Pregabalin and gabapentin for pain

### What you need to know A 65 year old woman presents with continuous dull back ache and leg pain over the past four years. She underwent lumbar decompression surgery three months ago, but the pain persists. She has no neurological deficits. She is on treatment for hypertension and chronic kidney disease and cannot take non-steroidal anti-inflammatory drugs. She has tried paracetamol, codeine, tramadol, and amitriptyline for her pain in the past with little benefit. You offer a trial of pregabalin and ask her to follow up if she feels dizzy or is not able to tolerate the drug. Pregabalin and gabapentin, collectively gabapentinoids, are primarily anticonvulsant drugs. Over the past decade, they have been increasingly prescribed for pain.1 They are recommended for neuropathic pain in adults23 (table 1), but are commonly used off-label for other pain disorders such as low back pain, sciatica, and migraine.910 Pregabalin was one of the highest selling drugs globally in 2017.11 In 2018, more than 14 million prescriptions of pregabalin and gabapentin were issued in England.12 This increase in gabapentinoid prescribing may be driven by a desire to avoid opioid analgesics.13 View this table: Table 1 Approved indications for pregabalin and gabapentin Pregabalin and gabapentin were reclassified as Class C drugs in the UK in April 2019 following an increase in the number of deaths caused by gabapentinoid misuse and addiction.14 Under the UK’s Misuse …