Intended for healthcare professionals


Prolonged use of opioids after surgery

BMJ 2014; 348 doi: (Published 11 February 2014) Cite this as: BMJ 2014;348:g1280

Re: Prolonged use of opioids after surgery

Just a cautionary note.

The authors suggest gabapentinoids as a first line treatment for peripheral neuropathic pain rather than opioids.

Of course it is true that opioid addiction can start with prescribed opioids for pain. However, in clinical addiction practice we are also seeing increasing problems with gabapentinoids such as gabapentin and pregabalin.

I would use the same caution in long term prescribing of these as with opioids in the knowledge that they are readily abusable and difficult to come off.

They are also difficult to detect in screening tests as they are not widely included in test panels, and of course they are not illegal. They are particularly problematic because the pain they treat is only really quantifiable subjectively and not objectively - therefore making clinical assessment more challenging.

We also know that there is evidence for lower pain thresholds in those who abuse opioids - therefore they are susceptible to the multiple misuse of drugs if they obtain a gabapentinoid to help with pain relief. Gabapentinoid effects can be similar to benzodiazepines psychologically as well - and we know how difficult it is to help people come off those.

I hope that is helpful for clinical practice - I am not saying we should deny people these medications, but we need to just be alert to the increasing problems that are emerging with them.

Competing interests: No competing interests

04 March 2014
Joss Bray
Substance Misuse Specialist
Stockton on Tees