Gabapentinoid prescription in Oral Medicine and Oral Surgery practice. Part II − a systematic scoping review of the literature

Audrey Chanlon,Nathan Moreau,Arek Sulukdjian,Richard L'Homme

doi:10.1051/mbcb/2020038

Abstract

Introduction: Gabapentinoids, pregabalin and gabapentin, neuronal voltage-gated calcium channel inhibitors are first-line treatments for painful neuropathic conditions (and several non-neuropathic painful conditions). Nevertheless, their efficacy and prescription in Oral Medicine and Oral Surgery practice has received little attention so far. A previous article, the first of a two-part series, presented the experience of a French tertiary orofacial pain clinic regarding the prescription of gabapentinoids in orofacial conditions. This second article aimed to explore the scientific literature on the subject. Material and methods: A systematic scoping review was conducted on multiple relevant databases (MEDLINE®, Cochrane®, Agence Nationale de Sécurité du Médicament et des produits de santé, Haute Autorité de Santé) and journal archives (JOMOS, JSOMFS) to assess the indications, non-indications and contraindications of gabapentinoids in an Oral Medicine/Oral Surgery context. Results: Out of 131 records selected during the initial screening, 34 matched the inclusion criteria and were used for subsequent analyses. Gabapentinoids were prescribed in three clinical contexts: orofacial pain management (32 studies), anxiolysis (1 study) and prevention of postoperative nausea/vomiting (1 study), with variable quality of evidence: high (6 studies), moderate (3 studies), low (5 studies) and very low (20 studies) quality studies (GRADE scale). Untoward effects of gabapentinoids were reported in 16 studies, mainly neurological (vertigo, drowsiness, sedation) and gastro-intestinal (nausea, vomiting, diarrhea, constipation). Gabapentinoids were ineffective in preemptive and postoperative analgesia and for the management of mucositis-related pain. Discussion: There is some evidence supporting the use of gabapentinoids in Oral Medicine/Oral Surgery in adherence with current practices observed in France and other countries (practices often extrapolated from their use in other non-orofacial painful conditions). The methodological quality of the studies included in this scoping review is often poor and publication bias is most probable in this field. Therefore, any conclusion drawn from such studies must be subject to circumspection. Conclusion: Data obtained from the present scoping review suggests the potential use of gabapentinoids as second-line treatments for anxiolysis, prevention of postoperative nausea/vomiting and the management of trigeminal neuralgia and masticatory myalgia. Other potential indications of gabapentinoids in Oral Medicine/Oral Surgery practice include cranial neuralgias, post-traumatic trigeminal neuropathies, first bite syndrome, burning mouth syndrome and migraine prophylaxis, when other treatment options are inefficient or unavailable.

Highlights

Gabapentinoids, pregabalin and gabapentin, a recent class of neuronal voltage-gated calcium channel inhibitors mainly used for the treatment of partial epilepsy and neuropathic pain have been increasingly prescribed these past few years [1,2], despite growing concerns regarding potential misuse of such drugs and increased mortality risk when associated with opioids [3]
Database search strategy and relevant keywords were chosen after detailing the scientific question using the PICOS methodology: – Population (P) = All patients referred to oral medicine/oral surgery practices regardless of age, sex or health status; – Intervention (I) = Prescription of pregabalin or gabapentin; – Comparison (C) = Standard of care, placebo or lack of treatment; – Outcome (O) = Effectiveness (=indication), ineffectiveness
The children’s behavior ratings were not significantly different between the groups, the number of “successful” treatment visits was higher in the pregabalin group compared to the placebo group

Summary

Introduction

Gabapentinoids, pregabalin and gabapentin, a recent class of neuronal voltage-gated calcium channel inhibitors mainly used for the treatment of partial epilepsy and neuropathic pain have been increasingly prescribed these past few years [1,2], despite growing concerns regarding potential misuse of such drugs and increased mortality risk when associated with opioids [3]. They are part of the recommended pharmacolog-. The aim of this article, the second of a two-part series, was to systematically review the scientific literature on gabapentinoid prescription in an Oral Medicine/Oral Surgery clinical context

Methods

Results

Discussion

Conclusion