery, hand surgery, carpal tunnel surgery and more. You can read the full study for yourself by clicking here.
Under the brand name Neurontin, gabapentin for years has been used as a backup pain reliever. Mostly, it’s used to treat seizures.
It is in a class of drugs called anticonvulsants. Little is understood about how gabapentin works on pain, and many say it has miserable side effects. Many patients report it does nothing at all for them.
Also, the drug is not without additional controversy. Gabapentin has been associated with an increased risk of anxiety, panic attacks, insomnia and suicidal thoughts too, as reported by Healthline.com.
Research also has shown gabapentin can cause respiratory depression and sleep apnea, not only in the elderly but in others as well. The elderly appear to be particularly at risk, however, according to the researchers.
But the researchers concluded that those given gabapentin for three days after surgery ceased taking opioids about 25 percent faster than those who didn’t.
Those given placebo were given an “active placebo” – in this case, lorazepam (Xanax) – before surgery.
They were given active placebo so they would think they were given a true sedative medicine prior to surgery. While lorazepam (Xanax, anxiety medication) can be dangerous, highly addictive and deadly, particularly for those also addicted to opioids, in this case only a modest does was given, and only once.
“The placebo group received one capsule of active placebo (lorazepam, 0.5 mg) and three capsules of inactive placebo preoperatively, followed by two capsules of inactive placebo three times a day starting on postoperative day one and continued for 72 hours (10 total doses),”the researchers explained.
“Post- operatively, active placebo was considered unnecessary since most patients received other analgesic medications. The treatment group received 4 capsules of gabapentin, 300 mg (1200 mg total), preoperatively and two capsules of gabapentin, 300 mg, three times a day (600 mg three times a day) postoperatively (10 total doses).”
Gabapentin didn’t reduce pain, mechanism of action uncertain
There was no reported reduction in pain for patients receiving gabapentin, even though they ceased opioids sooner after surgery than those who received placebo.
“Following a preplanned interim analysis, the study was stopped early for meeting a futility stopping boundary with regard to the primary end point: time to pain cessation,” the researchers wrote.
Gabapentin already is frequently given to opioid addicts who enter treatment, the researchers noted. It is believed it helps prevent hyperalgesia Hyperalgesia is when a person receiving opioids actually experiences pain from the opioids.
“Gabapentin significantly increased the rate of opioid cessation after hospital discharge,” the researchers concluded. “This finding resonates with earlier work suggesting that the determinants of the rate of opioid cessation are largely independent of the duration of pain and the determinants of time to pain resolution.”
Doctors not related to the research say it’s just a start
In an accompanying invited commentary, Drs. Michael Ashburn and Lee Fleisher point out shortcomings in the study but laud its efforts. They say more research into gabapentin and therapeutics like it, administered in conjunction with surgical procedures, is needed.
A small number of patients in each study group continued receiving opioids and reported continued pain for a year after surgery. Unfortunately, chronic pain develops in many patients following surgery, leading to long-term opioid use.
“The conduct of the anesthetic was not standardized, nor could it be, given the variety of surgical procedures included in this study,” the commentators noted. “However, the conduct of the anesthetic, especially with regard to the use of perioperative regional anesthesia, could certainly affect the patient’s pain experience and perhaps influence the development of chronic pain following surgery.
“Likewise, it appears that the prescribing of opioids following surgery was also not standardized and was left to the discretion of the treating physician.”
Unfortunately, that is the way it works. The CDC has been urging doctors to become extraordinarily judicious about prescribing opioids and adhere to the ever-evolving best practices.
Cbeck out my report on opioid addiction from the American College of Physicians Conference Internal Medicine Meeting in San Diego that I attended this year:
You can find me on Twitter @DavidHeitz