Gabapentin and pregabalin in the pain setting: All you need to know

The last decade has seen a marked increase in the use of gabapentinoid drugs for pain management. This, in part, reflects the shift from some non-steroidal anti-inflammatory drugs (NSAIDs), as well as issues arising from the protracted use of opioids. More extensive use of gabapentin and pregabalin has seen the clinical role widen to incorporate a range of unlicensed pain scenarios, as well as increased medicines costs. The evidence for efficacy in some pain conditions, namely post-herpetic neuralgia and diabetic neuropathic pain, is stronger than for non-neuropathic pain conditions, such as fibromyalgia. Anxiolytic properties, as well as widespread availability, have encouraged recreational misuse, which is associated with doses outside the therapeutic range. Safe use for neuropathic pain (central and peripheral), complex pain, and migraine, and the evidence for some non-neuropathic pain conditions will be discussed, as well as the emerging abuse issues. Anti-convulsant interventions will not be covered in this article, nor will use in children.