加巴噴丁對慢性疼痛患者認知功能的長期影響及失智風險評估

研究目的失智症的普遍患病率是全球健康關切的焦點，而慢性疼痛則被視為可能導致認知衰退的潛在因素之一。深入了解長期用於慢性疼痛治療的加巴噴丁可能產生的認知副作用至關重要。我們進行了一項人口數據庫研究，以調查在患有慢性疼痛的患者中，加巴噴丁使用與失智風險之間的關係。研究方法與資料我們設計了一項巢狀病例對照研究，使用跨足2000年至2019年的台灣長期健康保險數據庫，重點關注於2001年至2017年間年齡50歲及以上的患有慢性疼痛診斷的個體。經過排除後，失智病例與對照病例進行了匹配，考慮加巴噴丁處方歷史並調整各種共變數。敏感性分析，包括間歇期的納入，強化了結果。研究結果在最初的309,262例慢性疼痛病例中，有201,492例符合我們的研究標準，共有22,769例失智病例和22,644例非失智對照病例。加巴噴丁使用與失智風險的經調整勝算比（aOR）為0.91（95%置信區間0.83-1.01）。劑量效應分析顯示低劑量的aOR為0.90（0.79-1.03），高劑量的aOR為0.92（0.81-1.06）。依照年齡和性別進行的分層分析顯示，高低劑量也並未增加失智風險。結論與建議與近期文獻結果不同，我們的研究結果發現長期使用加巴噴丁於慢性疼痛治療似乎與使用劑量無顯著相關，不論年齡或性別如何。未來仍須進一步研究其潛在的認知影響與失智的風險評估。

Objective: The increasing prevalence of dementia is a global health concern, with chronic pain being explored as a possible contributing factor to cognitive decline. Understanding the potential cognitive side effects of gabapentin, commonly prescribed for chronic pain, is crucial. We conducted a population database study to investigate the relationship between gabapentin use and dementia risk in patients with chronic pain.Methods and Materials: We devised a nested case-control study using a longitudinal health insurance database spanning from 2000 to 2019 in Taiwan, focusing on individuals aged 50 and older diagnosed with chronic pain between 2001 and 2017. After exclusions, dementia cases were matched with controls, considering gabapentin prescription history and adjusting for various covariates. Sensitivity analyses, incorporating washout periods, corroborated the findings.Results: Out of the initial 309,262 chronic pain cases, 201,492 met our study criteria, resulting in 22,769 dementia cases and 22,644 non-dementia controls. The adjusted odds ratio (aOR) for the dementia risk associated with gabapentin use was 0.91 (95% confidence interval 0.83–1.01). The dose-effect analysis revealed aORs of 0.90 (0.79–1.03) for low dosages and 0.92 (0.81–1.06) for high dosages. Stratified analyses by age and gender showed no increased dementia risk across dosage levels.Conclusion and Recommendations: Long-term gabapentin therapy for chronic pain does not appear to be linked to a differential risk of dementia across dosage levels, irrespective of age or gender. Further investigation into its potential cognitive effects is warranted.