WSJ: The Hidden Risks of America’s Most Popular Prescription Painkiller

[drusso]

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https://www.wsj.com/health/gabapentin-painkiller-hidden-risks-603e6130?st=xfFmbx&reflink=desktopwebshare_permalink

"For Avery, neither the pain management specialist who prescribed him the medication nor a specialist he saw after surgery told him about adverse effects gabapentin might have or that he might need to taper off it, Avery and his wife, Lauren Avery, said. The pain management specialist told him that gabapentin couldn’t possibly be the cause of his symptoms, Avery said. His primary care doctor thought he had anxiety.

Several other doctors have since told him that gabapentin is likely the cause of his condition, including a neuropsychiatrist who diagnosed him with severe dysautonomia, or impairment of the autonomic nervous system.

Treatments he has tried, including other medications, have only made him worse, Lauren said. John now lies every day in a dark room on the first floor at his mother’s house. Light, screens, noise and the boisterousness of his toddler and preschool-aged children at his own home set off more symptoms.

“I thought it was harmless,” he said of the drug. Had he known the risks and that he should reduce his dose gradually when stopping it, Avery said, “I never would have taken it.”

 

[CleanUp]

Thank you for sharing.

Great! So we’re the bad guys for the opioids, NSAIDs and gabapentin.

Where is the piece for the patient who takes gabapentin and can actually sleep better or have less numbness and tingling?

 

[mdo1738]

Not saying gabapentin is harmless. But they did not pick a good poster child for this story. Symptoms more consistent with an untreated psychiatric condition as opposed to 2+ years of withdrawal.

 

[RoloTomassi]

Don't leave out tramadol

Widely prescribed opioid shows minimal pain relief and higher heart risk, study finds

 

[geauxg8rs]

Thank you for sharing.

Great! So we’re the bad guys for the opioids, NSAIDs and gabapentin.

Where is the piece for the patient who takes gabapentin and can actually sleep better or have less numbness and tingling?

We are also the bad guys for using black boxed steroids in our esis. For “killing” muscles with expensive lasers (aka RFA). The only time we are the good guys are when we carte blanch do opioid refills of generic opioids (oxy or hydro) not these new fangled low Morphine equivalent opioids.

 

[willabeast]

https://www.wsj.com/health/gabapentin-painkiller-hidden-risks-603e6130?st=xfFmbx&reflink=desktopwebshare_permalink

"For Avery, neither the pain management specialist who prescribed him the medication nor a specialist he saw after surgery told him about adverse effects gabapentin might have or that he might need to taper off it, Avery and his wife, Lauren Avery, said. The pain management specialist told him that gabapentin couldn’t possibly be the cause of his symptoms, Avery said. His primary care doctor thought he had anxiety.

Several other doctors have since told him that gabapentin is likely the cause of his condition, including a neuropsychiatrist who diagnosed him with severe dysautonomia, or impairment of the autonomic nervous system.

Treatments he has tried, including other medications, have only made him worse, Lauren said. John now lies every day in a dark room on the first floor at his mother’s house. Light, screens, noise and the boisterousness of his toddler and preschool-aged children at his own home set off more symptoms.

“I thought it was harmless,” he said of the drug. Had he known the risks and that he should reduce his dose gradually when stopping it, Avery said, “I never would have taken it.”

I sent a very critical email to the WSJ after I read this article. Unbalanced "news" IMHO.

 

[hyperalgesia]

I sent a very critical email to the WSJ after I read this article. Unbalanced "news" IMHO.

Sensationalist journalism. I think most people, even patients, are immune to this stuff by now.

 

[callmeanesthesia]

Sensationalist journalism. I think most people, even patients, are immune to this stuff by now.

Really? Have you met… people? Every time one of these types of stories comes out I get patients asking about it.

