New Concerns About Gabapentin

MDs have struggled to help the millions of people with chronic pain.

For years, opiates were used to help people reduce pain.

Unfortunately the use of opiods has led to the biggest drug problem our country have ever experienced… the opiod crisis.

As the awareness of the opiate problem came to light, MDs trying to help the massive numbers of people in pain have shifted their prescriptions from commonly prescribed opiates like hydrocodone with acetominophen (Lorcet, Lortab, Norco, Vicodin) and other opiod prescriptions to other medications that might help people relieve their pain.

The Rising Use Of Gabapentin

A recent article in The Atlantic (https://www.theatlantic.com/health/archive/2019/12/yes-you-can-overdose-gabapentin/603208/) discusses some real concerns about gabapentin.

A few of the important points from the article…

From 2012 to 2016, Gabapentin prescriptions rose 64%. Gabapentin is now the 10th most commonly prescribed medicine in the US!

The story mentions Kimberly Reynolds, a researcher at the University of Pittsburgh, found that people are increasingly using both gabapentin and baclofen to either get high or attempt suicide. From 2013 to 2017, people tried to commit suicide using gabapentin nearly 42,000 times, and thousands more abused or misused the substance.

Recently, there has been a high level of concern that taking this medication is just trading one very serious problem (opiates) for another very serious problem (Gabapentin).

Gabapentin is a central nervous system depressant.

The drug is used as an anticonvulsant used to reduce brain activity in seizure patients.

Gabapentin can lead to withdrawal side effects that can be severe when the medication is discontinued.

Gabapentin is often prescribed with another medication, Baclofen. Baclofen is a centrally acting medication called a ‘muscle relaxer‘ although the medication is a central nervous system depressant meaning it also reduces brain activity.

Baclofen also tends to raise blood sugar which could be a problem for people with diabetes or pre-diabetes.

Gabapentin and Baclofen appear to be a safer alternative to opiates.

The Question Is… Are They Really Safe?

Recent research strongly calls into question whether this is a good alternative to help the people suffering with chronic pain.

Gabapentin and baclofen are both central nervous system depressants which can be problematic for people with mood disorders, take other sedating medications, have depression or are suicidal especially could be at risk of serious problems. People taking opiates or alcohol would be at a higher risk of problems.

A recent 12 week study published in the Journal, Pain found that gabapentin is ineffective for treating back pain.

It had no difference in any outcome when compared to a placebo.

“Gabapentin appears to be ineffective for analgesia in chronic low back pain with or without a radiating component,” according to the study’s authors.

Reference:
A randomized controlled trial of gabapentin for chronic low back pain with and without a radiating component. Pain. 2016 Mar 8. Atkinson JH, Slater MA, Capparelli EV, Patel SM, et al. PubMed PMID: 26963844.

In another study…

A recent systematic review in the Canadian Medical Association Journal looked at the effectiveness of gabapentin for chronic low back pain and lumbar (low back) radicular pain.

Here’s what they found…

Conclusion:

“Evidence to date does not support the use of anti-convulsants for chronic low back pain or lumbar radicular pain.”

“This review found mostly moderate- to high-level quality of evidence suggesting no treatment benefit for pain and disability, and high-level evidence supporting the risk of harms.”

Anticonvulsants in the treatment of low back pain and lumbar radicular pain: a systematic review and meta-analysis. Oliver Enke, et al. CMAJ July 03, 2018 190 (26) E786-E793

https://www.cmaj.ca/content/190/26/E786

So the challenge remains for chronic pain sufferers.

There is no magic pill that will really have a meaningful impact without significant risk.

The biggest problem is this…

Medicine looks at the problem of pain primarily through a chemical lens, so the solution they offer is various chemicals designed to block specific pathways in our bodies which have multiple purposes.

Pain should be considered a neurological problem.

Melzach and Wall first proposed the “gate theory of pain” in 1965.

Essentially the theory talks about a pain gate in the spinal cord which is ‘closed’ by large nerve fibers.

In essence, pain is an imbalance between the small and large nerve fibers. The large fibers from muscles, tendons, and joints turn off the small fibers, the ‘pain’ fibers.

Medication can not change this.

This is why it’s critical that someone suffering from chronic pain sees a chiropractor that understands how to use various movement based treatments to reduce their pain.

Chiropractic is a critical part of pain management and helps so many people reduce their need for pain medications.