Abstract
CASE DESCRIPTION: A frail 85-year-old woman with chronic neuropathic pain after hip surgery, not responding to treatment with acetaminophen and morphine patches. Should she be prescribed a gabapentinoid?
DISCUSSION: Gabapentinoids and antidepressants are considered first-line therapies. They achieve clinically relevant (i.e. ≥ 50%) pain reduction in approximately one-third of patients with postherpetic neuralgia and peripheral diabetic neuropathy. Evidence for other types of neuropathic pain is limited. Adverse events occur frequently and are mostly mild in nature; serious adverse effects are rare. Prescription of gabapentinoids in specific patient groups (e.g. elderly patients and patients with a history of depression or substance abuse) deserves careful consideration, because the risk/benefit ratio in those groups may be altered. In order to reduce the risk of withdrawal symptoms, slow tapering is recommended.
CONCLUSION: Chronic neuropathic pain often has a negative impact on the quality of life and is difficult to treat. In general, treatment with a gabapentinoid is a possible first-line treatment option. However, they may be relatively contraindicated in vulnerable patients.
Translated title of the contribution | Whether or not to use gabapentinoids in adults with chronic neuropathic pain |
---|---|
Original language | Dutch |
Article number | D4797 |
Journal | Nederlands Tijdschrift voor Geneeskunde |
Volume | 164 |
Issue number | 36 |
Publication status | Published - 27 Aug 2020 |
Keywords
- Adult
- Aged
- Aged, 80 and over
- Analgesics/therapeutic use
- Chronic Pain/drug therapy
- Diabetic Neuropathies/drug therapy
- Female
- Gabapentin/therapeutic use
- Humans
- Male
- Middle Aged
- Neuralgia, Postherpetic/drug therapy
- Neuralgia/drug therapy
- Pain Management/methods
- Quality of Life