 

[Agast]

Well, now that THC is schedule III it will probably be the most popular prescription pain killer lol

 

[clubdeac]

Don't leave out tramadol

Widely prescribed opioid shows minimal pain relief and higher heart risk, study findsI looked

I looked at that study closer and I don’t think it was well designed to pick up true CV risk. I think the headline is a little sensational

As far as gabapentin, if you have a patient with any psychiatric diagnosis I think you need to taper off over a couple months, just like they are now recommending for most of the SSRIs except Prozac. The patient is likely experiencing protracted withdrawal and/or rebound of his underlying psychiatric disorder

 

[clubdeac]

Well, now that THC is schedule III it will probably be the most popular prescription pain killer lol

And with more neuropsychiatric and CV risk than anything we currently prescribe

70% of all new schizophrenia diagnosis are attributed to weed

 

[bubaghanush]

And with more neuropsychiatric and CV risk than anything we currently prescribe

70% of all new schizophrenia diagnosis are attributed to weed

View attachment 413263

No problem we can just use MDMA to treat that.

 

[Laryngospasm]

Ah yes the old n of 1. Would love to know this patients prior psych history and allergy list.

There are plenty of legitimate complaints about gabapentin. To pick this patient as the poster child is dumb. Also we all know when doctors don’t know the answer and a patient says “don’t you think it could be x,y,z doc?” And neuro prob faces more unknowns than anyone with the exception of psych. They will agree to not look stupid or disagree. We see it all the time with anesthesia. EVERYTHING is our fault. I always point out they are welcome to do the surgery without us if it makes them feel better.

 

[VA Hopeful Dr]

The comment section of this article, for what may be the first time in history, actually gives me more faith in humanity.

 

[PainDoc2025]

The comment section of this article, for what may be the first time in history, actually gives me more faith in humanity.

Just read them, wow, very impressed

 

[TheLoneWolf]

https://www.wsj.com/health/gabapentin-painkiller-hidden-risks-603e6130?st=xfFmbx&reflink=desktopwebshare_permalink

"For Avery, neither the pain management specialist who prescribed him the medication nor a specialist he saw after surgery told him about adverse effects gabapentin might have or that he might need to taper off it, Avery and his wife, Lauren Avery, said. The pain management specialist told him that gabapentin couldn’t possibly be the cause of his symptoms, Avery said. His primary care doctor thought he had anxiety.

Several other doctors have since told him that gabapentin is likely the cause of his condition, including a neuropsychiatrist who diagnosed him with severe dysautonomia, or impairment of the autonomic nervous system.

Treatments he has tried, including other medications, have only made him worse, Lauren said. John now lies every day in a dark room on the first floor at his mother’s house. Light, screens, noise and the boisterousness of his toddler and preschool-aged children at his own home set off more symptoms.

“I thought it was harmless,” he said of the drug. Had he known the risks and that he should reduce his dose gradually when stopping it, Avery said, “I never would have taken it.”

Gabapentin is not without its risks, as is everything we use. I had presented this paper during rounds and had the whole department stare daggers at me.

Gabapentin, opioids, and the risk of opioid-related death: A population-based nested case-control study - PubMed

In this study we found that among patients receiving prescription opioids, concomitant treatment with gabapentin was associated with a substantial increase in the risk of opioid-related death. Clinicians should consider carefully whether to continue prescribing this combination of products and...

pubmed.ncbi.nlm.nih.gov

 

[bedrock]

Gabapentin is not without its risks, as is everything we use. I had presented this paper during rounds and had the whole department stare daggers at me.

Gabapentin, opioids, and the risk of opioid-related death: A population-based nested case-control study - PubMed

In this study we found that among patients receiving prescription opioids, concomitant treatment with gabapentin was associated with a substantial increase in the risk of opioid-related death. Clinicians should consider carefully whether to continue prescribing this combination of products and...

pubmed.ncbi.nlm.nih.gov

of course. But walking out your door is a risk. That is life.

How about these critics come up with a solution instead of just complaining? Opioids have abuse and tolerance issues galore. Chronic NSAIDs cause many thousands to bleed out and/or destroy their kidneys.

Compared to the other primary options for pain, gabapentin is far more safe and far more accessible. Not perfect, but best we have for now.

 

[lobelsteve]

of course. But walking out your door is a risk. That is life.

