2026 Eastern States Conference

TITLE: Evaluation of gabapentinoid therapy and impact on chronic non-cancer pain for patients on concomitant chronic opioid therapy

AUTHORS:
Destiny Walker, PharmD
Laurence Martinez, PharmD, BCACP
Julia Kaminski, PharmD

LEARNING OBJECTIVE: Audience members will be able to evaluate the risk versus benefit of concomitant gabapentinoids and chronic opioid therapy to mitigate opioid dose escalation.

OBJECTIVE: The primary objective is to assess the impact on morphine milligram equivalents (MME) and safety outcomes for Veterans utilizing gabapentinoid therapy in combination with chronic opioid therapy compared to patients on opioid monotherapy.

METHODS: The Coatesville Veterans Affairs Medical Center (CVAMC) operates a multidisciplinary outpatient pain clinic managing high risk patients on chronic opioid therapy with complex comorbidities. This retrospective, single-center study reviewed Veterans who received chronic opioid therapy and were enrolled in the pain clinic between November 4th, 2022, and August 25th, 2025. The study aimed to evaluate the impact on MME and safety outcomes for Veterans prescribed opioids and gabapentinoids, and those prescribed opioid monotherapy by a CVAMC pain provider. Exclusion criteria encompassed patients initially prescribed tramadol, codeine with acetaminophen, buprenorphine, or gabapentinoids prior to opioids. Patients had to be prescribed therapy from CVAMC pain provider. If prescribed opioids for acute conditions and cancer pain the patients were excluded. A subgroup analysis was completed to further examine any outliers within the study groups, including rapid tapers and changes in therapy.

RESULTS: There were 117 Veterans’ charts reviewed, 63 patients were excluded primarily due to the initiation of gabapentinoid therapy prior to opioid therapy. A total of 24 patients were included in the gabapentinoid with concomitant opioid therapy group, while 30 patients were included in the opioid monotherapy group. The average change in MME was -4.36 in the gabapentinoid with opioid group and -19.66 in the opioid monotherapy group. The gabapentinoid with opioid group reported limited side effects, with somnolence being the most common effect with 8.3%. All participants were prescribed naloxone and received opioid overdose prevention education. No opioid overdoses were reported during the study period.

CONCLUSION: Adjuvant gabapentinoid therapy with chronic opioid therapy can be considered to further reduce pain with minimal side effects if all non-opioid treatments have been exhausted and risk mitigation strategies are utilized. Despite a greater reduction in mean MME in the opioid monotherapy group, the gabapentinoid with opioid therapy also saw MME reductions, possibly influenced by patient specific factors like etiology of pain, non-opioid therapies, and patient hesitancy with opioid dose reduction.

SELF-ASSESSMENT QUESTION:  Can gabapentinoids be an effective adjuvant therapy for patients on long-term opioid therapy to mitigate opioid dose escalation without increasing risks?