Gabapentin in Children with Complex Healthcare Needs: A Retrospective Analysis

Background and aims: Children with medical complexity (CMC) frequently experience pain and distressing symptoms. Although gabapentin is increasingly used in pediatric pain and palliative care (PPC), evidence remains limited. This study describes indications, dosing, and clinical outcomes of gabapentin use in a specialist PPC service. Methods: We retrospectively reviewed gabapentin treatment episodes in patients with CMC actively followed between November 2025 and January 2026. Records were screened for indications, dose, outcome, and adverse events. Response was classified as none, partial, or complete according to clinician assessment. Associations were analyzed using appropriate non-parametric tests. Results: Sixty-seven treatment episodes were included. Underlying conditions were predominantly severe neurological and neurodevelopmental disorders. Pain was the most common indication (59.7%), followed by spasticity/muscle spasms/dystonia (17.9%), epilepsy (7.5%), other indications (6%), sleep disorders (4.5%), and irritability/agitation (4.5%). Mean maximum maintenance dose was 20.6±12.1 mg/kg/day (range 3–58.5). Response data were available for 60 cases: 11 (18.3%) showed no response, 33 (55%) partial response, and 16 (26.7%) complete response. Response did not differ by indication. Higher maximum maintenance doses were associated with better response (Kruskal-Wallis X2=10, p=0.007). Partial and complete responders received higher maximum doses than non-responders (p=0.031 and p=0.009). Dose was positively associated with ordinal response (Spearman’s rho=0.388, p=0.002). No treatment-related hospitalizations occurred. Conclusions: Clinical improvement was frequently documented during gabapentin treatment, but the retrospective design, absence of standardized outcome measures, and polypharmacy preclude conclusions on effectiveness. Prospective studies are needed to define gabapentin’s role, optimal dosing, and safety in CMC.