The use of gabapentinoids and opioids and risk of developing opioid-induced respiratory depression among older breast cancer survivors with neuropathic pain

J Cancer Surviv. 2024 Jun;18(3):917-927. doi: 10.1007/s11764-023-01338-9. Epub 2023 Feb 8.

Abstract

Purpose: To estimate the combined effect of gabapentinoid and opioid therapy compared to opioid monotherapy on the risk of developing opioid-induced respiratory depression among breast cancer survivors with neuropathic pain.

Method: A nested case-control study of Medicare female breast cancer survivors with neuropathic pain receiving both opioids and gabapentinoids, opioid monotherapy, gabapentinoid monotherapy, and none of these drugs was conducted using SEER-Medicare between 2007 and 2015. Cases were survivors with respiratory depression and were matched with controls on the event date (± 1 year), age at diagnosis (± 5 years), and stage at diagnosis. Exposure to opioids and gabapentinoids was assessed 120 days before the event date. Conditional logistic regression was used to assess the impact of exposure among cases and controls.

Results: A total of 657 cases and 11,471 controls were identified. After matching, 656 cases and 5612 controls were retained, and cases were more likely to be diagnosed with mental health disorders (24.4% vs 10.5%, p < 0.0001) than controls. In the primary adjusted analysis, combined opioids and gabapentin use were associated with an increased risk of respiratory depression compared to opioid monotherapy (Adj. OR: 1.513; 95% CI: 1.473-2.350). Additionally, under secondary analysis, combined opioids and gabapentin use were associated with an increased risk of respiratory depression compared to receiving neither of these classes. (Adj. OR: 1.595; 95% CI: 1.050-2.421).

Conclusion: There is a need for dose titration strategies of gabapentinoids and caution when co-prescribing opioids and gabapentinoids in older cancer survivors.

Keywords: Adverse event; Breast cancer survivors; Gabapentinoids; Neuropathic pain; Opioid-induced respiratory depression; Opioids.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Aged
  • Aged, 80 and over
  • Analgesics / adverse effects
  • Analgesics / therapeutic use
  • Analgesics, Opioid* / adverse effects
  • Analgesics, Opioid* / therapeutic use
  • Breast Neoplasms* / complications
  • Breast Neoplasms* / drug therapy
  • Cancer Pain / drug therapy
  • Cancer Survivors* / psychology
  • Cancer Survivors* / statistics & numerical data
  • Case-Control Studies
  • Female
  • Gabapentin* / adverse effects
  • Gabapentin* / therapeutic use
  • Humans
  • Medicare
  • Neuralgia* / drug therapy
  • Neuralgia* / epidemiology
  • Respiratory Insufficiency* / chemically induced
  • Respiratory Insufficiency* / epidemiology
  • SEER Program
  • United States / epidemiology

Substances

  • Analgesics, Opioid
  • Gabapentin
  • Analgesics