In a previous rapid response, Mark Hallam wrote re gabapentin and pregabalin:
"Whilst these drugs clearly have appropriate uses, they should be avoided in those with a history of drugs and/or alcohol dependency."
I would like to take issue a bit with that statement. Perhaps a better wording would be "they should be used with caution in those with a history of drugs and/or alcohol dependency" rather than "avoided".
Otherwise we would be denying a whole swathe of people treatment which can be effective, for conditions that can be painful and/or disabling.
Surely, we must not believe that all people who have, or have had, substance misuse problems are either a) manipulative people who only want these drugs to get a "high" or b) if these drugs are prescribed they will automatically be abused or sold.
It is the same issue with opiate analgesia in people who have or have had an opiate addiction.
Each person is an individual and to make a blanket statement of "do not use" is not good medicine.
Do use if really needed clinically, but with informed caution and careful monitoring.
Of course, deciding on the clinical need is somewhat of an art as well as a science, given that the sorts of things treated by these substances are not really amenable to objective measurement. It's not easy, of course, but then that's why we are doctors....
I hope that this makes sense to people and that it takes the debate forward - and I hope that no one has taken offence with these observations - none was intended.
Rapid Response:
Re: Drugs for neuropathic pain
In a previous rapid response, Mark Hallam wrote re gabapentin and pregabalin:
"Whilst these drugs clearly have appropriate uses, they should be avoided in those with a history of drugs and/or alcohol dependency."
I would like to take issue a bit with that statement. Perhaps a better wording would be "they should be used with caution in those with a history of drugs and/or alcohol dependency" rather than "avoided".
Otherwise we would be denying a whole swathe of people treatment which can be effective, for conditions that can be painful and/or disabling.
Surely, we must not believe that all people who have, or have had, substance misuse problems are either a) manipulative people who only want these drugs to get a "high" or b) if these drugs are prescribed they will automatically be abused or sold.
It is the same issue with opiate analgesia in people who have or have had an opiate addiction.
Each person is an individual and to make a blanket statement of "do not use" is not good medicine.
Do use if really needed clinically, but with informed caution and careful monitoring.
Of course, deciding on the clinical need is somewhat of an art as well as a science, given that the sorts of things treated by these substances are not really amenable to objective measurement. It's not easy, of course, but then that's why we are doctors....
I hope that this makes sense to people and that it takes the debate forward - and I hope that no one has taken offence with these observations - none was intended.
Competing interests: No competing interests