Managing pain in seniors often requires the use of certain painkillers. However, many of these medications often present a range of negative side effects. While many of these risks are known, new ones are still being discovered regularly through various studies, such as the link between painkillers and heart health. A new study has indicated that there is a link between the use of pregabalin and heart failure. While managing pain is important, preventing heart failure in the elderly who use these medications is equally important. Chronic pain medication risks should not outweigh the benefits.
The Study on the Link Between Certain Painkillers and Heart Health
According to the new study, which was published in JAMA Network Open in August, use of the painkiller pregabalin was linked with a 48% higher risk for new-onset heart failure. It also found an 85% higher risk in those with a history of cardiovascular disease. The study involved more than 240,000 Medicare beneficiaries diagnosed with noncancer chronic pain.
Chronic pain can seriously affect a person’s life, and up to 30% of individuals aged 65 or older experience it. The study’s researchers noted that non-opioid medications such as gabapentin and pregabalin are widely prescribed for chronic pain. Pregabalin attaches more strongly than gabapentin to the α2δ subunit of the L-type calcium channel. Because of this, the body may hold onto salt and water more, which increases the risk of heart failure.
Conducted between 2014 and 2018, the study included 18,622 new pregabalin users and 227,615 new gabapentin users. The researchers rebalanced the two patient groups using a method called inverse probability weighting. During the follow-up period of 114,113 person-years, 1470 patients required hospital or emergency room visits for heart failure.
The rate of heart failure per 1000 person-years was 18.2 for pregabalin and 12.5 for gabapentin. This means that there were around 6 extra heart-failure cases per year for every 1,000 patients on pregabalin. Pregabalin was associated with a 48% higher risk after adjusting for other factors. The difference was even greater in those with a history of cardiovascular disease. However, there was no difference in all-cause mortality between the two groups.
What the Authors of the Study Say About the Results
According to the authors, these results further support existing guidelines from the European Medicines Agency that state that caution should be exercised when prescribing pregabalin to seniors with cardiovascular disease. Additionally, Robert Zhang and Edo Birati weighed in on the study, co-authoring an invited commentary. They noted that the findings have immediate clinical implications. For seniors diagnosed with chronic pain, especially those with cardiovascular disease, “clinicians should weigh the potential cardiovascular risks associated with pregabalin against its analgesic benefits.
This is particularly relevant given the growing use of gabapentinoids in older populations and ongoing polypharmacy issues in this age group.” They further noted that if the use of pregabalin is linked to new-onset heart failure, it increases the possibility that the medication may unmask underlying subclinical CVD.
This suggests a need for proper cardiac evaluation before prescribing the medication. The researchers concluded that “The study serves as an important reminder that not all gabapentinoids are created equal and that in the pursuit of safer pain control, vigilance for unintended harms remains paramount.”
Be Proactive
If pregabalin is currently being used, don’t panic and rather be proactive. It is best to first talk to the clinician prescribing the medication and heart health before starting and during treatment. A baseline check of the patient’s blood pressure, weight, swelling, history of fluid retention, and shortness of breath can help make the doctors aware of any potential risk.
After starting or changing the dose, keep an eye out for any changes in symptoms. If you experience any sudden weight gain, tightness in the chest, or swelling, contact your healthcare professional as soon as possible. Pregabalin is often prescribed long-term for chronic pain; therefore, it’s important to have your medication regularly reviewed.
This is particularly important for older individuals taking other medications such as blood pressure meds, diuretics, or medications that may affect the kidneys. It’s also important that you don’t suddenly stop taking your pregabalin prescription. If a change is needed, it is better to slowly taper off the medication. It’s also worth asking about alternatives that may possibly lower dose needs.
For certain conditions, gabapentin may be a viable option. However, it also has its own side effects and should be individualized if used. You can also use certain non-drug strategies to decrease pain. These include physical therapy, cognitive behavioral techniques for pain, and better sleep routines. However, it is always best to first discuss any change in your medication or pain control methods with your health practitioner.
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