Another gabapentin study...

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Risk of dementia following gabapentin prescription in chronic low back pain patients | Regional Anesthesia & Pain Medicine

Has anybody changed their prescription patterns yet? I've had quite a few patients express concern about this med over the past year or so.

 

[clubdeac]

Interesting. Also interesting that it said a recent analysis found no evidence of increased cognitive decline. I don’t know what to make of it but I tell patients to use it for as short a duration as possible

I hate this bc I’ve many times thought of going in gabapentin for RLS. Want to avoid the dopamine agonists

 

[Darkside_]

Risk of dementia following gabapentin prescription in chronic low back pain patients | Regional Anesthesia & Pain Medicine

Has anybody changed their prescription patterns yet? I've had quite a few patients express concern about this med over the past year or so.

Interesting. I wonder if the risks remain the same with pregabalin.

Are low dose opiates and/or Tylenol the safest option for oral medication therapy for chronic pain patients?

 

[callmeanesthesia]

They controlled for commodities supposedly, but gabapentin is going to correlate with DPNP which will correlate with poor glucose control, which I’m sure is a dementia risk factor.

 

[Kissmyabjj]

I never prescribe gabapentin or Lyrica for neck or back pain with or without radicular symptoms. There is just no evidence for it. You’re basically using a membrane channel stabilizer to try to address a focal compressive injury. It makes as much sense to use it for carpal tunnel syndrome as it does for radicular pain. I routinely stop these medications without any worsening of symptoms.

Every time I have a new resident in clinic recommend one of these medications for radicular pain, I always ask them to find me a few systematic reviews demonstrating efficacy. No one ever can. I then have them check up-to-date and they find out that neither medication is recommended. So then they realize that they have never seen any real evidence that either of these medications is effective. Instead, they just saw a few of their attendings prescribe them and assumed that they must work.

On the other hand I will blast patients with these medications in cases of polyneuropathy, and metabolic causes of plexopathy and polyradiculopathy. In these cases they really are lifesavers.

 

[Agast]

Studies also show increased risk of dementia with chronic opioid usage but somehow zero patients show up concerned about that

 

[MitchLevi]

Great sleep medication.

 

[clubdeac]

Interesting. I wonder if the risks remain the same with pregabalin.

Are low dose opiates and/or Tylenol the safest option for oral medication therapy for chronic pain patients?

Increased dementia risk has been associated with opioids, other AEDs, antihistamines and anticholinergics so likely all TCAs, most all sleep meds and benzos

 

[MitchLevi]

Yall know what’s a far bigger problem than gabadeen?

Insomnia and chronic neuropathic pain.

 

[IAmTheOne1]

Being alive has been shown to have a positive risk correlation to the chance of risky risks.

 

[bedrock]

Studies also show increased risk of dementia with chronic opioid usage but somehow zero patients show up concerned about that

Yall know what’s a far bigger problem than gabadeen?

Insomnia and chronic neuropathic pain.

Agree. There is a big difference between taking gabapentin at night only 90 minutes before bed, vs taking it all day.

I'm less convinced that it causes dementia, but it does affect cognition while in your system. Did this study test patient on chronic gaba, who then stopped it for 3 days before the test? If not, then its as accurate as testing dementia on a patient who just got IV versed.

 

[Ducttape]

retrospective study.

data mining.

please note that this study shows correlation not causation. it is not saying that gabapentin causes increased dementia. it is saying that physicians need to monitor more closely those on gabapentin, especially those who have gotten multiple prescriptions, and interestingly non-elderly.



in terms of safety profile, probably still safer than opioids.

Agree. There is a big difference between taking gabapentin at night only 90 minutes before bed, vs taking it all day.

I'm less convinced that it causes dementia, but it does affect cognition while in your system. Did this study test patient on chronic gaba, who then stopped it for 3 days before the test? If not, then its as accurate as testing dementia on a patient who just got IV versed.

see above. not the purpose of the study. your last line is not consistent with the study.

and for that matter "just taking a pill at nighttime" does not obviate the possible long term side effects of said medication.

gabapentin's half life is 5-7 hours. however, time to total elimination is closer to 25-35 hours. meaning that once day dosing will still eventually lead to steady state higher than zero.

 

[Baron S]

I take it every night and it's amazing. If my brain melts, oh well. Not much going on in there, anyways.

 

[clubdeac]

I take it every night and it's amazing. If my brain melts, oh well. Not much going on in there, anyways.

What do you take it for? RLS

 

[Baron S]

What do you take it for? RLS

Sleeptalking/walking