For the claim file handler in a workers’ compensation environment, Gabapentin (aka Neurontin or Gralise) is an antiepileptic medication that is indicated to treat seizure disorder(s). Other indications for this medication include neuropathy often associated with diabetes and other types of neuropathic pain. This medication is “conditionally recommended” for the approved clinical indications as noted in the Official Disability Guidelines.
To be clear, this is not an opioid analgesic type medication. The exact mechanism of how this medication works is not clear, but it is known to enhance the ability of opioid analgesics to address chronic pain situations. Thus, in theory, it requires lesser amounts of opioids to be employed. There are citations[1] noting that the utility of this medication in the immediate post-operative phase is not proven and is often indicated in a chronic situation only.
This medication can offer euphoric sequelae if misused or abused. It has been established that there is no clear clinical indication for the use of this medication in chronic pain, as the use of gabapentin in chronic pain scenario is an “off label” application. This is not a first-line analgesic medication.[2] Some of the side effects include sleepiness and dizziness. Issues with memory loss and significant respiratory compromise have been described relative to the use of this medication. This medication is often misused[3], and long-term use requires close careful clinical follow-up and evaluation of the efficacy and utility. Once considered relatively safe, rising incidence of abuse, misuse, and overdose have caused this to become a public health concern.[4] Therefore, in the workers compensation application of this protocol, careful consideration must be rendered prior to long-term, protracted use of what is thought to be an innocuous medication. Ask the prescribing provider, is this medication actually achieving what it is intended to accomplish?
[1] Smith RV, Havens JR, Walsh SL. Gabapentin misuse, abuse and diversion: a systematic review. Addiction. 2016 Jul;111(7):1160-74. doi: 10.1111/add.13324. Epub 2016 Mar 18. PMID: 27265421; PMCID: PMC5573873.
[2] Chiappini S, Schifano F. A Decade of Gabapentinoid Misuse: An Analysis of the European Medicines Agency’s ‘Suspected Adverse Drug Reactions’ Database. CNS Drugs. 2016 Jul;30(7):647-54. doi: 10.1007/s40263-016-0359-y. PMID: 27312320.
[3] Evoy KE, Sadrameli S, Contreras J, Covvey JR, Peckham AM, Morrison MD. Abuse and Misuse of Pregabalin and Gabapentin: A Systematic Review Update. Drugs. 2021 Jan;81(1):125-156. doi: 10.1007/s40265-020-01432-7. PMID: 33215352.
[4] Ibiloye EA, Barner JC, Lawson KA, Rascati KL, Evoy KE, Peckham AM. Prevalence of and Factors Associated with Gabapentinoid Use and Misuse Among Texas Medicaid Recipients. Clin Drug Investig. 2021 Mar;41(3):245-253. doi: 10.1007/s40261-021-01009-6. Epub 2021 Feb 12. PMID: 33580482.