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Gabapentin and pregabalin not effective for low back pain with or without radiculopathy
Clinical Question
Are anticonvulsants an effective treatment for low back pain?
Bottom line
The use of anticonvulsants like gabapentin for painful conditions has increased greatly in recent years. This review finds good evidence that these drugs are not an effective treatment for low back pain with or without radiculopathy, and are associated with an increased risk for adverse events. 1a
Reference
Study design: Meta-analysis (randomized controlled trials)
Funding: Self-funded or unfunded
Setting: Various (meta-analysis)
Synopsis
Particularly in this era of heightened awareness of the potential harms of opioids, anticonvulsants are often prescribed for the treatment of painful conditions. Although there is evidence of their effectiveness primarily for peripheral and diabetic neuropathy, they are increasingly prescribed for other conditions, including low back pain. This systematic review included a comprehensive search of the literature and the authors identified 9 randomized trials (3 of which were crossover studies) that compared topiramate, pregabalin, or gabapentin with placebo in patients with low back pain with or without radiculopathy. They excluded studies of pregnant women; pre-operative patients; and patients with mixed conditions, such as neck and back pain. The trials were assessed for risk of bias, and only 1 was at high risk. The studies used a range of pain scales, so the standardized mean difference in pain scores between treatment and placebo groups was the primary outcome. The 9 studies reported a total of 14 comparisons, with only 2 showing a statistically significant benefit. One was a small study of high-dose gabapentin (3600 mg/day) in 43 patients with lumbar radicular pain, and the other was a study of 96 patients with low back pain who were given 300 mg topiramate 300 each day. The other topiramate study found no benefit, as did none of the other studies of pregabalin or gabapentin. Where results could be pooled, there was essentially no difference between groups. Where results could be pooled, there was essentially no difference between groups. There was no difference in serious adverse events: 4 in the pregabalin group, 6 in the placebo group (though these were reported in only 2 studies with a total of 423 patients). Any adverse events, however, were significantly more common with active treatment (relative risk 1.4; 95% CI 1.2 - 1.7).
Reviewer
Mark H. Ebell, MD, MS
Professor
University of Georgia
Athens, GA
Comments
Une information utile mais avec les limites bien justifiables sur les opiacés, les risques des anti-inflammatoires et maintenant l’inefficacité des gabapentin / pregabalin on est mal pri à traiter ces douleurs lombaires.
Useful to know for sure since I now use PDTR to treat low back pain including many sciatica like presentations due to papas spasm, quite successfully in most cases,on the spot, in my practice. It works! Check out courses in all the world at PDTR-Global.com or PDTRUSA.com. PDTR is a novel manual treatment and acronym for Proprioceptive Deep Tendon Reflex. It is highly effective at long term relief especially in advanced hands which can utilize the full spectrum of available modalities to seek out and correct high priority sensory dysfunctions in patients. Surrogate diagnostic testing is possible with patients unable to co-operate with manual muscle testing, used as a diagnostic modality to interrogate the whole nervous system. This has truly changed my practice and the lives of many patients for the better, and does not involve the use of invasive or expensive equipment. See an advanced practitioner for best results. Then learn how to do it yourself and experience and pass on the benefits of this potentially life-changing therapy modality. Blessings, Dr André van der Merwe North Battleford/Saskatoon, SK. Canada
In my practice I usually do not use Gabapentin or pregabalin for low back pain . But It is good to know that they are not effective in treating low back pain.
what, other than activity, is left that works for chronic low back pain?
I HAVE FIND USE OF GABAPENTIN OR PREGABALIN IS EFFECTIVE IN ACUTE NEW RADICULOPATHY THESE ARE FEW PATIENT WITH SEVER ACUTE RADICULOPATHY NO HX CHRONIC PAIN BUT HX PREVIOUS RADICULOPATHY WITH OR WITHOUT PREVIOUS SURGERY RESPOND TO THESE DRUGS AND AFTER FEW DAYS PAIN BECOME LESS AND TOLERABLE THIS ALOW FOR NATURAL IMPROVEMENT HERNIATED DISC , I AGREE THEY ARE NOT EFFECTIVE IN CHRONIC PAIN OR EVEN ACUTE RADICULOPATHY WITH NO SIGNIFICANT LESION ON IMAGING STUDIES.
