The emerging issue of rising gabapentinoid misuse is being recognised alongside the lack of current evidence supporting the safe and effective deprescribing of gabapentinoids. This scoping review aimed to assess the extent and nature of gabapentinoid deprescribing interventions in adults, either in reducing dosages, or prescribing of, gabapentinoids. Electronic databases were searched on 23rd February 2022 without restrictions. Eligible studies included randomised, non-randomised and observational studies that assessed an intervention aimed at reducing/ceasing the prescription/use of a gabapentinoid in adults for any indication in a clinical setting. The research outcomes investigated type of intervention, prescribing rates, cessations, patient outcomes, and adverse events. Extracted outcome data was categorised as either short (≤ 3 months), intermediate (>3 but <12 months) or long (≥ 12 months) term. A narrative synthesis was conducted. The four included studies were conducted in primary and acute care settings. Intervention were of dose reducing protocols, education and/or pharmacological-based approaches. In the randomised trials, gabapentinoid use could be ceased in at least one-third of participants. In the two observational trials, gabapentinoid prescribing rates decreased by 9%. Serious adverse events and adverse events specifically related to gabapentinoids were reported in one trial. No study included patient-focussed psychological interventions in the deprescribing process, nor provided any long-term follow-up. This review highlights the lack of existing evidence in this area. Due to limited available data, our review was unable to make any firm judgements on the most effective gabapentinoid deprescribing interventions in adults, highlighting the need for more research in this area.

Background and aims: Opioids are commonly prescribed to patients with chronic low back pain (LBP) despite risks of harms. We conducted a discrete choice experiment (DCE) to determine factors contributing to a general practitioner’s (GP’s) decision to prescribe either an opioid or an NSAID to a patient with chronic LBP. Methods: GPs recruited through an online survey distributed in Australia were presented with 12 questions that represented hypothetical clinical scenarios of a patient with chronic LBP. The clinical scenario varied by two patient attributes; LBP with or without referred leg pain (sciatica) and comorbidities. Participants chose their preferred alternative either an opioid, NSAID or neither (“opt-out”). Each alternative varied by three clinical attributes: the type of opioid or NSAID, the degree of pain reduction and number of adverse events. Results: 210 GPs participated in the survey. Overall, GPs preferred to prescribe an NSAID (45.2%, 95% CI 38.7% to 51.7%) over an opioid (28.8%, 95% CI 23.0% to 34.7%). However, there was no difference between the type of NSAID or opioid preferred. Patient attributes of comorbidities (zero, one, two or three), and the presence of referred leg pain (sciatica) did not influence prescribing preferences, nor did clinical attributes of pain reduction and adverse events. Conclusions: GPs prefer to prescribe an NSAID over an opioid for a patient with chronic LBP. This preference appeared fixed and was not changed by clinical (drug type, degree of pain reduction or number of adverse events) or patient attributes (comorbidities or presence of referred leg pain).