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Pain And The Use Of Gabapentinoids In German Nursing Home Residents - Results From An Analysis Based On Statutory Health Insurance Data

Authors Bantel C, Hoffmann F, Jobski K

Received 2 July 2019

Accepted for publication 3 October 2019

Published 22 November 2019 Volume 2019:12 Pages 3175—3184

DOI https://doi.org/10.2147/JPR.S221579

Checked for plagiarism Yes

Review by Single anonymous peer review

Peer reviewer comments 2

Editor who approved publication: Dr Katherine Hanlon


C Bantel,1,2 F Hoffmann,3 K Jobski3

1Department of Anesthesiology, Critical Care, Emergency and Pain Medicine, Universität Oldenburg, Klinikum Oldenburg, Oldenburg, Germany; 2Department of Surgery & Cancer, Anaesthetics Section, Imperial College London, London, UK; 3Department of Health Services Research, Carl Von Ossietzky University Oldenburg, Oldenburg, Germany

Correspondence: C Bantel
Universitätsklinik für Anästhesiologie, Intensiv-, Notfallmedizin und Schmerztherapie, Universität Oldenburg, Klinikum Oldenburg Campus, Rahel-Straus-Strasse 10, Oldenburg 26133, Germany
Tel +49 441 403 77173
Fax +49 441 403 2774
Email carsten.bantel@uni-oldenburg.de

Background: Gabapentinoids (gabapentin and pregabalin) are psychoactive medications that are increasingly used for different conditions. Since there is evidence that psychotropic drugs, in general, are often inappropriately prescribed in elderly patients, we aimed to determine frequency and indications of gabapentinoid prescribing for nursing home residents.
Methods: We analyzed data from a large German statutory health insurance database. Included were records from people ≥65 years-of-age, who were admitted to a nursing home between January 2010 and December 2014. We determined the number and proportion of common indications for on- and off-label prescriptions, the most frequent co-medications, and the characteristics of patients and prescribers.
Results: Of 127,277 residents, 9539 (7.5%) received gabapentinoids and 4852 initiated treatment (4.0%; with 66.3% pregabalin). Median age of gabapentinoid initiators was 84 years (78.5% females). In these users, on-label prescribing was found in 57.4%, predominantly for neuropathic pain. Other painful conditions were also chief causes (84.7%) for off-label prescribing. Gabapentinoids were mainly started by general practitioners (64.5%) while pain specialists contributed <2%. Forty-six percent of users received additional opioids and in 27.5% gabapentinoids were prescribed only once.
Conclusion: Gabapentinoids were frequently used in nursing home residents. Regular co-prescribing with opioids and psychotropic drugs might indicate employment to improve pain or assist treatment of conditions that are frequently associated with disruptive behavior such as dementia. However, more research is needed to better understand decision-making regarding gabapentinoid prescribing, especially in view of aggressive marketing, uncertain analgesic effects, problematic side effects, and uncritical use in the elderly.

Keywords: gabapentinoids, prescribing, elderly, nursing home, pain management
 

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