NY Times: “Millions Take Gabapentin for Pain. But There’s Scant Evidence It Works.”

NY Times: “Millions Take Gabapentin for Pain. But There’s Scant Evidence It Works.”

Thanks to Stan Cohen for pointing out this reference.

An excerpt:

The drug was initially approved 25 years ago to treat seizure disorders, but it is now commonly prescribed off-label to treat all kinds of pain, acute and chronic…

Two doctors recently reviewed published evidence for the benefits and risks of off-label use of gabapentin (originally sold under the trade name Neurontin) and its brand-name cousin Lyrica (pregabalin) for treating all kinds of pain…

Gabapentin and Lyrica, both sold by Pfizer, have been approved by the Food and Drug Administration to treat only four debilitating pain problems: postherpetic neuralgia, diabetic neuropathy, fibromyalgia and spinal cord injury. Even for these approved uses, the evidence for relief offered by the drugs is hardly dramatic…

In many well-controlled studies they found there was less than a one-point difference on the 10-point pain scale between patients taking the drug versus a placebo, a difference often clinically meaningless….

the number of people taking gabapentinoids more than tripled from 2002 to 2015…

Related blog post: Brave New World: Psychotropic Manipulation and Pediatric Functional GI Disorders

Near Cathedral of Barcelona

ERAS -Enhanced Recovery After Surgery

Fortunately, only a small number of children need colorectal surgery.  For those who do need this surgery, there are advancements which are helping to reduce length of stay and shorten recovery.  Some of the concepts with “Enhanced Recovery After Surgery” or ERAs have been around for more than 10 years.  One of our surgical colleagues, Dr. Kurt Heiss, described his experience in applying these techniques in the pediatric population and was kind enough to share his slides.  Slide 10 (see below) outlines the key points.

The immediate challenge in improving the quality of surgical care is not discovering new knowledge, but rather how to integrate what we already know into practice –Urbach DR, Baxter NN, BMJ 2005

Preoperative:

  • Counseling family
  • Avoid bowel prep –>can lead to bowel edema
  • Avoid prolonged fast prior to surgery.  Fluid/carbohydrate loading
  • Use of Neurontin preoperative
  • Antibiotic prophylaxis
  • Thromboprophylaxis

Intraoperative:

  • Short-acting anesthetics
  • Use of TAP and/or short-term epidural. Avoid narcotics
  • Avoid excessive fluid administration
  • No drains
  • Maintenance of normothermia

Postoperative:

  • Early feeding (same night)
  • No NG
  • Avoid/minimize narcotics
  • Early mobilization

ERAS: leads to shorter length of stay, reduced nonsurgical complications and no increase in readmission rates.

Resources:

My take: ERAS concept/team approach is leading to better outcomes.  GI surgery is likely to benefit more than other areas due to the often-slow recovery of the GI tract after operations.

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