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.