Pharmacovigilance in hospice/palliative care: Net effect of gabapentin for neuropathic pain

Sanderson, C; Quinn, SJ; Agar, M; Chye, R; Clark, K; Doogue, M; Fazekas, B; Lee, J; Lovell, MR; Rowett, D; Spruyt, O; Currow, DC

Pharmacovigilance in hospice/palliative care: Net effect of gabapentin for neuropathic pain

Sanderson, C

Quinn, SJ Agar, M

Chye, R Clark, K Doogue, M Fazekas, B Lee, J Lovell, MR

Rowett, D Spruyt, O Currow, DC

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Publication Type:: Journal Article
Citation:: BMJ Supportive and Palliative Care, 2015, 5 (3), pp. 273 - 280
Issue Date:: 2015-01-01

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Field	Value	Language
dc.contributor.author	Sanderson, C https://orcid.org/0000-0001-5423-5778	en_US
dc.contributor.author	Quinn, SJ	en_US
dc.contributor.author	Agar, M https://orcid.org/0000-0002-6756-6119	en_US
dc.contributor.author	Chye, R	en_US
dc.contributor.author	Clark, K	en_US
dc.contributor.author	Doogue, M	en_US
dc.contributor.author	Fazekas, B	en_US
dc.contributor.author	Lee, J	en_US
dc.contributor.author	Lovell, MR https://orcid.org/0000-0002-1407-2748	en_US
dc.contributor.author	Rowett, D	en_US
dc.contributor.author	Spruyt, O	en_US
dc.contributor.author	Currow, DC https://orcid.org/0000-0003-1988-1250	en_US
dc.date.available	2014-09-09	en_US
dc.date.issued	2015-01-01	en_US
dc.identifier.citation	BMJ Supportive and Palliative Care, 2015, 5 (3), pp. 273 - 280	en_US
dc.identifier.issn	2045-435X	en_US
dc.identifier.uri	http://hdl.handle.net/10453/122490
dc.description.abstract	Objective Hospice/palliative care patients may differ from better studied populations, and data from other populations cannot necessarily be extrapolated into hospice/palliative care clinical practice. Pharmacovigilance studies provide opportunities to understand the harms and benefits of medications in routine practice. Gabapentin, a γ-amino butyric acid analogue antiepileptic drug, is commonly prescribed for neuropathic pain in hospice/palliative care. Most of the evidence however relates to nonmalignant, chronic pain syndromes (diabetic neuropathy, postherpetic neuralgia, central pain syndromes, fibromyalgia). The aim of this study was to quantify the immediate and short-term clinical benefits and harms of gabapentin in routine hospice/palliative care practice. Design Multisite, prospective, consecutive cohort. Population 127 patients, 114 of whom had cancer, who started gabapentin for neuropathic pain as part of routine clinical care. Settings 42 centres from seven countries. Data were collected at three time points-at baseline, at day 7 (and at any time; immediate and shortterm harms) and at day 21 (clinical benefits). Results At day 21, the average dose of gabapentin for those still using it (n=68) was 653mg/24h (range 0-1800mg) and 54 (42%) reported benefits, of whom 7 (6%) experienced complete pain resolution. Harms were reported in 39/127 (30%) patients at day 7, the most frequent of which were cognitive disturbance, somnolence, nausea and dizziness. Ten patients had their medication ceased due to harms. The presence of significant comorbidities, higher dose and increasing age increased the likelihood of harm. Conclusions Overall, 42% of people experienced benefit at a level that resulted in continued use at 21 days.	en_US
dc.relation.ispartof	BMJ Supportive and Palliative Care	en_US
dc.relation.isbasedon	10.1136/bmjspcare-2014-000699	en_US
dc.subject.mesh	Humans	en_US
dc.subject.mesh	Neuralgia	en_US
dc.subject.mesh	Amines	en_US
dc.subject.mesh	gamma-Aminobutyric Acid	en_US
dc.subject.mesh	Cyclohexanecarboxylic Acids	en_US
dc.subject.mesh	Analgesics	en_US
dc.subject.mesh	Palliative Care	en_US
dc.subject.mesh	Hospice Care	en_US
dc.subject.mesh	Prospective Studies	en_US
dc.subject.mesh	Adult	en_US
dc.subject.mesh	Aged	en_US
dc.subject.mesh	Aged, 80 and over	en_US
dc.subject.mesh	Middle Aged	en_US
dc.subject.mesh	Female	en_US
dc.subject.mesh	Male	en_US
dc.subject.mesh	Pharmacovigilance	en_US
dc.subject.mesh	Gabapentin	en_US
dc.title	Pharmacovigilance in hospice/palliative care: Net effect of gabapentin for neuropathic pain	en_US
dc.type	Journal Article
utslib.citation.volume	3	en_US
utslib.citation.volume	5	en_US
utslib.for	1110 Nursing	en_US
utslib.for	1117 Public Health and Health Services	en_US
pubs.embargo.period	Not known	en_US
pubs.organisational-group	/University of Technology Sydney
pubs.organisational-group	/University of Technology Sydney/Faculty of Health
pubs.organisational-group	/University of Technology Sydney/Faculty of Health/IMPACCT
pubs.organisational-group	/University of Technology Sydney/Students
utslib.copyright.status	open_access
pubs.issue	3	en_US
pubs.publication-status	Published	en_US
pubs.volume	5	en_US

Abstract:

Objective Hospice/palliative care patients may differ from better studied populations, and data from other populations cannot necessarily be extrapolated into hospice/palliative care clinical practice. Pharmacovigilance studies provide opportunities to understand the harms and benefits of medications in routine practice. Gabapentin, a γ-amino butyric acid analogue antiepileptic drug, is commonly prescribed for neuropathic pain in hospice/palliative care. Most of the evidence however relates to nonmalignant, chronic pain syndromes (diabetic neuropathy, postherpetic neuralgia, central pain syndromes, fibromyalgia). The aim of this study was to quantify the immediate and short-term clinical benefits and harms of gabapentin in routine hospice/palliative care practice. Design Multisite, prospective, consecutive cohort. Population 127 patients, 114 of whom had cancer, who started gabapentin for neuropathic pain as part of routine clinical care. Settings 42 centres from seven countries. Data were collected at three time points-at baseline, at day 7 (and at any time; immediate and shortterm harms) and at day 21 (clinical benefits). Results At day 21, the average dose of gabapentin for those still using it (n=68) was 653mg/24h (range 0-1800mg) and 54 (42%) reported benefits, of whom 7 (6%) experienced complete pain resolution. Harms were reported in 39/127 (30%) patients at day 7, the most frequent of which were cognitive disturbance, somnolence, nausea and dizziness. Ten patients had their medication ceased due to harms. The presence of significant comorbidities, higher dose and increasing age increased the likelihood of harm. Conclusions Overall, 42% of people experienced benefit at a level that resulted in continued use at 21 days.

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http://hdl.handle.net/10453/122490