As promised in last week’s Choosing Wisely briefing, we would like to introduce some tools to manage patients who are on so called anticonvulsants (typically gabapentin and pregabalin) for musculoskeletal pain, in view of recent evidence that these agents are not as effective as once thought.
We always try to keep in mind the concept of shared decision making, especially in conditions such as musculoskeletal pain. We need to be
explicit in the decision that needs to be made, providing information about the options and outcomes, and by clarifying personal values
which have so much influence on how patients approach their own problems.
We need to first approach our practice database, find the subset of patients who are involved, and decide how to approach them. It could be a call from our office to set up an appointment for a specific discussion, or in the form of a reminder that appears in the patient profile when they come in for a visit.
In our Quick Links section, you will find a link to the Pharmacy webpage on the HFHT Intranet. On this page, you will find a heading called "EMR Searches" and under it, will find a search related to gabapentinoids. You can download this file to your computer and the import it into Telus PS.
Running the search identifies patients on Lyrica, pregabalin, Neurontin and gabapentin, and outputs a list of patients with a diagnosis column as some patients may be on one of these medications for diabetic neuropathy, for which there is evidence of efficacy.
Instructions for importing the search:
- In the Telus PS EMR, go to the "Records" section.
- Select "Settings".
- Select "Import Searches"
- Choose the search titled "gabapentinoids v2.srx" from the folder you downloaded it to on your computer.
Importing the same search file as Reminder will insert a reminder into the patient chart. The reminder will insert text “enquire gaba, lyrica re msk pain” as a prompt to initiate a discussion if desired.
If you need help importing this search/reminder into your EMR, please contact your QIDSS for assistance.
The aim is to determine an appropriate treatment plan together, and in the spirit of Choosing Wisely, avoid treatments that are not supported by evidence and reduce exposure of patients to harm.