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Original Article

Pregabalin for chronic pain: does one medication fit all?

, , , , &
Pages 1403-1411 | Accepted 09 Apr 2015, Published online: 11 May 2015
 

Abstract

Background:

Pregabalin is frequently prescribed for chronic non-cancer pain. No previous study has examined its off-label use.

Objectives:

Our primary aim was to assess the proportion of patients taking pregabalin for conditions approved by Health Canada (‘on-label’) and compare their perspectives on its use to those who use pregabalin for other conditions (‘off-label’).

Methods:

Patients who have used pregabalin within the past year were recruited from two registries of chronic non-cancer pain patients treated in tertiary care clinics: the Quebec Pain Registry and the Fibromyalgia Patients Registry. Data on the use of pregabalin and its perceived benefits were collected from the registries and from completed questionnaires.

Results:

Out of 4339 screened chronic non-cancer pain patients, 355 (8.18%) met the study selection criteria. Three-quarters of them (268/355) used pregabalin for pain conditions not approved by Health Canada and were therefore regarded as off-label users. The most prevalent condition for pregabalin use was lumbar back pain (103/357; 28.85%). There were no significant differences between on- and off-label users in their perceived satisfaction from pregabalin therapy and its effect on function and quality of life. Among former users, the most prevalent reason for discontinuation was adverse effects, mainly dry mouth and weight gain.

Conclusions:

We conclude that despite specific indications for pregabalin prescription, it is mainly used off-label, notably for low back pain. Nevertheless, off-label users were equally satisfied with its clinical effects. Although formal exploration of the broader analgesic properties of pregabalin is warranted, treating heterogeneous chronic pain conditions with pregabalin may be legitimate.

Limitations:

The main limitations of the study are patients’ low response rate, the recruitment of participants solely from a tertiary pain center and not from the general patient population and a possible recall bias that may have arisen from the retrospective nature of the study.

Transparency

Declaration of funding

This study was supported by unrestricted education and research grants from the Louise and Alan Edwards Foundation, Montreal, Canada.

Declaration of financial/other relationships

This study was envisioned and conducted as a researcher-initiated project. H.G., M.-A.F., X.T. and Y.S. have disclosed that they have no significant relationships with or financial interests in any commercial companies related to this study or article. M.A.W. and M.C. have no relevant relationships to disclose related to this study, but have disclosed that they have received speaker fees and grants from Pfizer Canada Inc.

CMRO peer reviewer 1 has no relevant financial or other relationships to disclose. Peer reviewer 2 has no relevant financial or other relationship pertaining to this study, but has disclosed that he has received honoraria and/or has participated in advisory boards on behalf of: Alkermes, AstraZeneca, Grunenthal, Johnson & Johnson, Lundbeck, Merck, Merz, M’s Science Corporation, Otsuka Pharmaceuticals, Pierre Fabre Pharmaceuticals, Pfizer, PharmaNeuroBoost, Richter, Roche, Servier, Synosis, Takeda, Theracos, Targacept, Transcept and Xytis. Peer reviewer 3 also has no relevant financial or other relationships related to this specific research, but maintains the following relationships: Consultant for Inspirion, Baxter, Purdue Pharma LLP, Grunenthal GmhB, Iroko, and Johnson and Johnson.

Acknowledgments

The authors thank Anna Serapins, Hélène Lanctôt and Sylvie Toupin for their editorial assistance.

Previous presentation: This study was presented as a poster in the Canadian Pain Society conference in May 2013 in Winnipeg, Manitoba, Canada.

Notes

*Cymbalta is a registered trade name of Eli Lilly and Company, Indianapolis, IN, USA

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