Anticonvulsants as Analgesics: 11 Questions on Benefits vs Risks

Question 1. Between 2012 and 2016, the number of prescriptions for gabapentin in the US increased by approximately how much?

Answer: E. >50%. The number of gabapentin prescriptions increased from 39 million in 2012 to 64 million in 2016.¹

Question 2. True or false? Sales of pregabalin doubled in the US from 2012 to 2016.

Answer: A. True. Between 2012 and 2016, the sales of pregabalin in the US increased from $2 billion to over $4 billion.¹

Question 3. Gabapentin is FDA-approved for the management of which of the above conditions?

Answer: B. Postherpetic neuralgia. This is the only pain condition for which gabapentin is FDA-approved.

Question 4. Pregabalin is FDA-approved for the management of which of the above conditions?

Answer: E. All of the above. Pregabalin is FDA-approved for the management fibromyalgia, postherpetic neuralgia, diabetic neuropathic pain, and neuropathic pain secondary to spinal cord injuries.

Question 5. True or false? Although neither gabapentin or pregabalin is FDA-approved for LBP or sciatica, current research indicates both drugs are effective treatment for both conditions.

Answer: B. False. Studies on anticonvulsants, including gabapentin and pregabalin, for LBP and sciatica have failed to show efficacy for either type of pain.^2,3

Question 6. True or false? Prescribing gabapentin or pregabalin together with an opioid has been established as being safe.

Answer: B. False. Although there is limited research on the safety of co-prescribing pregabalin and opioids, there is evidence that prescribing gabapentin with opioids increases the risk of opioid-related death. As pregabalin and gabapentin appear to have similar modes of action, it is probable that there would be similar concerns about pregabalin.⁴

Question 7. A recent study on patients with chronic pain found that prescribing gabapentin and opioids together vs opioids alone increased the risk of opioid-related deaths by how much?

Answer: E. >50%. The study found that in patients with chronic pain, the use of gabapentin and an opioid together increased the risk of opioid related deaths by 60% vs patients just taking an opioid.⁴

Question 8. True or false? Using a standard measurement of abuse potential, it has been found that gabapentin and pregabalin have a high level for potential abuse.

Answer: A. True. Measures of abuse potential for gabapentin (19%) and pregabalin (15%) were found to be higher vs alprazolam (14%) and zolpidem (13%); both gabapentin and pregabalin met the standard threshold value of 15% that indicates high potential for abuse.⁶

Question 9. Risk factors for gabapentin and pregabalin abuse appear to include which of the above?

Answer: D. All of the above. All of these factors appear to increase the risk of gabapentin and pregabalin abuse. However, the factor that seems to increase the risk the most is a history of opioid abuse with reports that as many as 68% of opioid abusers may also abuse the anticonvulsants.^5,6

Question 10. In small clinical studies, gabapentinoids have displayed drug-liking effects similar to which of the above?

Answer: E. A and B. Gabapentinoids have displayed drug-liking effects similar to tetrahydrocannabinol and diazepam. Anecdotal reports from recreational users describe effects including sedation, dissociation, relaxation, numbness contentment, uninhibited behavior, improved sociability, empathy, or audio/visual hallucinations.⁶

Question 11. Which of the above appears to be true of opioids and/or gabapentinoids?