Gold Laura S, Heagerty Patrick J, Hansen Ryan N, Friedly Janna L, Johnston Sandra K, Deyo Richard A, Curatolo Michele, Turner Judith A, Rundell Sean D, Wysham Katherine, Jarvik Jeffrey G, Suri Pradeep
Department of Radiology, School of Medicine, University of Washington, Seattle, WA, United States.
Clinical Learning, Evidence, and Research Center, University of Washington, Seattle, WA, United States.
Pain. 2025 Apr 1;166(4):e51-e59. doi: 10.1097/j.pain.0000000000003448. Epub 2024 Oct 11.
Given the negative impact of opioid use on population health, prescriptions for alternative pain-relieving medications, including gabapentin, have increased. We wanted to determine whether people who filled gabapentin and opioid prescriptions concurrently ("gabapentin + opioids") had greater mortality than those who filled an active control medication (tricyclic antidepressants [TCAs] or duloxetine) and opioids concurrently ("TCAs/duloxetine + opioids"). In this population-based, propensity score-matched cohort study, we identified Medicare beneficiaries with spine-related diagnoses from 2017 to 2019. We compared people treated with gabapentin + opioids (n = 67,133) to people treated with TCAs/duloxetine + opioids (n = 67,133) who were matched on demographic and clinical factors. The primary outcome was mortality at any time, and a secondary outcome was occurrence of a major medical complication at any time. Among 134,266 participants (median age 73.4 years; 66.7% female), 2360 died before the end of follow-up. No difference in mortality was observed between groups (adjusted hazard ratio and 95% confidence interval for gabapentin + opioids 0.98 [0.90-1.06]; P = 0.63). However, people treated with gabapentin + opioids were at slightly increased risk of a major medical complication (1.02 [1.00-1.04]; P = 0.03) compared to those treated with TCAs/duloxetine + opioids. Results were similar in analyses (1) restricted to ≤30-day follow-up and (2) that required ≥2 fills of each prescription. When treating pain in older adults taking opioids, the addition of gabapentin did not increase mortality risk relative to addition of TCAs or duloxetine.
鉴于阿片类药物的使用对人群健康有负面影响，包括加巴喷丁在内的替代止痛药物的处方量有所增加。我们想确定同时开具加巴喷丁和阿片类药物处方（“加巴喷丁+阿片类药物”）的人是否比同时开具活性对照药物（三环类抗抑郁药[TCAs]或度洛西汀）和阿片类药物处方（“TCAs/度洛西汀+阿片类药物”）的人有更高的死亡率。在这项基于人群的倾向评分匹配队列研究中，我们确定了2017年至2019年患有脊柱相关诊断的医疗保险受益人。我们将接受加巴喷丁+阿片类药物治疗的人（n = 67133）与接受TCAs/度洛西汀+阿片类药物治疗的人（n = 67133）进行比较，这些人在人口统计学和临床因素方面相匹配。主要结局是任何时间的死亡率，次要结局是任何时间发生的重大医疗并发症。在134266名参与者中（中位年龄73.4岁；66.7%为女性），2360人在随访结束前死亡。两组之间未观察到死亡率差异（加巴喷丁+阿片类药物的调整后风险比和95%置信区间为0.98[0.90 - 1.06]；P = 0.63）。然而，与接受TCAs/度洛西汀+阿片类药物治疗的人相比，接受加巴喷丁+阿片类药物治疗的人发生重大医疗并发症的风险略有增加（1.02[1.00 - 1.04]；P = 0.03）。在（1）限于≤30天随访的分析和（2）要求每种处方至少开具2次的分析中，结果相似。在治疗服用阿片类药物的老年人的疼痛时，相对于添加TCAs或度洛西汀，添加加巴喷丁不会增加死亡风险。
