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Research
Pharmacovigilance in hospice/palliative care: net effect of gabapentin for neuropathic pain
  1. Christine Sanderson1,2,
  2. Stephen J Quinn3,
  3. Meera Agar2,4,
  4. Richard Chye5,
  5. Katherine Clark6,
  6. Matthew Doogue7,
  7. Belinda Fazekas2,
  8. Jessica Lee8,
  9. Melanie R Lovell4,
  10. Debra Rowett9,
  11. Odette Spruyt10 and
  12. David C Currow2,3
  1. 1Department of Palliative Medicine, Calvary Health Care, Sydney, New South Wales, Australia
  2. 2Discipline, Palliative and Supportive Services, Flinders University, Adelaide, South Australia, Australia
  3. 3Flinders Clinical Effectiveness, Flinders University, Adelaide, South Australia, Australia
  4. 4Department of Palliative Care, Braeside Hospital, HammondCare, Sydney, New South Wales, Australia
  5. 5Sacred Heart Palliative Care Services, Darlinghurst, New South Wales, Australia
  6. 6Department of Palliative Care, Calvary Mater Hospital, Newcastle, New South Wales, Australia
  7. 7Christchurch & Canterbury District Health Board, University of Otago, Christchurch, New Zealand
  8. 8Department of Palliative Medicine, Concord Hospital, Sydney, New South Wales, Australia
  9. 9Drug and Therapeutics Information Service, Repatriation General Hospital, Adelaide, Australia
  10. 10Department of Pain and Palliative Care, Peter MacCallum Cancer Centre, University of Melbourne, Melbourne, Victoria, Australia
  1. Correspondence to Professor David C Currow, Palliative and Supportive Services, Health Sciences Building, Repatriation General Hospital, Daws Road, Daw Park, Adelaide, SA 5041, Australia; david.currow{at}health.sa.gov.au

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 non-malignant, 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 short-term harms) and at day 21 (clinical benefits).

Results At day 21, the average dose of gabapentin for those still using it (n=68) was 653 mg/24 h (range 0–1800 mg) 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.

  • Drug administration
  • Pain
  • Terminal care

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

https://doi.org/10.1136/bmjspcare-2014-000699

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