Further, “The lack of efficacy is accompanied by increased risk of adverse events from use of gabapentinoids, for which the level of evidence is high,” the authors conclude. The most common adverse events were drowsiness or somnolence, dizziness and nausea.
Dr. Lin notes, “What clinicians should do instead is to focus on the non-drug aspect of management.”
“Most people with low back pain and sciatica recover with time,” she says, “so the most important approach is to reassure patients of that, encourage them to stay active and avoid resting in bed.”
“Beyond that, if the pain persists, first try non-drug treatments such as physiotherapy,” she concludes.
Dr. Vijay Vad, a sports medicine specialist at the Hospital for Special Surgery in New York City, comments, “There is increasing scrutiny on narcotics, so physicians are looking for alternatives.”
“Pregabalin was approved for chronic pain and fibromyalgia (in the U.S.),” he tells Reuters Health. “When that happened, there was a huge marketing push and it got prescribed like crazy, along with its cheaper sister gabapentin.”
“I almost never prescribe pregabalin because of side effects like balance and dizziness issues, feeling ‘out of it,’ and weight gain,” he says by email.
- Enke O, New HA, New CH, et al. Anticonvulsants in the treatment of low back pain and lumbar radicular pain: A systematic review and meta-analysis. CMAJ. 2018 Jul 3;190(26):E786–E793.