Is pregabalin being prescribed for pain other than neuropathic pain? Is it being used according to guidelines and the best available evidence? Once prescribed, are patients receiving optimal benefit?
Providing health professionals with answers to these questions is essential for ensuring accurate diagnosis, appropriate prescribing of neuropathic pain medicines and improved quality of life of patients with neuropathic pain.
Figure 1: PBS prescription volumes for pregabalin, amitriptyline and duloxetine, July 2006 to Jun 2016.1
The number of pregabalin prescriptions in Australia was turbocharged when it was PBS-listed in March 2013. From fewer than 200,000 prescriptions in 2012–13, it leapt to 3.26 million in 2015–16 and 3.61 million in 2016–17.1
A 2015 Drug Utilisation Sub-committee (DUSC) report on the first 2 years after pregabalin’s PBS listing found that the number of prescriptions was much higher than predicted. It suggested that prescribing for pain other than neuropathic pain may have been a contributing factor.2
Prescribing pregabalin for non-neuropathic low back pain (LBP) has been a standout concern. This may be happening due to misunderstanding of neuropathic pain among prescribers, as well as the effects of advertising.3 It’s also been suggested that pregabalin is being used for many types of acute and chronic non-neuropathic pain, such as osteoarthritis, in a desperate move to get patients off opioids.4