I'm not here just to feed your GABAergic urges
I think we’d all agree it’s a damn good thing those gabapentinoids, or pregabalinoids, or whateveroids, are going to become officially ‘controlled’.
Because that renders official what we’ve all known for some time. Which is that these drugs have been prescribed in an uncontrolled way, largely when all else has failed and just prior to the patient being discharged back to the care of the GP, and, yes, I’m pointing the finger at you, rheumatology and pain clinics.
So, hopefully, gab and preg will go the same way as diazepam, as others have suggested. Though, given their murky use and clear abuse, they’re less a benign chill-pill for mummies and more ‘junky’s little helper’.
Hence the type of dialogue I had the other day with the dodgy and very assertive partner of a dodgy and very passive young woman with, uh, ‘back pain’. This kicked off with him innocently commenting, ‘I’ve heard pregabalin is very good’, escalated through increasingly tenuous levels of pseudo-pharmacological reasoning and culminated in an outright aggressive demand.
To which I replied that, if he’d like to retake his A-levels, spend five years at med school, do another two as a foundation doc, a further three as a trainee GP and top it off with 29 actually in practice dealing with people like him, and her, then I’d be happy to re-open the conversation as equals, although the answer would still be no. True, I could have simply pointed out that I’m the one with the prescription pad, but sometimes the scenic route is more fun.
Anyhow. To those wringing their hands in despair at a lack of therapeutic options for those in genuine need, the key learning point is that you can only do so much with chronic pain. Achieve about 50% relief, tops, in fact – a realistic target that should be set from the beginning and beyond which you are very much in law-of-diminishing-returns territory, a land of many drugs, much frustration and zilch benefit.
So the gabapentinoid news actually acts as a useful reminder or portfolio learning credit: we can’t cure all pain, and the management of the bit that’s refractory can be pretty much summed up by ‘get on with it’.
Mind you, next time my sciatica flares up, I might change my tune.
Dr Tony Copperfield is a jobbing GP in Essex