4.4 Gap and directions for future research
This review highlights the lack of evidence within existing literature and demonstrates the need for more high-quality studies surrounding the deprescribing of gabapentinoids. Future robust research is required to identify which deprescribing interventions are effective in safely ceasing or tapering gabapentinoids. Specifically, more dose reduction/tapering protocols, such as the study by Kasper et al, (32) should be investigated and include well-defined tapering schedules and longer follow up timepoints, to better inform physicians of regimens that have proved to be effective. Non-pharmacological interventions that are primarily patient-focused and aimed to aid gabapentinoid cessation and decrease the desire and misuse of medications, such as mindfulness, cognitive behavioural therapy and counselling, are effective in deprescribing benzodiazepines and opioids (44, 45) that have still yet to be investigated for potential benefits in gabapentinoid deprescribing. Other interventions, such as electroacupuncture have been shown to reduce opioid consumption safely and effectively in participants with chronic musculoskeletal pain, and could potentially have similar results in gabapentinoid users. (46) It is important that future studies focus on deprescribing gabapentinoids in populations with non-cancer pain, especially in cases where there is no clear diagnosis of neuropathic pain or radiculopathy, and in high-risk patient populations (e.g. those with substance use disorders, polypharmacy). Although we found clinician-focused interventions reduced the number of patients taking gabapentinoids, future studies may consider interventions that target initial prescribing decisions to directly affect the current baseline prescribing trends. Included studies were based in primary and acute care, and future studies should also consider interventions to reduce initial prescribing by pain specialists and other medical specialists who may provide the initial prescription or recommendation for prescription. As this emerging area of research grows, it will inform and shape the foundations of gabapentinoid deprescribing guidelines for clinicians, and will help prompt change in current clinical prescribing patterns of gabapentinoids.
ACKNOWLEDGEMENTS: SM holds a Health Professional Research Early Career Fellowship (APP1158463) from Australia’s National Health and Medical Research Council. DG holds a Dementia Leadership Fellowship (APP1136849) from Australia’s National Health and Medical Research Council.
FUNDING: No funding was received to conduct this review.