Welcome to this month’s Rx Rundown, a new feature designed to help claims professionals better understand medications commonly prescribed in workers’ compensation claims Each month, we’ll spotlight a different medication or therapeutic class, breaking down what it is, why it’s prescribed, potential concerns, and its place in workers’ compensation treatment. Our goal is to provide you with clear, concise information that you can apply in your daily work, helping you make more informed decisions and communicate more effectively with healthcare providers and recovering employees alike. Let’s dive into this month’s feature.
In a Nutshell: What are Gabapentinoids?
Gabapentinoids are a class of medications that includes gabapentin (brand names such as Neurontin and Gralise) and pregabalin (brand name Lyrica). These are anticonvulsant medications originally developed to treat epilepsy but have since found wider application in managing various types of pain.
Why are Gabapentinoids Prescribed?
In workers’ compensation, gabapentinoids are commonly prescribed for:
- Neuropathic pain: Often resulting from nerve damage or conditions like diabetic neuropathy
- Post-surgical pain management
- Chronic pain conditions, particularly those involving nerve pain
- As part of a multimodal pain management strategy to reduce opioid use
Gabapentinoids work by altering the way nerves send messages to the brain, effectively reducing the sensation of pain. They’re often preferred over opioids due to their lower risk of addiction and abuse.
What Are the Concerns?
While generally considered safer than opioids, gabapentin is not without risks:
- Side effects: Common side effects include dizziness, drowsiness, and fatigue, which could impact a recovering employee’s ability to perform certain tasks safely.
- Potential for misuse: Although less addictive than opioids, there’s growing concern about the potential for abuse, particularly when combined with other substances.
- Withdrawal symptoms: Abrupt discontinuation can lead to withdrawal symptoms, necessitating a gradual tapering off under medical supervision.
- Off-label use: Gabapentinoids are often prescribed for off-label uses, which may raise questions about their appropriateness in certain cases.
- Effectiveness varies: Not all patients experience significant pain relief with gabapentinoids, and their effectiveness can be highly individual.
- Long-term use concerns: The CDC’s 2022 revised opioid guideline notes that gabapentin and pregabalin can have ‘small to moderate improvements’ on pain, but evidence for long-term use is lacking. This raises questions about the appropriateness of chronic use in some cases.
- Co-prescribing risks: There are significant concerns about co-prescribing gabapentinoids with opioids, benzodiazepines, and other sedatives, especially in older patients. This combination can increase the risk of respiratory depression and other adverse effects.
Is There a Place for It in Workers’ Compensation?
Gabapentinoids do have a place in workers’ compensation treatment plans, particularly for managing neuropathic pain and as part of opioid-sparing strategies. However, their use should be carefully considered and monitored:
- Appropriate prescribing: Ensure it’s being prescribed for conditions where it’s proven effective, particularly neuropathic pain.
- Monitoring: Regular follow-ups to assess effectiveness and side effects are crucial.
- Safety considerations: Be aware of potential impacts on the worker’s ability to perform job duties safely, especially in roles involving driving or operating machinery.
- Duration of use: Have clear plans for both the duration of use and, if necessary, how to safely discontinue the medication. Given the lack of long-term efficacy evidence, chronic use should be carefully evaluated.
- Part of a comprehensive plan: Gabapentinoids should ideally be part of a broader pain management strategy that includes other modalities like physical therapy and cognitive behavioral therapy.
- Careful consideration of co-prescriptions: Be particularly vigilant about the concurrent use of gabapentinoids with opioids, benzodiazepines, or other sedatives, especially in older patients.
Conclusion
The emergence of GLP-1 medications presents both benefits and challenges in the broader workers’ compensation landscape, but there is not clear evidence that coverage should be authorized for workers’ compensation. Looking ahead, workers’ compensation payers may need to develop guidelines for claims professionals to help with coverage decisions.
As the market for GLP-1 agonists continues to evolve, with new formulations being developed and patents eventually expiring, the cost-benefit equation may shift. Claims payers should remain informed, continuously reassessing the impact of these medications on claim outcomes and overall costs.
Contact us if you have questions about gabapentinoids.