Gabapentin for Pain in Pediatric Palliative Care

Ross Drake; Grace Prael; Yinyin Phyo; Sungwon Chang; Jane Hunt; Anthony Herbert; Christine Mott; Jenny Hynson; Marianne Phillips; Mary Cossich; Martha Mherekumombe; Min Sun Kim; Poh Heng Chong; Maja Abitz; Mercedes Bernada; Madeline Avery; Matt Doogue; Debra Rowett; David Currow

doi:10.1016/j.jpainsymman.2023.11.011

Gabapentin for Pain in Pediatric Palliative Care

J Pain Symptom Manage. 2024 Mar;67(3):212-222.e1. doi: 10.1016/j.jpainsymman.2023.11.011. Epub 2023 Nov 29.

Authors

Ross Drake¹, Grace Prael², Yinyin Phyo², Sungwon Chang², Jane Hunt², Anthony Herbert³, Christine Mott⁴, Jenny Hynson⁵, Marianne Phillips⁶, Mary Cossich⁷, Martha Mherekumombe⁸, Min Sun Kim⁹, Poh Heng Chong¹⁰, Maja Abitz¹¹, Mercedes Bernada¹², Madeline Avery¹³, Matt Doogue¹⁴, Debra Rowett¹⁵, David Currow¹⁶

Affiliations

¹ Starship Children's Health (R.D.), Auckland, New Zealand; University of Technology Sydney (UTS) (R.D., G.P., Y.P., S.C., J.H., A.H., D.C.), Centre for Improving Palliative, Aged, and Chronic Care through Clinical Research and Translation (IMPACCT), Sydney, Australia. Electronic address: RossD@adhb.govt.nz.
² University of Technology Sydney (UTS) (R.D., G.P., Y.P., S.C., J.H., A.H., D.C.), Centre for Improving Palliative, Aged, and Chronic Care through Clinical Research and Translation (IMPACCT), Sydney, Australia.
³ University of Technology Sydney (UTS) (R.D., G.P., Y.P., S.C., J.H., A.H., D.C.), Centre for Improving Palliative, Aged, and Chronic Care through Clinical Research and Translation (IMPACCT), Sydney, Australia; Centre for Children's Health Research (A.H.), Queensland University of Technology (QUT), Brisbane, Australia.
⁴ Queensland Children's Hospital (C.M.), Brisbane, Australia.
⁵ Royal Children's Hospital Melbourne (J.H.), Melbourne, Australia.
⁶ Perth Children's Hospital (M.P.), Perth, Australia.
⁷ Women's & Children's Hospital Adelaide (M.C.), Adelaide, Australia.
⁸ Westmead Children's Hospital (M.M.), Sydney, Australia.
⁹ Seoul National University Hospital (M.S.K.), Seoul, South Korea.
¹⁰ HCA Hospice Care (P.H.C.), Singapore.
¹¹ PABU, Copenhagen University Hospital (M.A.), Copenhagen, Denmark.
¹² Pereira Rossell Centre (M.B.), Montevideo, Uruguay.
¹³ Boston Children's Hospital (M.A.), Boston, USA.
¹⁴ University of Otago (M.D.), Christchurch, NZ.
¹⁵ Drug & Therapeutics Information Service (D.R.), Adelaide, Australia; University of South Australia (D.R.), Adelaide, Australia.
¹⁶ University of Technology Sydney (UTS) (R.D., G.P., Y.P., S.C., J.H., A.H., D.C.), Centre for Improving Palliative, Aged, and Chronic Care through Clinical Research and Translation (IMPACCT), Sydney, Australia; University of Wollongong (D.C.), Sydney, Australia.

PMID: 38036114
DOI: 10.1016/j.jpainsymman.2023.11.011

Abstract

Objective: Gabapentin is commonly used to treat pain in children receiving pediatric palliative care. This study describes the real-world use of gabapentin and the associated benefits and adverse effects/events (AEs).

Methods: A prospective, multicenter cohort of standardized data collection after a clinical decision was made to use gabapentin for managing neuropathic or nociplastic pain in children attended on by a pediatric palliative care service. It was conducted across 11 sites in seven countries including hospital, inpatient, and outpatient services. Clinical outcomes were graded using pain scales validated for age and cognitive ability and the National Cancer Institute Common Terminology Criteria for Adverse Events (NCICTCAE) at baseline, 14 days, 28 days, six weeks and 12 weeks after initiation of gabapentin. Ad-hoc safety reporting continued throughout the study.

Results: Data were collected from 127 children with a median age of 4.7 years (IQR 0.1-17.9); 61% had a neurological disorder, 21% advanced cancer and the cohort had a high level of disability (Lansky/Karnofsky performance score 37.1). Gabapentin was prescribed at standard pediatric doses. On average, 76% of children had a reduction in pain and 42% experienced a potential AE. The mean pain score decreased from 6.0 (SD 2.6) at baseline to 3.3 (SD 2.4) at 14 days and 1.8 (SD 1.8) after 12-weeks of gabapentin therapy. Ten percent had increased pain at each time point. AEs did not increase when individual changes over time were accounted for except for somnolence (7%). Serious AEs attributable to gabapentin were possible or probable in 3% of children.

Conclusions: Gabapentin prescribed at standard doses for advanced cancer and severe neurological injury in children under a pediatric palliative care service was associated with generally improved pain intensity at previously described levels of adverse effects.

Keywords: Pediatric palliative care; gabapentin; pain; quality improvement.

Publication types

Multicenter Study

MeSH terms

Adolescent
Amines / adverse effects
Amines / therapeutic use
Analgesics
Child
Child, Preschool
Cyclohexanecarboxylic Acids* / adverse effects
Cyclohexanecarboxylic Acids* / therapeutic use
Gabapentin / therapeutic use
Humans
Infant
Neuralgia* / chemically induced
Palliative Care
Prospective Studies
gamma-Aminobutyric Acid / adverse effects
gamma-Aminobutyric Acid / therapeutic use

Substances

Gabapentin
Analgesics
Amines
gamma-Aminobutyric Acid
Cyclohexanecarboxylic Acids