Gabapentin and pregabalin are medications commonly prescribed for neuropathic pain and epilepsy. While they can be effective for some patients, recent research has highlighted significant risks that need to be carefully considered. This article examines the benefits and potential dangers of these drugs.

Intended Uses and Benefits

Gabapentin and pregabalin are primarily used to treat:

• Neuropathic pain conditions
• Epilepsy
• Fibromyalgia (pregabalin only)
• Anxiety disorders (off-label use)

When effective, these medications can provide significant pain relief and improved quality of life for some patients. A meta-analysis found that pregabalin reduced pain scores and improved sleep compared to placebo in neuropathic pain conditions[3].

The “Trap”

Some argue these medications are overprescribed in situations where:

• The underlying cause of pain or symptoms is unclear
• Other treatments have failed
• Doctors are unsure how else to help the patient

This can lead to patients being put on these medications long-term without addressing root causes.

Cardiovascular Risks

Recent research has uncovered concerning cardiovascular risks associated with gabapentin and pregabalin use, particularly in patients with diabetic neuropathy[1]:

• Increased risk of deep vein thrombosis (58% higher for gabapentin, 57% higher for pregabalin)
• Higher rates of myocardial infarction (25% increase for gabapentin, 29% for pregabalin)
• Elevated stroke risk (31% increase for gabapentin, 26% for pregabalin)
• Increased risk of heart failure (14% for gabapentin, 20% for pregabalin)

These risks were observed even with short-term (3-month) use of the medications.

Adverse Effects and Safety Concerns

Both gabapentin and pregabalin are associated with a range of adverse effects[3][4][5]:

• Dizziness and drowsiness (affecting up to one-third of patients)
• Ataxia (loss of muscle control)
• Fatigue
• Visual disturbances
• Peripheral edema
• Weight gain
• Increased risk of respiratory depression, especially when combined with opioids

The FDA has issued warnings about the risk of respiratory depression, particularly in patients with underlying respiratory conditions or when combined with other CNS depressants[5].

Abuse and Dependence Potential

Both medications carry risks of misuse, abuse, and dependence[5]:

• Pregabalin has a higher abuse potential than gabapentin
• Risk is increased in patients with a history of substance abuse
• Abrupt discontinuation can lead to withdrawal symptoms

The UK has classified pregabalin as a controlled substance due to these concerns.

Suicide is a Hidden Danger of Gabapentinoids

Gabapentin and pregabalin, widely prescribed medications, carry a significant risk that deserves serious attention. The FDA mandates warnings about increased suicidal thoughts and behaviors for both drugs, underscoring the gravity of this concern.

A Personal Tragedy

This risk isn’t merely theoretical. This author lived though a heartbreak where someone taking gabapentin tragically took her own life. Despite recognizing that her suicidal thoughts were influenced by the medication – she said she knew “it was the drugs talking” – this awareness wasn’t enough to prevent the devastating outcome.

Given these risks, I strongly advise against the use of these medications. The potential consequences are  too severe. Further, I believe there’s a case for legal action against pharmaceutical companies producing these drugs, given the profound impact they can have on some individuals.

Efficacy Considerations

While these medications can be effective for some patients, their overall efficacy is limited:

• Only 30-40% of patients taking gabapentin achieve a 50% reduction in pain.
• Up to 60% of patients may experience side effects without significant pain relief.

Avoiding the Trap

To avoid the “Gabapentin and Pregabalin Trap,” patients should work closely with their healthcare providers to ensure proper diagnosis and treatment. Request a thorough evaluation to identify the underlying cause of symptoms before accepting these medications. Discuss alternative treatment options, including non-pharmacological approaches.

Here are some evidence-based alternatives that have shown promise in managing neuropathic symptoms:

Treating Underlying Conditions

Addressing underlying causes like Lyme disease can be crucial. This approach aligns with the principle of targeting the root cause of neuropathic pain. Treating some conditions, however, is extremely tricky. There are microbes which have acquired immunity to our drugs and creative new approches may be needed. Frustratingly, what works one day, may not work the next. This can result in patients spending huge amounts on many different supplements. Nevertheless, some things do seem to work and the fight to be healthy is worth waging.

