Kim Emily, Raji Mukaila A, Westra Jordan, Wilkes Denise, Kuo Yong-Fang
School of Medicine, University of Texas Medical Branch, Galveston, TX, United States.
Division of Geriatrics and Palliative Medicine, Department of Internal Medicine, University of Texas Medical Branch, Galveston, TX, United States.
Pain. 2024 Jan 1;165(1):144-152. doi: 10.1097/j.pain.0000000000003006. Epub 2023 Aug 4.
Gabapentinoid (GABA) prescribing has substantially increased while opioid prescribing has decreased since the 2016 Centers for Disease Control and Prevention Guidelines restricted opioid prescribing for chronic pain. The shift to GABA assumes equal analgesic effectiveness to opioids, but no comparative analgesic effectiveness data exist to support this assumption. We compared GABA to opioids by assessing changes in pain interfering with activities (activity-limiting pain) over time in patients with chronic pain. We used 2017 to 2019 data from a 20% national sample of Medicare beneficiaries diagnosed with chronic pain who initiated a GABA or opioid prescription for ≥30 continuous days and received home health care in the study year. The main outcome was the difference in reduction in pain score from pre- to post-prescription assessments between the 2 groups. Within a 60-day window before-and-after drug initiation, our sample comprised 3208 GABA users and 2846 opioid users. Reduction in post-prescription scores of pain-related interference with activities to less-than-daily pain was 48.1% in the GABA group and 41.7% in the opioid group; this remained significant (odds ratio = 1.29, 95% confidence interval: 1.17-1.43, P < 0.0001) after adjustment for patient demographics and comorbidities. The adjusted difference in reduced pain-related interference score between the 2 groups was -0.10 points on a 0 to 4 scale ( P = 0.01). Gabapentinoid use had greater odds of less-than-daily pain post-prescription, in a dose-dependent manner. Thus, GABA use was associated with a larger reduction in chronic pain than opioids, with a larger effect at higher GABA dosage. Future research is needed on functional outcomes in patients with chronic pain prescribed GABA or opioids.
自2016年美国疾病控制与预防中心发布指南限制慢性疼痛的阿片类药物处方以来，加巴喷丁类药物（GABA）的处方量大幅增加，而阿片类药物的处方量则有所下降。转向使用GABA意味着其镇痛效果与阿片类药物相当，但尚无比较镇痛效果的数据支持这一假设。我们通过评估慢性疼痛患者中随着时间推移干扰活动的疼痛（限制活动的疼痛）变化，对GABA和阿片类药物进行了比较。我们使用了2017年至2019年的数据，这些数据来自全国20%被诊断患有慢性疼痛的医疗保险受益人的样本，他们开始连续30天以上使用GABA或阿片类药物处方，并在研究年度接受了家庭医疗护理。主要结局是两组从处方前到处方后评估的疼痛评分降低的差异。在药物开始使用前后的60天窗口期内，我们的样本包括3208名GABA使用者和2846名阿片类药物使用者。GABA组中与活动相关的疼痛干扰的处方后评分降低至低于每日疼痛的比例为48.1%，阿片类药物组为41.7%；在对患者人口统计学和合并症进行调整后，这一差异仍然显著（优势比=1.29，95%置信区间：1.17-1.43，P<0.0001）。两组之间疼痛相关干扰评分降低的调整后差异在0至4分的量表上为-0.10分（P=0.01）。使用加巴喷丁类药物后，低于每日疼痛的几率更高，且呈剂量依赖性。因此，与阿片类药物相比，使用GABA与慢性疼痛的更大程度减轻相关，在更高的GABA剂量下效果更大。需要对开具GABA或阿片类药物处方的慢性疼痛患者的功能结局进行进一步研究。
