Gabapentinoid prescriptions in Isolated Low Back Pain patients by primary care physicians not useful: Study

Gabapentinoids have been increasingly studied as a non-narcotic option for neuropathic and postoperative pain. However, there is evidence suggesting that off-label use of these medications for the treatment of isolated LBP is not effective.

Low back pain (LBP) remains one of the leading causes of disability worldwide. In wake of the ongoing opioid epidemic, reducing narcotic use is a high priority for patients, physicians, and systems. For some indications, non narcotic analgesic alternatives exist – such as gabapentinoids – however, evidence does not support their use for axial LBP.

Maloy et al conducted a study to evaluate prescription patterns for gabapentinoids among patients with isolated low back pain. The study has been published in ‘Global Spine Journal.’

Adult patients with LBP were abstracted from the dataset using International Classification of Diseases (ICD-10) code M54.5. Patients were excluded if they had a diagnosis of neurologic symptoms, history of spinal surgery, spinal fracture, or conditions for which gabapentinoids are FDA approved. Gabapentinoid and narcotic prescriptions within one year of LBP diagnosis were identified. Patient characteristics and prescriber specialty were extracted from the dataset and predictors of gabapentinoid prescriptions were determined using univariate and multivariate analyses.

Key findings of the study:

• Among the 1,158,875 isolated LBP patients, gabapentinoids were prescribed for 11% (gabapentin for 85%, pregabalin for 12% pregabalin, and both for 3%), narcotics for 8%, and both for 3%.

• The most common prescriber specialties included: primary care physicians (45%), nurse practitioners (15%), pain management physicians (5%), neurology (4%), physical medicine and rehabilitation (4%), psychiatry (3%), rheumatology (2%), orthopedic surgery (2%), unknown (11%), and other fields (9%).

• Independent predictors of gabapentinoid prescriptions included: female sex, region of the country, and insurance type (P-values <0.001).

The authors concluded - “In sum, of nearly 1.2 million isolated LBP patients identified, 14.2% were prescribed gabapentinoids within one year of their LBP diagnosis, a number greater than narcotics and prescribed most commonly be primary care physicians. Several factors were identified as independent predictors of gabapentinoid prescription, include patient sex, region of residence, and insurance plan. While clinicians are being encouraged to shift away from the use of narcotics for isolated LBP, evidence does not well support gabapentinoids for this indication and its off label use for this population may be questioned.”

Further reading:

Characterizing Gabapentinoid Use Among Patients With Isolated Low Back Pain Gwyneth C. Maloy et al Global Spine Journal 2024 DOI: 10.1177/21925682231224390