Evidence map›Paper›PMID 40157427›Full record

ArticleThe spine journal : official journal of the North American Spine Society2025

Adverse respiratory events during treatment with gabapentin and opioids among older adults with spine-related conditions: a propensity-matched cohort study in the US Medicare population.

Laura S Gold, Patrick J Heagerty, Ryan N Hansen, Janna L Friedly, Richard A Deyo, Michele Curatolo, Judith A Turner, Sean D Rundell, Jeffrey G Jarvik, Pradeep Suri

Abstract read
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In one paragraph

Article in The spine journal : official journal of the North American Spine Society, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.

0numbers the graph read from it
0cells of the map it votes in
2citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

2 citing papers in PubMed.

  1. Article
  2. Review
4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

10 authors.

Laura S GoldDepartment of Radiology, School of Medicine, University of Washington, Seattle, WA, USA; Evidence, and Research Center, Clinical Learning, University of Washington, Seattle, WA, USA. Electronic address: goldl@uw.edu.
Patrick J HeagertyEvidence, and Research Center, Clinical Learning, University of Washington, Seattle, WA, USA; Department of Biostatistics, University of Washington, Seattle, WA, USA.
Ryan N HansenDepartment of Pharmacy, University of Washington, Seattle, Washington, USA.
Janna L FriedlyEvidence, and Research Center, Clinical Learning, University of Washington, Seattle, WA, USA; Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA.
Richard A DeyoDepartments of Family Medicine and Internal Medicine, Oregon Health & Science University, Portland, OR, USA.
Michele CuratoloEvidence, and Research Center, Clinical Learning, University of Washington, Seattle, WA, USA; Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, WA.
Judith A TurnerEvidence, and Research Center, Clinical Learning, University of Washington, Seattle, WA, USA; Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA; Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA.
Sean D RundellEvidence, and Research Center, Clinical Learning, University of Washington, Seattle, WA, USA; Departments of Family Medicine and Internal Medicine, Oregon Health & Science University, Portland, OR, USA.
Jeffrey G JarvikDepartment of Radiology, School of Medicine, University of Washington, Seattle, WA, USA; Evidence, and Research Center, Clinical Learning, University of Washington, Seattle, WA, USA.
Pradeep SuriEvidence, and Research Center, Clinical Learning, University of Washington, Seattle, WA, USA; Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA.

Funding

UW Core Center for Clinical Research of Musculoskeletal ConditionsP30AR072572 · NIAMS · UNIVERSITY OF WASHINGTON · PI JEFFREY G JARVIK, Pradeep Suri · 2017 to 2026
$8.3M
NIAMS NIH HHS P30 AR072572
6 · The paper itself

Abstract

background contextRecent work indicates no increased mortality risk with concurrent gabapentin and opioid use when using an active comparator control design. However, concurrent gabapentin and opioid prescriptions have been associated with greater risk of respiratory depression in some studies. PURPOSE: To compare the risk of respiratory events among Medicare enrollees with histories of spine-related diagnoses treated with gabapentin+opioids versus those treated with tricyclic antidepressants (TCA) or duloxetine+opioids. We hypothesized that enrollees treated with gabapentin+opioids would have increased risk of adverse respiratory events compared to those treated with an active control+opioids. STUDY DESIGN/

settingPropensity score-matched cohort study with an incident user, active comparator (TCA/duloxetine) control design. The primary analysis included those who concurrently (within 30 days) filled ≥1 incident gabapentin+≥1 opioid or ≥1 incident TCA/duloxetine+≥1 opioid prescription. PATIENT SAMPLE: US Medicare beneficiaries with histories of spine-related diagnoses 2017 to 2019. People treated with gabapentin+opioids (n=66,860) were matched on demographic and clinical factors to people treated with TCAs/duloxetine+opioids (n=66,860). OUTCOME MEASURES: Time to a composite respiratory outcome consisting of mechanical ventilation, intubation, respiratory failure, pneumonia, or acute respiratory distress syndrome.

methodsCox proportional hazard regression was used to estimate adjusted hazard ratios (aHRs) and 95% confidence intervals (95% CIs).

resultsAmong 133,720 Medicare enrollees (median age 73.3 years; 66.9% female), 6277 (4.7%) experienced respiratory events before the end of follow-up. A total of 3,469 (5.2%) of people who were treated with gabapentin+opioids (median initial dose/day of gabapentin was 300 mg) had respiratory events compared to 2808 (4.2%) of those treated with an active control+opioids. The increased risk in those treated with gabapentin+opioids was statistically significant after adjustment (HR 1.19; 95% CI 1.13, 1.25; p<.0001). The most common respiratory events were pneumonia (3.7% of people in the gabapentin+opioids group versus 3.0% of people in the TCA/duloxetine+opioids group) and respiratory failure (2.3% in the gabapentin+opioids group versus 1.8% in the TCA/duloxetine+opioids group). Results were similar in analyses (a) restricted to ≤30-day follow-up and (b) that required ≥2 fills of each prescription.

conclusionsWhile recent work indicates no increased mortality risk with concurrent gabapentin and opioid use in this population, the current findings suggest clinicians should exercise caution in prescribing gabapentin to older adults with spine conditions who are using opioids, due to possible impacts on respiratory events. However, we cannot be certain that unmeasured confounding may explain these results and replication is needed.

Indexed as

Analgesics, OpioidGabapentinRespiratory InsufficiencySpinal DiseasesAgedAged, 80 and overAntidepressive Agents, TricyclicCohort StudiesDuloxetine HydrochlorideFemaleHumansMaleMedicarePropensity ScoreUnited StatesAnalgesics, OpioidAntidepressive Agents, TricyclicDuloxetine HydrochlorideGabapentinAntidepressantsDuloxetineGabapentinOpioidsPropensity matchingSpine pain

Identifiers

PMID40157427
PMCPMC12353996

What OpenQuestion holds

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.