By Amy Orciari Herman
Edited by David G. Fairchild, MD, MPH, and Lorenzo Di Francesco, MD, FACP, FHM
Gabapentinoids, increasingly used for chronic low back pain, offer little benefit and carry substantial risks in this setting, finds a systematic review in PLOS Medicine.
Researchers examined eight randomized trials in which gabapentin or pregabalin was compared with active or inactive treatments in adults with low back pain lasting at least 3 months. Doses ranged from 300–3600 mg/day for gabapentin and 100–600 mg/day for pregabalin. Among the findings:
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Gabapentin was associated with a small reduction in pain compared with placebo (very-low-quality evidence).
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Pregabalin was less effective than comparator treatments (e.g., amitriptyline, celecoxib) in relieving pain (very-low-quality evidence).
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Gabapentin was associated with increased risks for dizziness (number needed to harm, 7), fatigue (NNH, 8), mental difficulties (6), and visual disturbances (6).
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Pregabalin was associated with elevated risk for dizziness (NNH, 11).
The researchers conclude, “Given the lack of efficacy, risks, and costs associated, the use of gabapentinoids for [low back pain] merits caution.”
LINK(S):
PLOS Medicine article (Free)
Recent NEJM perspective on increased gabapentinoid prescribing (Free)
Background: NEJM Journal Watch General Medicine coverage of trial showing no benefit of pregabalin for sciatica (Your NEJM Journal Watch registration required)