Meds and you

Updated 11 August 2017

Doctors at fault for prescribing epilepsy drugs for pain

Designed to treat epilepsy, these 'opioid alternatives' only dampen certain types of pain, and potentially have serious side effects.

Physicians might be relying too heavily on "off-label" use of epilepsy drugs as an alternative to prescribing narcotic painkillers, two experts in internal medicine contend.

Off-label” use of medication is when it is used to treat a condition other than what it was designed for, in other words, a condition not mentioned on the label.

According to the South African Medical Journal (SAMJ), compared with the USA, issues surrounding the off-label use of medication have received little attention in South Africa.

Doctors are prescribing the anti-seizure drugs gabapentin (Neurontin) and pregabalin (Lyrica) to treat pain more frequently, partly in response to the opioid epidemic in the United States, said Dr Allan Brett. He's a professor of clinical internal medicine with the University of South Carolina School of Medicine in Columbia.

Potentially serious side effects

However, the drugs might not be doing any good for many people suffering from chronic pain such as back pain, Brett said.

That's because the medications are only FDA-approved to treat certain types of pain. Yet, "increasing numbers of patients [are] being prescribed either of these drugs for any kind of pain symptoms," he said.

Brett and co-author Dr Christopher Goodman, an assistant professor of clinical internal medicine, argued their point in a letter published in the New England Journal of Medicine. In many cases, gabapentin and pregabalin could fail to ease pain while also creating potentially serious side effects, Brett noted.

"They can be sedating. They can cause dizziness," he said. "I've found that some patients who take these drugs say they seem to affect their thinking or cognition in a subtle way that troubles the patient."

Other side effects include allergic reaction, fatigue, balance problems, impotence, change in bowel movements, sluggishness and confusion, said Dr Minisha Sood, an endocrinologist with Lenox Hill Hospital in New York City.

Avoiding opioids

Brett said that gabapentin and pregabalin originally were developed as anti-seizure drugs for epilepsy, but clinical trials found the drugs also showed promise in relieving certain kinds of nerve-related pain.

As a result, the US Food and Drug Administration approved them for use in treating shingles pain, fibromyalgia, and nerve pain associated with diabetes or spinal cord injuries, the authors said in background information.

Doctors struggling to ease patients' pain without resorting to opioids appear to be turning to the anti-seizure drugs, even in cases where the pain doesn't fall under FDA guidelines, Brett said.

Correct medication for back pain

When in pain, it's important to stick to the medication specifically manufactured for that purpose. Treat back pain with over-the-counter medication such as simple analgesics (paracetamol) and non-steroidal anti-inflammatory drugs (NSAIDs) to reduce muscle and joint inflammation. If your back pain persists, consult your doctor for prescription pain medication such as non-steroidal anti-inflammatory drugs (NSAIDs) and muscle relaxants to relieve mild to moderate back pain and muscle spasm. Corticosteroid injections may be prescribed for more severe back pain.

Visit Health24's pain centre for suggestions on home treatments for various types of pain.

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