Osteoarthritis (OA) is a large and growing problem. Doctors may have started to prescribe medications (gabapentinoids) traditionally used for epilepsy and neuropathic pain (nerve pain) to control osteoarthritis pain. This could be due to the ineffectiveness of existing painkillers and to research suggesting that osteoarthritis pain can sometimes be partly neuropathic. Yet there is very limited evidence of the effectiveness of gabapentinoids in this population and mounting concern over the increasing use of these medications in general because of their addictive properties and potential for illegal misuse.
Our study will investigate recent UK trends in the prescribing of gabapentinoids in patients with OA to address the following questions:
? Has their use been increasing in patients with osteoarthritis? How much of their use might be for osteoarthritis (rather than other conditions the patient has)? Is their use related to patient age, sex? Does it vary a lot by which part of the country they live in?
? Does their use reduce after patients have a knee replacement?
OA is a common, painful, disabling condition leading to a million GP consultations in the UK each year. There is anecdotal evidence that gabapentinoids such as gabapentin and pregabalin are being used in patients with OA. Licensed for neuropathic pain, their possible usage in OA patients may be due to concerns with current options, but also literature suggesting some OA patients have a neuropathic element to their pain. There is, however, little evidence that gabapentinoids are effective for OA pain and they are not mentioned in current clinical practice guidelines for OA. The UK government is now intending to reclassify these dependence-forming medicines as class C controlled substances.
Our study aims to describe the patterns and trends in gabapentinoid prescriptions in patients with OA. A secondary objective is to conduct a simple before-after study to describe gabapentinoid prescriptions before and after primary total knee replacement, a highly effective treatment for end-stage knee OA. This should help us further understand gabapentinoids may be getting prescribed independently of the severity of OA pain.
Health outcome = recorded prescription of gabapentinoids (code lists derived from6) (Appendix 4)
George Peat - Chief Investigator - Keele University
Dahai Yu - Collaborator - Keele University
John Bedson - Collaborator - Keele University
Julie Ashworth - Collaborator - Keele University
Thomas Appleyard - Collaborator - Keele University
Patient Level Index of Multiple Deprivation