Journal of clinical neuroscience : official journal of the Neurosurgical Society of Australasia · 2026
Comparative safety and health service utilization for gabapentin versus non-steroidal anti-inflammatory drugs for cervical radiculopathy: A retrospective cohort study of academic centers.
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Baumann AN, Trager RJ, McGlamery D, Yazdanpanah S, Conry KT, Preston G, Hoffmann JC
Аннотация
BACKGROUND: Off-label use of gabapentin for neuropathic pain conditions such as cervical radiculopathy (CR) remains controversial due to limited evidence of benefit and safety concerns (e.g., opioid co-prescription, adverse drug events [ADEs], dizziness, and hospitalization risk), necessitating further research. This study explores safety risks and health service utilization in adults with newly diagnosed CR, comparing gabapentin to nonsteroidal anti-inflammatory drugs (NSAIDs) to inform clinical practice.
METHODS: This retrospective propensity-matched cohort study using the TriNetX database included opioid-naïve adults (≥18 years) with newly-diagnosed CR without history of spinal surgery, spinal neoplasms, myelopathy, opioid-use disorder or cervical injection. Patients were divided into gabapentin or NSAID cohorts based on prescription at CR diagnosis, and matched for demographics, prescriptions, and comorbidities. Outcomes included incidence and risk ratios (RRs) of safety and health service utilization markers assessed through one year. Significance was evaluated at P < 0.0036 (Bonferroni-corrected).
RESULTS: After matching, there were 23,379 patients (mean age: 53 years; 57% female) per cohort. About 14% of patients per cohort were co-prescribed opioids at CR diagnosis. Compared to the NSAID cohort, the gabapentin cohort had a statistically significant (P < 0.0036) increased risk of posterior cervical fusion (RR: 3.23), opioid-related disorder (RR: 2.87), cervical corticosteroid injection (RR: 2.52), opioid-related ADEs (RR: 2.32), anterior cervical discectomy and fusion (RR: 2.10), acute respiratory failure (RR: 1.80), cervical spine magnetic resonance imaging (RR: 1.43), inpatient visits (RR: 1.38), oral opioid prescription (RR: 1.34), and cervical spine radiographic imaging (RR: 1.21). Risk of dizziness, falls, somnolence, and emergency department visits was not significantly increased (P > 0.0036).
CONCLUSION: Gabapentin prescription for newly-diagnosed CR in adults was associated with increases in opioid prescription, adverse safety events, and health service utilization compared to NSAIDs, corroborating its lack of guideline recommendation for CR. No outcome favored gabapentin over NSAIDs. Gabapentin was occasionally co-prescribed with opioids at CR diagnosis, raising concerns.
LEVEL OF EVIDENCE: Level IV.
METHODS: This retrospective propensity-matched cohort study using the TriNetX database included opioid-naïve adults (≥18 years) with newly-diagnosed CR without history of spinal surgery, spinal neoplasms, myelopathy, opioid-use disorder or cervical injection. Patients were divided into gabapentin or NSAID cohorts based on prescription at CR diagnosis, and matched for demographics, prescriptions, and comorbidities. Outcomes included incidence and risk ratios (RRs) of safety and health service utilization markers assessed through one year. Significance was evaluated at P < 0.0036 (Bonferroni-corrected).
RESULTS: After matching, there were 23,379 patients (mean age: 53 years; 57% female) per cohort. About 14% of patients per cohort were co-prescribed opioids at CR diagnosis. Compared to the NSAID cohort, the gabapentin cohort had a statistically significant (P < 0.0036) increased risk of posterior cervical fusion (RR: 3.23), opioid-related disorder (RR: 2.87), cervical corticosteroid injection (RR: 2.52), opioid-related ADEs (RR: 2.32), anterior cervical discectomy and fusion (RR: 2.10), acute respiratory failure (RR: 1.80), cervical spine magnetic resonance imaging (RR: 1.43), inpatient visits (RR: 1.38), oral opioid prescription (RR: 1.34), and cervical spine radiographic imaging (RR: 1.21). Risk of dizziness, falls, somnolence, and emergency department visits was not significantly increased (P > 0.0036).
CONCLUSION: Gabapentin prescription for newly-diagnosed CR in adults was associated with increases in opioid prescription, adverse safety events, and health service utilization compared to NSAIDs, corroborating its lack of guideline recommendation for CR. No outcome favored gabapentin over NSAIDs. Gabapentin was occasionally co-prescribed with opioids at CR diagnosis, raising concerns.
LEVEL OF EVIDENCE: Level IV.