PLOS MED: Adding gabapentin to pain relief after opioid use is associated with increased risk of falls!

Gabapentinoids are increasingly used to manage chronic noncancer pain (CNCP) in older adults
.

When used concomitantly with opioids, gabapentinoids may exacerbate central nervous system (CNS) depression and increase the risk of falls

Management When used concomitantly with opioids, gabapentinoids may exacerbate central nervous system (CNS) depression and increase the risk of falls

Researchers conducted a population-based cohort study between 2011-2018 using a 5% national sample of Medicare beneficiaries in the United States
.

The study sample included fee-for-charge (FFS) beneficiaries aged ≥65 years with a diagnosis of CNCP and initiation of opioid use

diagnosis

Using risk set sampling, each concurrent user was matched with up to 4 opioid-only users on the day of opioid initiation
.

Patients were followed from index day to first fall-related injury event, treatment discontinuation or conversion, death, Medicare cancellation, hospitalization or nursing home admission, or study end, as determined using a valid claims-based algorithm

Ultimately 6733 concurrent users and 27092 matched pure opioid users were identified in cohort 1 and 5709 concurrent users and 22388 matched pure opioid users in cohort 2
.

During follow-up, the rate of falls-related injuries per 24.

Fall-related injuries occurred at a rate of 24.

In cohort 1, those who used both opioids and gabapentin had a similar risk of fall-related injury as those who used opioids alone (aHR=0.
97, 95% CI 0.
71-1.
34, p=0.
874), but in cohort 2, Concomitant use had a nearly 70% higher risk of fall-related injury than opioid-only use (aHR=1.
69, 95% CI 1.
17-2.
44, p = 0.
005)
.

In cohort 1, those who used both opioids and gabapentin had a similar risk of fall-related injury as those who used opioids alone (aHR=0.
97, 95% CI 0.
71-1.
34, p=0.
874), but in cohort 2, Concomitant use had a nearly 70% higher risk of fall-related injury than opioid-only use (aHR=1.
69, 95% CI 1.
17-2.
44, p = 0.
005)
.

In cohort 1, those who used both opioids and gabapentin had a similar risk of fall-related injury as those who used opioids alone (aHR=0.

Concomitant use of gabapentin and opioids in CNCP older adults did not increase falls-related injuries, but adding gabapentin to existing opioid regimens was associated with an increased risk of falls

Concurrent use of prescription gabapentinoids with opioids and risk for fall-related injury among older US Medicare beneficiaries with chronic noncancer pain: A population-based cohort study.

Concurrent use of prescription gabapentinoids with opioids and risk for fall-related injury among older US Medicare beneficiaries with chronic noncancer pain: A population-based cohort study.
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