Prescribing of antiepileptic drugs for the treatment of pain

Abstract Background Antiseizure medications (ASMs), particularly gabapentinoids like pregabalin, are increasingly prescribed for pain management. Despite their growing use, evidence of their effectiveness for pain is mixed. This highlights the need for a clearer understanding of the prevalence and prescribing patterns of ASMs in pain management. Aims To investigate the initiation of ASMs in people with and without pain or epilepsy diagnoses and to explore the concurrent use of opioids. Method This cross-sectional study used deidentified primary care data from 542 general practices in Victoria, Australia. Descriptive statistics were used to analyze ASM prevalence, concurrent opioid use, and prescribing patterns by age and gender. Results We identified 171,619 primary care patients who initiated an ASM between January 1, 2018, and May 31, 2023, of whom 80.1% had pain without epilepsy. Pregabalin was the most commonly initiated ASM, particularly among older adults with pain diagnoses, while sodium valproate, lamotrigine, levetiracetam, and carbamazepine were more commonly initiated for epilepsy. We also found high rates of opioid use preceding ASM initiation, particularly among patients with pain but not epilepsy. Conclusion Given the widespread off-label use of gabapentinoids and the potential for serious harm, further research is warranted to better understand their clinical and safety outcomes.