Off-Label Use of Gabapentinoids in Non-diabetic Patients Referred to a Rheumatology Clinic: A Cross-Sectional Study

Background Gabapentin is FDA-approved for postherpetic neuralgia and partial-onset seizures, while pregabalin is approved for several neuropathic pain conditions, fibromyalgia, and as adjunctive therapy for partial-onset seizures. Despite limited evidence for many off-label uses, gabapentinoids are frequently prescribed, raising concerns about adverse effects, misuse, and dependence. This study examines gabapentinoid prescribing patterns among patients referred to our rheumatology clinic. Patients and methods A cross-sectional study of patients without diabetes (N=466) was conducted among newly referred patients to our rheumatology clinic. Data was extracted from the electronic medical records system and recorded in the REDCap database. Patients' presenting complaints, comorbid conditions, and current medications were analyzed. Descriptive analyses were performed, and statistical analyses were conducted using a t-test for continuous variables, a chi-square test for categorical variables, and effect sizes were reported as odds ratios (OR). Key results Our findings reveal that 17.8% of patients referred to our clinic were prescribed gabapentinoids, many of whom also received concomitant prescriptions for opioids, including tramadol (34%), and antidepressants (32.5 %). Gabapentinoid use was more prevalent among patients with depression (OR=4.51) and anxiety (OR=3.69). Additionally, patients presenting with back pain (OR=3.78) and fatigue (OR=1.75) were more likely to be taking gabapentinoids. In contrast, symptoms such as multiple joint pain, dry eyes, and dry mouth showed no significant difference. Conclusion Our study provides insight into prescribing practices of gabapentinoids within the rheumatology setting. About one-third of the patients on gabapentinoids were also taking other medications with greater potential for harm with concomitant use. Evidence supporting the efficacy of gabapentinoids in different medical conditions is needed to guide clinicians.