Why Doctors Are Overprescribing Gabapentin and Pregabalin (Lyrica) for Pain
Most doctors have a difficult time managing chronic pain patients. One physician once said, “When I see a patient suffering severe chronic pain come in the front door, I want to go out the back door.” That’s because there are few good options. Drugs like hydrocodone or oxycodone used to be prescribed in huge quantities. Now gabapentin (Neurontin) and pregabalin (Lyrica) are on the rise while opioids are shunned.
The Opioid Epidemic
Doctors are dismayed by the opioid epidemic sweeping the nation. Headlines about opioid overdoses and deaths have scared many physicians into cutting back on prescribing drugs like hydrocodone or oxycodone.
Many overdose deaths are caused by illicit fentanyl, a synthetic opioid 50–100 times more potent than morphine. Fentanyl and its analogs are being increasingly detected in overdose deaths and the illicit drug supply, primarily sourced from China and Mexico.
Because of these dangers, doctors have dramatically reduced opioid prescriptions, supported by federal guidelines and restrictions.
Gabapentinoids: What Are They?
As a result of the shift away from opioids, many people in severe pain have been left without relief. Physicians have started prescribing gabapentinoids—gabapentin (Neurontin) and pregabalin (Lyrica)—more frequently.
Gabapentin and pregabalin are mainly used to treat nerve pain. Doctors prescribed these medications three times more often in 2015 than they did in 2002, despite no major change in the number of patients with neuropathic pain.
Experts caution the use of gabapentinoids due to concerns over:
- Lack of long-term safety data
- Modest effectiveness
- Increased risk of overdose, especially when combined with opioids
- High rates of off-label prescribing and related side effects
A perspective published in the New England Journal of Medicine argued that gabapentinoids are being prescribed excessively, partly as a reaction to the opioid crisis. The authors pointed out that while acetaminophen and NSAIDs are first-line treatments for osteoarthritis and low back pain, they often aren’t sufficient. Still, they warned that gabapentinoids are not a suitable substitute for opioids in most cases.
They concluded:
“Patients who are in pain deserve empathy, understanding, time, and attention. Some may benefit from gabapentin or pregabalin for certain conditions, but clinicians shouldn’t assume these drugs are effective for most pain syndromes.”
Gabapentin Side Effects
Gabapentin (Neurontin) was originally approved in 1993 for epilepsy. Over time, it became a go-to drug for treating chronic pain, with prescriptions rising sharply—from 39 million in 2012 to 64 million in 2016.
However, gabapentin carries potential side effects, including:
- Depression
- Dizziness
- Fatigue
- Drowsiness
- Digestive upset
- Trouble with balance
- Cognitive difficulties
- Visual problems
Importantly, the FDA warns that gabapentin and other antiepileptic drugs may increase the risk of suicidal thoughts or behavior. Patients must be monitored for mood changes, depression, or any unusual behavior.
