Clinical correlates and outcomes associated with pregabalin use among people prescribed opioids for chronic non‐cancer pain: A five‐year prospective cohort study

Abstract

Pregabalin has become widely used as an alternative to opioids in treating certain types of chronic non-cancer pain, but few studies have examined its clinical efficacy outside trials. We address this gap by examining the utilization, correlates and clinical outcomes of pregabalin use among an Australian community-based cohort of people prescribed opioids for chronic non-cancer pain.Methods: Through a five-year prospective cohort study (n = 1514) we examined associations between pregabalin use and pain severity and interference, mental health, opioid dose and past month use of ambulance and emergency department services. We used fixed-effects regression models to examine within-participant differences, and random-effects regression models to examine within-and betweenparticipant differences in clinical outcomes.Results: In an analysis of cases with complete data over five-years (n = 896), the prevalence of pregabalin use ranged from 16% at cohort entry to 29% at 36-and 48-months, and 46% reported pregabalin use at any time during the five years.Pregabalin use was associated with greater pain severity and interference and greater use of high-risk opioid doses (>90 oral morphine equivalents/day). Pregabalin useThe authors confirm that the PI for this paper is Louisa Degenhardt and that she had direct responsibility for study conduct.

Trajectories of pregabalin use and their association with longitudinal changes in opioid and benzodiazepine use

“…26 An Australian cohort study of 1514 people taking opioids for chronic noncancer pain found that pregabalin use was associated with greater opioid doses compared with people taking opioids alone. 35 Similarly, our data are not consistent with pregabalin having an opioid-sparing effect, with higher doses being used postpregabalin initiation than before.…”

Risk Prescriptions of Strong Opioids in the Treatment of Chronic Non-Cancer Pain by Primary Care Physicians in Catalonia: Opicat Padris Project

“…Another study by the same author [19] found a 68% increase in deaths related to SO in patients who received pregabalin concomitantly, especially at high doses (>300 mg daily). A study by Nielsen et al [40] related the use of pregabalin with the consumption of high doses of SO.…”

Non-medical Use of Prescription Gabapentinoids (Gabapentin and Pregabalin) in Five European Countries

“…This combination could increase the risk for overdose death ( 30 ). Otherwise, the usefulness of the combination of pregabalin and opioids for the treatment of some kind of pain is not clear, as some researchers have described that pregabalin plus opioids was associated with more pain severity and higher oral doses of opioids; furthermore, pregabalin use was not associated with improvements on mental health symptoms ( 31 ).…”