Example of an Alternative Treatment Which Stopped Burning Feet for a Night

Supplements: Tick Formula, Chlorella, Cistus Tea, Stevia, Omega 3 fish oil, Curcumen, D3, K2, Hyaluronic Acid, Cranberry extract, Magnesium L-Threonate, Vitamin C, B-1, B-2, Niacin, B-6, Folate, B-12, Biotin, Pantothenic Acid, Boswellia
Actions: Exercises from YouTube, walking 1 hour, massage of legs and feet, meditation, prayer, not sitting for more than 15 minutes at a stretch, sitting with out cutting off leg circulation, good neck and arm position at all times, removing tight socks and shoes.

Non-Pharmacological Approaches

1. Exercise and Physical Therapy: Regular exercise, such as walking three times a week, can help reduce neuropathic pain, improve muscle strength, and aid in blood sugar control. Physical therapy can also improve mobility and balance for those experiencing muscle weakness.
2. Transcutaneous Electrical Nerve Stimulation (TENS): This therapy uses low-voltage electrical currents to relieve pain and has shown effectiveness in some cases of neuropathic pain.
3. Acupuncture: While evidence is still limited, some studies suggest acupuncture may help alleviate neuropathic pain, particularly in chemotherapy-induced peripheral neuropathy.
4. Cognitive Behavioral Therapy (CBT): This form of psychotherapy can help patients manage pain and improve their quality of life.
5. Neurostimulation: Techniques like spinal cord stimulation and repetitive transcranial magnetic stimulation have shown promise in managing refractory neuropathic pain, especially in diabetic peripheral neuropathy.

Other Considerations

• Dietary Modifications: Weight loss through dietary changes can be beneficial, especially for diabetic neuropathy.
• Orthotic Footwear: Proper footwear can help prevent complications in patients with diabetic neuropathy.
• Structured Graded Desensitization: This approach can be helpful for peripheral nervous system issues.

Conclusion

Gabapentin and pregabalin can provide benefits for some patients with neuropathic pain and epilepsy. However, the potential risks, including cardiovascular events, adverse effects, and abuse potential, must be carefully weighed against these benefits. Patients and healthcare providers should have thorough discussions about the appropriateness of these medications, considering individual risk factors and exploring alternative treatment options when possible.

Read More
^{[1] https://www.drugsandalcohol.ie/24965/
[2] https://emj.bmj.com/content/30/10/874.2
[3] https://www.addictioncenter.com/drugs/lyrica-addiction-abuse/
[4] https://resurgencebehavioralhealth.com/lyrica-addiction-and-abuse/
[5] https://americanaddictioncenters.org/prescription-drugs/lyrica-withdrawal-symptoms
[6] https://www.northpointrecovery.com/blog/is-there-a-possibility-that-lyrica-can-be-abused/
[7] https://delamere.com/addiction-treatment/prescription-drugs/pregabalin
[8] https://www.bbc.com/news/uk-northern-ireland-66579996
[9] https://www.mayoclinic.org/drugs-supplements/gabapentin-oral-route/side-effects/drg-20064011
[10] https://www.reddit.com/r/ChronicPain/comments/l6jss2/has_anyone_gotten_pins_and_needles_or_burning/
[11] https://mstrust.org.uk/a-z/gabapentin
[12] https://www.health.harvard.edu/staying-healthy/gabapentin-uses-side-effects-and-what-you-should-know-if-youve-been-prescribed-this-medication
[13] https://www.mayoclinic.org/drugs-supplements/gabapentin-oral-route/side-effects/drg-20064011?p=1
[14] https://medlineplus.gov/druginfo/meds/a694007.html
[15] https://www.nhs.uk/medicines/gabapentin/side-effects-of-gabapentin/
[16] https://www.drugs.com/sfx/gabapentin-side-effects.html}