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What Does the Research Say?
Fall Risk and Pain Medications: The Surprise Finding
A 2025 study of 57,086 older adults with neuropathic pain challenged a common assumption about which pain medications are safer for fall risk.
2×
Duloxetine users had nearly twice the rate of fall-related healthcare visits compared to gabapentin users at 180 days: 158 vs. 84 per 1,000 person-years.
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This finding was unexpected. Duloxetine has been widely assumed to be safer than gabapentinoids for fall risk in older adults. The 2023 Beers Criteria lists both classes as requiring caution, but this study found gabapentin users had a hazard ratio of 0.52 for fall-related visits compared to duloxetine users.
Duloxetine Fall Visits
158.2
Per 1,000 person-years at 180 days. Includes all fall-related healthcare encounters, not limited to severe falls.
Gabapentin Fall Visits
84.4
Per 1,000 person-years at 180 days. No difference in severe falls including hip fracture or falls requiring emergency care.
Gabapentin Hazard Ratio
0.52
48% lower risk of fall-related visits compared to duloxetine. This challenges the assumption that gabapentinoids are uniformly more dangerous.
Study Population
57,086
Older adults with neuropathic pain in the largest head-to-head comparison of these two drug classes for fall risk outcomes.
3 Takeaways for Your Practice
1
Risk Assessment
Neither Drug Class Gets a Free Pass on Falls
Both duloxetine and gabapentinoids carry fall risk in older adults. Individualized risk-benefit assessment is essential. Consider the patient's baseline fall risk, other medications, and whether topical alternatives could reduce the need for systemic agents.
2
Medication Selection
Topical Agents First for Localized Neuropathic Pain
Topical lidocaine patches and capsaicin 8% patches provide localized pain relief with no fall risk, no drug interactions, and no cognitive effects. For localized neuropathic conditions, start topical before reaching for systemic agents.
3
Monitoring Protocol
Monitor Falls Actively When Starting Either Agent
For patients starting duloxetine or gabapentin, implement fall risk screening at baseline and at 30, 90, and 180 days. Use Timed Up and Go and sit-to-stand tests to detect objective changes in balance and functional mobility before a fall occurs.
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This content is for informational purposes for licensed clinicians and does not constitute medical advice or a substitute for your own clinical research and judgment. Content may include AI-synthesized information; all clinical data, protocols, and dosages must be verified against official primary sources prior to patient care. Any reference to CE rules or regulations is provided as a guide and must be independently verified against current governing body requirements prior to completing credits. This article may contain links to external websites or third-party AI platforms. Ridley Learning has no control over the nature, content, and availability of those sites and does not necessarily endorse the views expressed within them. Ridley Learning is not liable for any injury, loss, clinical outcomes, or licensure issues resulting from the use of or reliance on this information. Your use of this site constitutes acceptance of these terms.
Meet the Author: Anne Osborn, PT, MPT
Anne Perry Osborn is a distinguished physical therapist and entrepreneur with over two decades of experience bridging clinical practice and healthcare education. She holds a Master of Physical Therapy from Texas Tech University Health Sciences Center and currently serves as the Owner and Director of Quality and Accreditation at Ridley Learning. With a background that includes clinical roles in outpatient rehabilitation and home health, Anne brings practical, hands-on insight to her leadership in continuing education, ensuring that learning opportunities remain relevant and impactful for today's practitioners.
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