IN OTHER PATIENT ARE HAPPY WITH IMPROVED SLEEP WHICH HELPS THEM TO COUP WITH THEIR PAIN.
I REVIEWED FULL ARTICLE IN CMAJ THEY MENTION IMPORTANT SIDE FFECT BUT THEY ARE NOT SAYING WHAT ARE SIDE EFFECT THE MOST COMMON ONE IS DECREASE COGNITIVE FUNCTION,AND PT DISCONTINUE MEDICATION AND COMES BACK AND SAYS THOSE PILLS MADE STUPID.
ATAXIA IS OTHER COMPLICATION WHICH TOLERABLE.
I ALSO FIND IT IS BENEFICIAL IN INTERMITTENT POST RADICULOPATHY NEUROPATHIC RADICULAR PAIN ON PRN BASIS THAT MEENS PT IS ONLY TAKE ONE OR 2 DOSE AND PAIN IS GONE FOR ANOTHER PERIOD OF SEVERAL MONTHS
BUT AGAIN ALL PAIN MEDS AND ANTI INFLAMMATORIES.
THE IMPORTANT FACTOR IS TO DISCUS AND EDUCATE PATIENT ABOUT HER/HIS CONDITION AND MECHANISM OF TREATMENT,
good poem
In the current overwhelming move to trash opiates as a futile attempt to reduce the opiate overdose deaths everyone should stop and think about the many useless, harmful drugs being prescribed without any thought as to whether they are effective.
Worth pointing out that gabapentin-like drugs are often used with opioids in an attempt to decrease total opioid doses, yet this combination is associated with a higher risk of fatal overdose. Also, gabapentinoids are less effective for neuropathic pain in general than the often-forgotten alternative of tricyclic antidepressants.
It has been a scam from the beginning and have pushed this medication for everything and in my experience they don’t work
I might add topiramate
Il aurait été plus pertinent de s'intéresser principalement à la radiculopathie, avec ou sans lombalgie. Les anticonvulsivants n'auront effectivement aucun effet lorsque la lombalgie est le symptôme prédominant. Mais, par expérience clinique, lorsque l'on identifie une douleur clairement neuropathique (par exemple avec un DN4 positif) et que l'on a une imagerie qui démontre une lésion (ex. : hernie comprimant une racine ou sténose spinale) pouvant expliquer les symptômes, les anticonvulsivants sont alors efficaces. Il faut faire attention de ne pas conclure que les anticonvulsivants n'ont pas d'utilité en radiculopathie, puisque la problématique principale étudiée ici est la lombalgie et que les patients ont été recrutés en fonction de cela.
anticonvulsants not helpful in back pain
good to know
what is the best treatment for low back pain
I will use treatments other than anticonvulsants for low back pain
sometimes muscle relaxants are helpful
Patients that I see in prison who have had “ low back pain “ are often on ultra large doses of either Lyrica or GABA with questionable benefit . Shades of addiction in the overuse.
It is important to see the evidence for and against the alternatives for chronic pain management as the role of opioids are reassessed and reduced.
Most low back pain comes from displaced sacroiliac joints, not from the lumbar spine and certainly not from lumbar radiculopathy which would be manifest in the lower legs. I did a chart review of 180 low back pain cases of which 164 had sacroiliac joint abnormalities and 78% were relieved of their pain using a specific 2 minute exercise to straighten out their SI joints depending on the direction of the SI displacement. I am currently going to do a prospective study to assess if those home-based exercises provide long-term pain relief, if they need additional use of a pelvic belt or of prolotherapy. That will be infinitely more effective in treating severe low back pain than anticonvulsants, marijuana, narcotics or other painkillers, as these techniques can actually cure the cause.