• Ariel Berger, Ellen Dukes, Bill McCarberg, Marty Liss, and Gerry Oster.
• Policy Analysis Inc., Brookline, Massachusetts 02445, USA.
• Clin Ther. 2003 Nov 1;25(11):2809-21.

BackgroundPostherpetic neuralgia (PHN) is a chronic painful disorder that sometimes develops after an acute episode of herpes zoster infection (shingles) and can be difficult to treat. Although opioids are sometimes effective for chronic neuropathic pain, adverse effects are common, particularly among the elderly, and may cause many patients to discontinue therapy.ObjectiveThis study examined changes in opioid use after the initiation of gabapentin therapy in patients with PHN.MethodsA health insurance claims database was used to identify all persons aged >or= 18 years who began therapy with gabapentin in 2000 or 2001 and had either (1) >or=2 medical claims with a diagnosis of PHN during the 6-month period before the first receipt of gabapentin (index date) or (2) 1 such claim or=2 prescriptions for gabapentin.ResultsForty-five patients with PHN began therapy with gabapentin during the period of interest; 35 (77.8%) received >or=2 prescriptions for gabapentin. The proportion of patients receiving opioids decreased significantly between pretreatment and follow-up (from 88.9% to 71.1%; P = 0.03); the mean number of opioid prescriptions per patient also decreased significantly (from 3.9 to 3.0; P = 0.03). These reductions were observed only in patients who received >or=2 prescriptions for gabapentin; there was no significant change in opioid use among those who received only 1 prescription for gabapentin.ConclusionIn this study, initiation of gabapentin therapy in patients with PHN was associated with a reduction in the use of opioid analgesics.

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