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Concern about overuse of conventional opioids for pain management has pushed clinicians to substitute other medications that are thought to be effective and safe, including gabapentinoids and tramadol. In 2019, researchers addressed this issue in several studies and reviews, with mostly discouraging findings.
Some clinicians might not realize that gabapentin's only FDA-approved pain indication is postherpetic neuralgia; for pregabalin, FDA-approved pain indications are postherpetic neuralgia, diabetic neuropathy, fibromyalgia, and spinal cord injury. The increasing use of gabapentinoids for non–FDA-approved indications led to a review of 34 randomized trials in which researchers examined off-label use for non-cancer, non-postoperative pain. …
