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J Burn Care Res. 2019 Mar 20. pii: irz036. doi: 10.1093/jbcr/irz036. [Epub ahead of print]

The Effects of Early Neuropathic Pain Control with Gabapentin on Long-Term Chronic Pain and Itch in Burn Patients.

Author information

1
Medicine Regional Burn Center, Seattle, WA.

Abstract

Gabapentin has analgesic efficacy for neuropathic pain and is increasingly used in burn care. This study investigated the effect of a neuropathic pain control protocol, as well as early gabapentin initiation (< 72 hours from injury) on total inpatient opioid use, chronic pain, and itch. This is a single-institution retrospective cohort study of patients over age 14 admitted between 2006 and 2016 with burns. We compared patients who did not receive gabapentin with those who had early gabapentin initiation vs. late initiation. We also compared patients who used gabapentin prior to initiation of a neuropathic pain protocol (February 2015) to those after. Primary outcomes were total inpatient gabapentin, morphine equivalents (MED), longitudinal pain and itch, as well as SF-12v2 Health Survey mental and physical component scores (MCS/PCS) at discharge, 6, 12, and 24 months post-injury. Ordinal logistic regression analysis was used to examine pain and itch scores. Linear regression models examined MCS and PCS between groups. Models were adjusted for age, sex, TBSA burned, area grafted, MED, and ICU stay. There was no significant difference in MED with early initiation, yet inpatient gabapentin use increased from 43.9 g to 59.5 g (p<0.001) with late initiation. The neuropathic pain protocol did not significantly change total gabapentin use (p = 0.184) in patients receiving gabapentin but decreased opioid use from 58.1 g to 17.4 g MED (p = 0.008). Our results suggest neither early gabapentin nor its use in a standardization neuropathic pain protocol improves long-term pain, itch, PCS or MCS scores.

KEYWORDS:

Chronic itch and pain; Gabapentin; Neuropathic pain; Opioid dose reduction

PMID:
30893433
DOI:
10.1093/jbcr/irz036

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