Changes in Gabapentinoid Use Among Danish Patients With Spinal Pain: A Comparison of Two Secondary Care Cohorts 2013-2014 and 2021-2022.

BACKGROUND

Gabapentinoids (gabapentin and pregabalin) are increasingly prescribed for spinal pain despite limited evidence of benefit and recognised risks. Understanding which characteristics influence prescribing and how prescription use has evolved may inform safer and more evidence-based practice.

OBJECTIVES

To compare determinants of gabapentinoid use and changes over time between two separate cohorts of patients referred to the Spine Centre of Southern Denmark.

METHODS

Our study comprised two cohorts: the first, from 2013 to 2014 (n = 16,732), and the second, from 2021 to 2022 (n = 13,939). Redeemed gabapentinoid prescriptions were assessed within a 12-month window (6 months before and after the spine centre index date) and linked with diagnostic, socioeconomic and patient-reported information. Patients were categorised as continued users, initiators, discontinuers or non-users using a ≥ 30 defined daily dose classification threshold to distinguish sporadic from more sustained dispensing. Multinomial logistic regression, incorporating demographic, socioeconomic and clinical covariates, identified characteristics associated with use.

RESULTS

Gabapentinoid use more than doubled from Cohort 1 to Cohort 2, with continued users increasing from 2.4% to 6.6% and initiators increasing from 3.5% to 6.1%. Radiculopathy, higher disability and concurrent opioid or weak analgesic use showed the strongest positive associations with use across both cohorts.

CONCLUSIONS

Gabapentinoid use for patients with spinal pain attending secondary care in Denmark increased substantially across the decade, despite only modest differences in patient characteristics. Gabapentinoid use remained concentrated among patients with radiculopathy and concurrent analgesic use, underscoring continued reliance on pharmacological management.

SIGNIFICANCE STATEMENT: This study identifies a marked rise in gabapentinoid prescribing for spinal pain in secondary care and shows that the increase was only partly explained by differences in patient characteristics. The findings highlight continued use in patient groups where clinical benefit remains unproven, reinforcing the need for safer, more evidence-based prescribing strategies.