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December 11, 2019 06:30 pm

Chronic Pain is an Impossible Problem

A "safe" alternative to opioid painkillers turns out to be not so safe. From a report: Gabapentin was supposed to be the answer. Chronic pain afflicts about a fifth of American adults, and for years, doctors thought it could be treated with prescription painkillers like Oxycontin. But as the drugs began killing the equivalent of three planeloads of Americans every week, opioid prescriptions fell off precipitously. Many doctors embraced gabapentin, an anticonvulsant drug traditionally used to prevent seizures, as a way to treat neuropathic pain while avoiding triggering life-threatening addiction. From 2012 to 2016, prescriptions for gabapentin increased 64 percent. It's now the 10th-most-commonly-prescribed medication in the United States. Baclofen, a muscle relaxant, has become another popular opioid replacement. Though gabapentin and baclofen can cause a boozelike "high" for some people, they're far less addictive and less likely to be fatal when taken in large quantities than opioids are. But now their own pitfalls are becoming clear. Though gabapentin and baclofen are much safer alternatives to opioids, recent research suggests that they're not as safe as some doctors might have hoped, especially in combination with other sedating medications. The findings are a frustrating turn that suggests there's still no silver bullet for chronic pain. By examining the National Poison Data System, which collects reports of poisonings around the United States, Kimberly Reynolds, a researcher at the University of Pittsburgh, and her co-authors recently found that people are increasingly using both gabapentin and baclofen to either get high or attempt suicide. From 2013 to 2017, people tried to commit suicide using gabapentin nearly 42,000 times, and thousands more abused or misused the substance. In most cases -- nearly 70 percent -- the poisoned individuals took a combination of gabapentin and other drugs. Meanwhile, the majority of the poison cases involving baclofen were suicide attempts. "It's rare, but overdose from large quantities of gabapentin or baclofen can be fatal," Reynolds told me via email.

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