How about these critics come up with a solution instead of just complaining? Opioids have abuse and tolerance issues galore. Chronic NSAIDs cause many thousands to bleed out and/or destroy their kidneys.

Compared to the other primary options for pain, gabapentin is far more safe and far more accessible. Not perfect, but best we have for now.

The bigger risk that NZ is a 31% increase chance of a heart attack or stroke if taken on a regular basis. Except for diclofenac where the risk goes to 50%. G.I. liver and kidney problems are also worth mentioning but heart attack attacks and strokes should get the headline.

 

[clubdeac]

The bigger risk that NZ is a 31% increase chance of a heart attack or stroke if taken on a regular basis. Except for diclofenac where the risk goes to 50%. G.I. liver and kidney problems are also worth mentioning but heart attack attacks and strokes should get the headline.

What’s higher, diclofenac or Celebrex

 

[calvnandhobbs68]

This guy takes a month of gabapentin over a year ago, can't do anything except "lay in a dark room in his mother's house" now and you're telling me this is the gabapentin come on now.

It's like the people who take an SSRI for like a few weeks and then get interviewed by an article saying they had sexual side effects for years afterwards. I think there was an NYT article about that a while back where some guy said he took one dose of an SSRI or something and had chronic sexual side effects from it.

 

[lobelsteve]

What’s higher, diclofenac or Celebrex

Diclofenac by a lot.

 

[specepic]

This guy takes a month of gabapentin over a year ago, can't do anything except "lay in a dark room in his mother's house" now and you're telling me this is the gabapentin come on now.

It's like the people who take an SSRI for like a few weeks and then get interviewed by an article saying they had sexual side effects for years afterwards. I think there was an NYT article about that a while back where some guy said he took one dose of an SSRI or something and had chronic sexual side effects from it.

SSRI can unfortunately cause irreversible sexual side effects per neuropsych/parm conference I was at a few years ago

Gabapentin has been a popular punching bag recently, although seems a bit coordinated I am not really sure who is driving it

Definitely been some medical social media influencers hitting gabapentin hard

 

[Ducttape]

diclofenac orally.

havent seen data with topical diclofenac (voltaren gel), though dont doubt that it can cause increased risk (it is absorbed systemically)


gabapentin is not a new risk. in the last 10 years, + urine tox for gabapentin has been seen at a higher than anticipated rate in overdose patients. gabapentin is a schedule V drug in 8 states, and has been such since 2017 in Kentucky and 2018 in Tenn.


everything we do has risks, with the possible exception of the psychological treatment for the suffering engendered by chronic pain

 

[calvnandhobbs68]

SSRI can unfortunately cause irreversible sexual side effects per neuropsych/parm conference I was at a few years ago

Gabapentin has been a popular punching bag recently, although seems a bit coordinated I am not really sure who is driving it

Definitely been some medical social media influencers hitting gabapentin hard

I'm aware of it as a reported phenomenon but it's a topic of controversy whether this is an actual downstream side effect from SSRIs as a group after discontinuation (especially when we're talking about timeframes like years later) in general vs specific SSRIs/SNRIs vs other confounding factors that have nothing to do with the SSRI itself.

Someone who's been on an SSRI for years, I could see it although again have never had this be a complaint even when I've weaned people off SSRIs they've been on for some time at OCD level doses, but it would make more sense. Someone who took an SSRI for a month and complains that their anorgasmia or genital numbing a year later is from that? Sorry but color me skeptical.

Again they pick weird poster children for these articles, I think the idea is to the layperson this sounds compelling because they're like "wow look at how dramatically bad this medicine is" where to us it just sounds bizarre.

 

[clubdeac]

I'm aware of it as a reported phenomenon but it's a topic of controversy whether this is an actual downstream side effect from SSRIs as a group after discontinuation (especially when we're talking about timeframes like years later) in general vs specific SSRIs/SNRIs vs other confounding factors that have nothing to do with the SSRI itself.

