OBJECTIVES : One in four US nursing home (NH) residents received antiepileptic drugs (AEDs). Gabapentinoid use was presumably associated with pain. This study described the prevalence and assessed the factors associated with AED use in NH residents with pain.

METHODS : We performed a cross- sectional study among 14,398 US NHs on Sep 1, 2016. Minimum Dataset 3.0 (MDS 3.0) was used to identify demographics and other covariates (i.e., conditions associated with AED indications, AED safety, and epilepsy comorbidities). Medicare Part D ascertained the use of AEDs. We conducted robust Poisson and multinomial logistic regression models to estimate adjusted prevalence ratios (aPR) and odds ratios (aOR), respectively, accounting for the clustering within NH facilities.

RESULTS : The study included 132,222 residents with pain. Overall, 34.4% used AEDs. Gabapentin (23.3%), levetiracetam (4.2%), pregabalin (3.6%), phenytoin (1.7%), and lamotrigine (1.4%) were most commonly prescribed. Greater AED use was associated with epilepsy (aPR = 2.39; 95% CI= 2.34- 2.42), bipolar disorder (aPR = 1.15; 95% CI = 1.13- 1.18), diabetes (aPR = 1.27; 95% CI = 1.25- 1.28), anxiety (aPR = 1.08; 95% CI = 1.06- 1.10), depression (aPR = 1.17; 95% CI = 1.15- 1.19) or stroke (aPR = 1.10; 95% CI = 1.08- 1.12). Decreased AED use was associated with Alzheimer’s disease/ dementia (aPR = 0.93; 95% CI = 0.92- 0.95) or cognitive impairment (aPR _{severe vs. no impairment} = 0.50; 95% CI = 0.48- 0.52). Gabapentinoid use was not associated with an epilepsy indication, but with diabetes (aOR = 1.69; 95% CI = 1.64- 1.73) and depression (aOR = 1.34; 95% CI = 1.30- 1.38).

CONCLUSIONS : AEDs are commonly used by nursing home residents with pain, gabapentinoids in particular. Multiple comorbidities were associated with AED use.