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When the protocol works best, it's not uncommon for us to do major surgery
accompanied by an injection of a local anesthetic, and then have patients solely
on oral medications in the recovery room. Some patients say they don't even
feel as if they've had surgery. They came to the hospital in pain and were never
in pain again. They gave up their walking aids after a week of recovery and they
never took the opioid painkillers we'd prescribed for them. Amazingly, most
patients fall into that category. Of course there are some patients who need
higher levels of pain management. They may be opioid-dependent, have border-
line depression or just tolerate pain poorly.
Pregabalin, which is used to treat neuropathic pain and is a component in multi-
modal pain regimens, has been linked to major birth defects, according to a
study (osmag.net/wxwg6u) recently published in the
journal Neurology.
Researchers compared 164 pregnant women who had first-trimester exposure
to pregabalin with 656 women who did not take the drug. The findings show that
major birth defect rate was nearly 3 times as high (6.0% vs. 2.1%) in women who
took pregabalin.
But that's far from the final word on the medication. The authors caution that
"several limitations" may have impacted the study, including a "small sample
size, differences across groups in maternal conditions and concomitant medica-
tion exposure."
If confirmed through independent studies, however, the findings have signifi-
cant implications for all women of child-bearing age, since, as the authors point
out, a significant number of pregnancies are unplanned. Widespread use of pre-
gabalin may therefore lead to inadvertent exposure during early pregnancy,
notes the study. That's something to monitor and consider if the drug is part of
your multimodal pain management regimen. — Jim Burger
ADVERSE EVENTS
Study: Pregabalin Linked to Birth Defects
