Healthcare Practitioner and Other Professionals' Perspectives on Gabapentinoid Misuse and Dependence: A Systematic Review of Qualitative Studies

IF 3.4 2区医学 Q1 ANESTHESIOLOGY

European Journal of Pain Pub Date : 2025-09-02 DOI:10.1002/ejp.70116

Amy G. McNeilage, Evan Browne, Suzanne Nielsen, Claire E. Ashton-James, Bridin Murnion

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Abstract

Background and Objective

The global rise in gabapentinoid prescriptions for chronic pain has been striking. However, this trend has been accompanied by growing concerns about misuse and dependence. This qualitative systematic review aimed to synthesise the perspectives of healthcare practitioners and other professionals on these emerging challenges.

Databases and Data Treatment

Six databases (MEDLINE, Scopus, Web of Science, CINAHL, EMBASE, PsycINFO) were searched to May 2025. Eligible studies used qualitative or mixed methods to explore professional views on gabapentinoid misuse or dependence. Studies focusing solely on patient perspectives or therapeutic use were excluded. Methodological quality was assessed using the Critical Appraisal Skills Programme checklist. Data were analysed using thematic synthesis, and confidence in the findings was evaluated using GRADE-CERQual.

Results

After screening 1584 records, 19 original studies were included. Most were conducted in substance use treatment and law enforcement settings, where professionals frequently encounter vulnerable populations and more severe patterns of misuse than in general clinical care. Reported drivers of misuse included polydrug use, opioid substitution, psychological distress and poor access to non-pharmacological care. Signs of misuse included early refills, dose escalation and reluctance to taper. Professionals described ethical tensions in prescribing and dispensing and proposed harm reduction strategies, including prescriber education, regulatory reform, expanded treatment access and public awareness.

Conclusions

Gabapentinoid misuse is shaped by clinical, social and structural factors. Tackling these challenges requires systemic responses that go beyond individual prescribers. Lessons from opioid policy responses should inform balanced, compassionate and evidence-informed strategies to reduce harm and improve care.

Significance Statement

This is the first systematic review to synthesise professional perspectives on gabapentinoid misuse and dependence, drawing on studies from Europe, North America, the Middle East and Africa. Integrating insights from healthcare, law enforcement and policy settings, it reveals the structural drivers behind rising misuse—including opioid regulation, socioeconomic hardship and limited access to alternatives—and highlights gaps in clinical guidance. The findings offer actionable, cross-sector strategies to support safer prescribing, informed policy and more effective harm reduction.

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医疗从业者和其他专业人士对加巴喷丁类药物滥用和依赖的看法：定性研究的系统回顾

背景与目的加巴喷丁类药物在全球范围内治疗慢性疼痛的用量显著增加。然而，伴随这一趋势而来的是对滥用和依赖的日益关注。本定性系统综述旨在综合医疗从业人员和其他专业人员对这些新兴挑战的看法。检索到2025年5月的六大数据库（MEDLINE、Scopus、Web of Science、CINAHL、EMBASE、PsycINFO）。合格的研究采用定性或混合方法探讨加巴喷丁类药物滥用或依赖的专业观点。仅关注患者观点或治疗用途的研究被排除在外。使用关键评估技能计划检查表评估方法学质量。使用专题综合分析数据，并使用GRADE-CERQual评估结果的可信度。结果共筛选1584份记录，纳入19份原始研究。大多数是在药物使用治疗和执法环境中进行的，在这些环境中，专业人员经常遇到弱势群体和比一般临床护理更严重的滥用模式。报告的滥用驱动因素包括多种药物使用、阿片类药物替代、心理困扰和难以获得非药物治疗。滥用的迹象包括早期补充、剂量增加和不愿逐渐减少。专业人员描述了开处方和配药方面的道德紧张局势，并提出了减少危害的战略，包括开处方者教育、监管改革、扩大治疗机会和提高公众意识。结论加巴喷丁类药物滥用受临床、社会和结构因素的影响。应对这些挑战需要超越个体处方者的系统性反应。阿片类药物政策应对的经验教训应为平衡、富有同情心和循证战略提供信息，以减少伤害和改善护理。这是第一个综合了加巴喷丁类药物滥用和依赖的专业观点的系统综述，借鉴了来自欧洲、北美、中东和非洲的研究。该报告综合了来自医疗保健、执法和政策设置的见解，揭示了滥用药物上升背后的结构性驱动因素——包括阿片类药物监管、社会经济困难和获得替代药物的机会有限——并突出了临床指导方面的差距。研究结果提供了可操作的跨部门战略，以支持更安全的处方、知情的政策和更有效的减少危害。

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来源期刊

European Journal of Pain 医学-临床神经学

CiteScore

7.50

自引率

5.60%

发文量

163

审稿时长

4-8 weeks

期刊介绍： European Journal of Pain (EJP) publishes clinical and basic science research papers relevant to all aspects of pain and its management, including specialties such as anaesthesia, dentistry, neurology and neurosurgery, orthopaedics, palliative care, pharmacology, physiology, psychiatry, psychology and rehabilitation; socio-economic aspects of pain are also covered. Regular sections in the journal are as follows: • Editorials and Commentaries • Position Papers and Guidelines • Reviews • Original Articles • Letters • Bookshelf The journal particularly welcomes clinical trials, which are published on an occasional basis. Research articles are published under the following subject headings: • Neurobiology • Neurology • Experimental Pharmacology • Clinical Pharmacology • Psychology • Behavioural Therapy • Epidemiology • Cancer Pain • Acute Pain • Clinical Trials.