Someone who's been on an SSRI for years, I could see it although again have never had this be a complaint even when I've weaned people off SSRIs they've been on for some time at OCD level doses, but it would make more sense. Someone who took an SSRI for a month and complains that their anorgasmia or genital numbing a year later is from that? Sorry but color me skeptical.

Again they pick weird poster children for these articles, I think the idea is to the layperson this sounds compelling because they're like "wow look at how dramatically bad this medicine is" where to us it just sounds bizarre.

Assume you’re a psychiatrist. Do you believe in slow weans when weaning off SSRIs or is the possibility of protracted withdrawal and rebound also internet hype and sensationalism?

 

[specepic]

HRT is an interesting example of overestimating harm to the point of causing major negative downstream effects

 

[calvnandhobbs68]

Assume you’re a psychiatrist. Do you believe in slow weans when weaning off SSRIs or is the possibility of protracted withdrawal and rebound also internet hype and sensationalism?

Others might have different opinions, but I do actually think the whole need for "hyperbolic taper" thing is a bit overblown based on the number of patients who show up in my office on SSRIs/SNRIs going "oh yeah doc I just stopped that medicine like a few weeks ago forgot to tell you" or like randomly start and stop taking these medications for days or weeks at a time, then hop right back on. There are some particularly nasty medications to come off of (Paxil, Effexor, Cymbalta occasionally) but people again generally do alright with a slower wean. I do taper people of these medications but rarely do I find that they need to be tapered off over months and months. Have definitely had cases of Effexor withdrawal where we had to go particularly slow and cross into another lower dose SSRI.

Keep in mind there's now a whole business built up around the "need" to wean people slowly off SSRIs which surprise surprise is run by a particularly anti-medication UK psychiatrist (Horowitz) who pumps out a lot of this literature about the need for protracted weans and withdrawal symptoms. Super weird they're cash only and cost $208 a month to make sure you go down REALLYYY slowly on your SSRI.

Outro Health | About Us

Outro is an evidence-based antidepressant tapering platform, built by world-leading experts in deprescribing. We can help build a taper plan that works for you.

www.outro.com

I do see primarily a younger population, so mostly teenagers to young adults who tend to be more resilient overall with this stuff but also some of the most inconsistent with compliance over time...very likely to go to college and randomly stop taking an SSRI they've been on since high school.
Older adult who's been taking for a while, probably more likely to need a longer taper.

 

[clubdeac]

Don't leave out tramadol

Widely prescribed opioid shows minimal pain relief and higher heart risk, study finds

Is tramadol really ineffective and risky?

New headlines claim tramadol is risky and ineffective. A critical review of the data reveals flaws in the study and confirms tramadol's value. Learn more.

www.doximity.com

 

[bedrock]

Is tramadol really ineffective and risky?

New headlines claim tramadol is risky and ineffective. A critical review of the data reveals flaws in the study and confirms tramadol's value. Learn more.

www.doximity.com

it’s a meta Analysis so they can make the results whatever they want.

That aside, what do these pencil neck academics propose we use instead of tramadol and gabapentin given the far more serious and far more common risks of opioids and NSAIDS?

 

[clubdeac]

it’s a meta Analysis so they can make the results whatever they want.

That aside, what do these pencil neck academics propose we use instead of tramadol and gabapentin given the far more serious and far more common risks of opioids and NSAIDS?

probably CBT, mindfulness, THC and Kratom

 

[Ducttape]

the feds do not like kratom. DEA tried to make it schedule 1. failed to do so.
FDA has fact sheet out about its dangers.

it’s a meta Analysis so they can make the results whatever they want.

That aside, what do these pencil neck academics propose we use instead of tramadol and gabapentin given the far more serious and far more common risks of opioids and NSAIDS?

consider the opposite. the data shows that these pills dont work for the majority of people, and there are side effects. a lot of patients are never told this and wonder why something didnt work or developed side effects.


now you and i know deep down that these pills dont do that much, though they can be beneficial for a small group of people. this just solidifies our experiences.

it needs to be discussed with the patient. if they and the prescriber want to try these meds, then thats on them. theres no law about not using tramadol or gabapentin.