Amy McNeilage, from the Royal North Shore Hospital’s Pain Management and Research Centre with support from the Pain Foundation, is pursuing a PhD at the University of Sydney. Her research focuses on the potential risks linked to gabapentinoid drugs like gabapentin and pregabalin, which are now among the most widely prescribed pain medications in Australia.
There is growing concern about the misuse and diversion of these drugs in the community.
Gabapentinoids were originally developed to treat epilepsy and are also approved in Australia for the management of neuropathic pain. However, according to McNeilage, there is anecdotal and research evidence to suggest Australian doctors are now turning to them to treat a wide array of chronic pain conditions, despite there being very little evidence for their effectiveness.
“Pregabalin, which most people know as Lyrica, has overtaken opioids like codeine and oxycodone to become the most widely dispensed prescribed pain medication in Australia,” she says.
“There has been a lot of pressure in recent years to deprescribe opioids and it has left doctors and patients desperate for alternatives. Gabapentinoids were marketed as a safe alternative but, unfortunately, it increasingly looks as though they are not as safe as initially thought.”
“There is a growing body of research which suggests there is the potential for dependence and other harms with these drugs. There is also some very worrying emerging evidence that there may be psychiatric side effects, including suicidal ideation, for some patients, particularly when attempting to come off these drugs.”
Through her PhD research, which is supported by Pain Foundation Limited and its generous donors, McNeilage hopes to improve understanding of the harms associated with these commonly prescribed drugs and to develop strategies to mitigate these harms.
In the United States, pharmaceutical giant Pfizer has paid more than $3 billion in fines and settlements for promoting unapproved uses of gabapentinoids, including for chronic pain.
“The thing that is particularly concerning from the patient perspective is that the evidence for the effectiveness of these drugs is very weak. In fact, there is quite good evidence that they don’t work for many of the chronic pain conditions they are being prescribed for,” said McNeilage.
“We know that placebo is very strong, so this wouldn’t necessarily be a problem, except that the drugs can come with nasty side effects.”
This research is going beyond medical use to look at the emerging use of these drugs recreationally and within vulnerable communities around the world.
“We definitely cannot say that this crisis will reach the level of the opioid epidemic, as research is still evolving, but there are definitely reasons for concern,” she said.
Amy McNeilage’s PhD and subsequent research has been part-funded by the Pain Foundation, based in Sydney. Her PhD supervisor is A/Prof Claire Ashton-James, who says “so much of the ground-breaking research we are able to conduct at The Pain Management Research Institute we owe to the conviction and generosity of Pain Foundation Limited and their donor network.
“Federally funded research is typically incremental and low-risk. We are taking bold steps to make big changes in the care of people with chronic pain through community support,” she added.