Chronic pain is one of the common reasons people seek chiropractic care. Many patients manage pain using a mix of therapies — including medications such as gabapentin or pregabalin (gabapentinoids) — while pursuing non-drug options like spinal adjustment, soft tissue work, rehabilitation, and lifestyle strategies.

A newly published study in JAMA Network Open raises an important caution: among older adults with chronic noncancer pain, initiating pregabalin was associated with a significantly higher risk of developing heart failure (HF) compared to initiating gabapentin.

As chiropractors, we don’t prescribe or manage those medications directly — but we do often interface with patients who take them. So, what can this mean for your health, and how might you incorporate this insight into your care?

What the Study Found

Here are the highlights of what the researchers observed:

In a large Medicare cohort of adults aged 65 to 89 with chronic noncancer pain and no prior history of heart failure, new users of pregabalin had a higher incidence of hospitalizations or emergency visits for HF than new users of gabapentin.
The rate of HF events was about 18.2 per 1,000 person-years in the pregabalin group versus 12.5 per 1,000 person-years in the gabapentin group. Adjusted hazard ratio ≈ 1.48 (i.e., ~48% higher risk) for pregabalin vs. gabapentin.
The difference in risk was even more pronounced in those with preexisting cardiovascular disease (e.g. hypertension, coronary disease), with an adjusted hazard ratio ~1.85 (i.e. 85% higher risk) in that subgroup.
They also found a modest increase in outpatient (nonhospital) diagnoses of HF in those starting pregabalin (adjusted HR ~1.27).
The study did not demonstrate a statistically significant difference in all-cause mortality between the two drugs.

What You Can Do — and What You Should Discuss

If you're reading this as someone receiving chiropractic care (or considering it), here are steps you might take:

Don’t stop or change any medication without guidance. This study is observational (non-randomized) and shows associations, not proof of cause–effect in everyone. Always consult your prescribing physician or pharmacist before making any changes.
Bring this up with your physician or pharmacist. Ask whether pregabalin is appropriate given your cardiovascular history, age, and other risk factors. Share this recent study and ask whether gabapentin (or another alternative) might be safer in your situation.
Ask about monitoring. If you remain on pregabalin (or any drug with possible cardiac effects), it’s reasonable to ask your medical team whether you should be monitored for signs or symptoms of heart failure (e.g. shortness of breath, swelling, fatigue) and how frequently.
Manage modifiable cardiovascular risk factors. Whether or not you use these medications, controlling hypertension, diabetes, obesity, salt intake, and maintaining a healthy lifestyle is crucial to protect your heart and vascular system.
Integrate nonpharmacologic pain strategies. Chiropractic care, exercise, manual therapy, education, posture, ergonomics, nutrition, and stress management can all help reduce reliance on medications — or at least allow the lowest effective dose. This reduces cumulative risk.
Stay active. The majority of noncancer, MSK pain responds well to physical activity and exercise. The gold standard of treatment should always be guided exercise therapy and then manual therapy etc. Your chiropractor can help prescribe which exercises are most beneficial depending on your condition.

This new JAMA Network Open study suggests that in older adults managing chronic noncancer pain, starting pregabalin was associated with a notably higher risk of new-onset heart failure compared to starting gabapentin. While the study is not definitive, it does raise a clinically relevant concern — especially in patients with cardiovascular risk.

As a chiropractic patient or practitioner, this doesn’t mean avoiding all prescribing decisions. But it does suggest that:

We should be aware of medication risks and how they interact with the body systems.
Patients should feel empowered to discuss these issues with their physicians and pharmacists.
Integrating nonpharmacologic pain strategies can help reduce overall risk.
Patients need to be informed properly and given options.

As always we are here for you. Reach out to us if you have further questions!

References:

Initiation of pregablin vs gabapentin and development of hearth failure.