The Effects of Early Neuropathic Pain Control with Gabapentin on Long-Term Chronic Pain and Itch in Burn Patients

Gabapentin has analgesic efficacy for neuropathic pain and is increasingly used in burn care. This study investigated the effect of a neuropathic pain control protocol, as well as early gabapentin initiation (<72 hours from injury) on total inpatient opioid use, chronic pain, and itch. This is a single-institution retrospective cohort study of patients over age 14 admitted between 2006 and 2016 with burns. They compared patients who did not receive gabapentin with those who had early gabapentin initiation vs late initiation. They also compared patients who used gabapentin before initiation of a neuropathic pain protocol (February 2015) to those after. Primary outcomes were total inpatient gabapentin, morphine equivalent dose (MED), longitudinal pain and itch, as well as SF-12v2 ® Health Survey mental and physical component summary (MCS/PCS) at discharge, 6, 12, and 24 months postinjury. Ordinal logistic regression analysis was used to examine pain and itch scores. Linear regression models examined MCS and PCS between groups. Models were adjusted for age, sex, TBSA burned, area grafted, MED, and ICU stay. There was no significant difference in MED with early initiation, yet inpatient gabapentin use increased from 43.9 to 59.5 g (P <.001) with late initiation. The neuropathic pain protocol did not significantly change total gabapentin use (P =.184) in patients receiving gabapentin but decreased opioid use from 58.1 to 17.4 g MED (P =.008). Their results suggest that neither early gabapentin nor its use in a standardized neuropathic pain protocol improves long-term pain, itch, PCS, or MCS.