The Food and Drug Administration approved Gabapentin and Lyrica, which sold Pfizer both, to treat only four debilitating pain problems: postnatal neuralgia, diabetic neuropathy, fibromyalgia and injury to the spinal cord. Even for these approved uses, the evidence of relief offered by the dramatic drugs is rare. Goodman and Brett reported in Internal Medicine JAMA online.
In many well-controlled studies, they found that there was less than any point difference on the 10 point pain scale between patients who took the drug against placebo, often clinically senseless difference. For example, among 209 patients with sciatica, Lyrica did not significantly reduce the intensity of leg pain compared to placebo, and the 108 patients who took the drug often reported dizziness.
But when patients complain about pain-related conditions from sciatica and osteoarthritis to foot pain and migraine, clinicians often reach the prescription pad and order gabapentin or Lyrica more expensive.
Following the approval of Neurontin, his producer at the time, Warner-Lambert, who was dealing with the government, was an illegal marketing campaign leading to sales of over $ 2 billion a year before his patent expired. in 2004. The campaign succeeded in paying attention to all doctors who deal with pain that continually affects life.
It is not that there are no alternatives to opioids to treat chronic pain, including physical therapy, cognitive behavioral therapy, hypnosis and mental training. However, practicing clinicians may not be aware of the options, most of which require more effort than writing a drug prescription and that it is not as easy or accessible to patients as patients. pill swallowing.
As Dr. Michael E. Johansen, a family doctor in Columbus, Ohio, “I use gabapentin clinically and try to stay close to the approved signs, but from time to time the choices do not address patients who hurt. These drugs rarely end pain, and I won't tell patients that their pain will go away. If there is any benefit, it is probably marginal. ”
Despite the limited benefit evidence, in a study published in JAMA's Internal Medicine in February, t Dr. Johansen found that the number of people taking gabapentinoids increased more than tripled from 2002 to 2015, with more than four out of five people accepting the usual type, gabapentin.