The use of gabapentin in pediatric patients with neuropathic pain

Abstract

Summary The lack of randomized prospective studies ofgabapentin in the pediatric population reflects the obstacles in executing clinical trials in this age group. Thus, the decision to employ gabapentin in off-label use for pain management will be up to physicians who feel the benefits justify the use of this novel antiepileptic drug. The use of gabapentin for neuropathic pain in children appears to have no greater risk than that experienced in the adult population; however, clinical trials are needed to validate the safety and efficacy of this agent in treating pediatric neuropathic pain. Drug tolerance is good with limited adverse effects. Nonetheless, the impact of psychostimulation and behavioral changes reported warrant further investigation. The risks and benefits must be weighed on a case-by-case basis, and a history of behavioral problems should be sought. A better formulation that allows easy titration and administration of gabapentin by weight is desirable. The use of antidepressants in the management ofneuropathic pain has better validation and continues to be the pharmacological choice of treatment. The side effects of dry mouth, sedation, and lethargy from the most frequently used antidepressants can make daily activities of school and play difficult for children. Gabapentin, with its low incidence of adverse effects, may be ideal as first-line pharmacological therapy in pediatric neuropathic pain. Multicenter pediatric studies are needed to validate and empower the existing prescribing practices of gabapentin for neuropathic pain in children.