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Drs. Brett and Goodman publish paper on opioid alternatives in the New England Journal of Medicine

Drs. Allan Brett and Chris Goodman, clinical professor of internal medicine and assistant professor of clinical internal medicine, respectively, published a paper titled “Gabapentin and Pregabalin for Pain — Is Increased Prescribing a Cause for Concern?” in the prestigious New England Journal of Medicine on Aug. 3, 2017.

The paper explores the increasing prescription of gabapentinoids, a class of drug historically used to treat seizure disorders, as an alternative to opioids. The paper states that in 2016, the drug gabapentin was the 10th most commonly prescribed medication in the United States: 64 million gabapentin prescriptions were dispensed, up from 39 million in 2012. Brett and Goodman attribute this trend largely to the opioid epidemic, and the desire to find safer alternatives to traditional opioids. However, Brett and Goodman find this trend concerning for several reasons including a lack of evidence that these drugs are effective for treating common pain syndromes, non-trivial side effects and the potential for patients t misuse these drugs.

The paper also addresses the tendency for clinicians to view the treatment of pain through a pharmacologic lens due to the perception that patients expect to be given a drug prescription and the time constraints of heavy patient loads. Brett and Goodman discuss that providers may need to move toward working with patients to set realistic goals for managing pain, not necessarily eliminating it. They also mention the benefits of non-pharmacological treatments, such as cognitive behavioral therapy and physical therapy. The paper concludes by stating that gabapentinoids may be a suitable alternative to opioids in some instances, but additional research is needed to more clearly define their role in pain management.

To read the full paper and listen to an in-depth interview with Dr. Goodman, visit http://www.nejm.org/doi/ref/10.1056/NEJMp1704633#t=article.


August 7th, 2017