2026 American Academy of Neurology Abstract Website

Madhav Sankaranarayanan¹, Rebeka Bustamante Rocha⁴, Julianne Brooks⁴, Maria Donahue⁴, Shuo Sun⁵, Mamoon Habib⁴, Sonia Hernández-Díaz², Alexander Tsai⁶, Joseph Newhouse⁷, Sebastien Haneuse³, Lidia Maria Moura⁴
¹Biostatistics, ²Epidemiology, Harvard T.H. Chan School of Public Health, ³Harvard T.H. Chan School of Public Health, ⁴Massachusetts General Hospital, ⁵Population Health Sciences, Weill Cornell Medicine, ⁶Harvard Medical School, ⁷Harvard University

Objective:

We aim to analyze differences in hospital readmissions, a quality metric, for older adults initiating gabapentin in contrast to other medicines for post-stroke pain.

Background:

Acute ischemic stroke (AIS) is highly prevalent among older adults and commonly results in pain. Primary care providers generally manage follow-up care, although ideal pain management strategies remain unclear. Treatment options include gabapentinoids, tricyclic antidepressants, and various antiseizure medications.

Design/Methods:

In this matched cohort study, we analyzed a 20% sample of U.S. Medicare beneficiaries aged 65 and over hospitalized for AIS between December 31, 2016, and December 31, 2021, who were discharged home. Individuals met insurance coverage criteria and did not take recommended pharmacological treatments for neuropathic pain (gabapentin, pregabalin, amitriptyline, lamotrigine, carbamazepine, and phenytoin) before hospitalization. Individuals who initiated gabapentin within 90 days of discharge (N = 1,546) were matched on days from discharge to medication initiation to individuals who initiated medications other than gabapentin (N = 285). We investigated the time to readmissions using a semi-competing risks framework.

Results:

The matched cohort of 1,831 initiators had a median age of 76 (IQR 11) and was 57.2% female and 81.3% Non-Hispanic White. The cumulative risks of readmission by 180 days post-initiation were 9.77% for gabapentin and 12.98% for other pain medications; risks for mortality were 9.97% and 12.63%, respectively. The average hazard ratio of readmissions, given that death had not occurred, was 0.871 (95% CI: 0.517, 1.466).

Conclusions:

We found no significant difference in hospital readmission rates between gabapentin and other post-stroke pain treatment strategies. Our findings contribute to the pharmacovigilance of gabapentin in real-world Medicare beneficiaries post-AIS.