While gabapentinoids are often prescribed to treat neuropathic pain, it is not recommended for patients with carpal tunnel syndrome (CTS). Despite this some doctors prescribe it for pre- and post-operative use. The concern with this is that it could lead to persistent gabapentinoid and opioid use, a new study finds.
Gabapentinoids: A Slippery Slope for Carpal Tunnel Patients
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Secondary#carpaltunnel#gabapentinoids
According to a research letter published in JAMA Internal Medicine in February 2018, gabapentinoid use in the U.S. tripled from 2002 to 2015. The spike was in part a response to the opioids epidemic and the push to find alternative drugs for chronic pain. Experts say that the trend is concerning and there is potential for harm.
The study, “Inappropriate Preoperative Gabapentinoid Use Among Patients With Carpal Tunnel Syndrome,” published in the August 2020 issue of the Journal of Hand Surgery, confirms that this concern is warranted and that preoperative gabapentinoid use is a slippery slope for carpal tunnel syndrome patients.
The researchers conducted a retrospective cohort study of patients who didn’t fill a gabapentinoid or opioid prescription within three months of undergoing surgical release between 2010 and 2017.
The primary outcomes were preoperative gabapentinoid prescription fills associated with carpal tunnel syndrome and persistent prescription fills of gabapentinoids and opioids at 91 to 180 days after surgery. Overall, 56,593 patients were included in the study.
According to the data collected, 3,474 patients filled a gabapentinoid prescription before their carpal tunnel release and 835 of them continued to refill it at 91 to 180 days after surgery.
The data confirmed that preoperative gabapentinoid use is 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 opioid use (preoperative gabapentinoid, 18% adjusted probability; 95% CI, 17%-20%), no preoperative gabapentinoid, 9%; 95% CI, 8.6%-9.1%).
The researchers wrote, “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.”
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This is a fascinating development. In my practice we've seen similar outcomes with the revised protocol. The key differentiator seems to be patient selection criteria. Has anyone else noticed the correlation with BMI thresholds?
Great point. I'd push back slightly on the conclusion, the sample size in the cited study is too small to draw population-level inferences. That said, the directional signal is compelling and worth a larger RCT.
We implemented a similar approach last year. Early results are promising but we're still gathering 12-month follow-up data. Happy to share our protocol if anyone is interested.
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