Despite the CDC’s recommendation that pain treatment utilize non-opioid medications, like Lyrica, there is no evidence for its effectiveness in one of the most common pains: sciatica.
Pregabalin for sciatica, increasing prescription but is it effective? by Stephanie Mathieson – Body in Mind
Few clinical guidelines for the treatment of sciatica exist and evidence regarding effective medical treatments is limited. One medicine that is prescribed for the management of sciatica is pregabalin (also known as Lyrica®).
Pregabalin is a neuropathic pain medicine, effective in reducing neuropathic pain in conditions such as post-herpetic neuralgia and diabetic peripheral neuropathy.
Pregabalin was once thought to be a useful treatment for sciatica because of the coexisting neuropathic pain component with nociceptive pain. However, despite increasing prescription rates of pregabalin for back and neck pain, there was no robust evidence for its efficacy and safety in patients with sciatica.
Sciatica was defined as radiating pain into one leg below the knee, accompanied by the presence of at least one of the following clinical features: dermatomal leg pain, myotomal weakness, sensory deficits, or diminished reflex,
We randomised 209 patients of which 82% had chronic sciatica, to receive either pregabalin (maximum dose of 600 mg/day) or matching placebo for up to eight weeks.
Our results clearly found that there was no significant difference between groups in leg pain intensity or any secondary outcome at week 8 or over one year.
However, the number of adverse events in the pregabalin group was significantly higher than the placebo group (P = 0.002). The most common side effect in both groups was dizziness, with 70 events reported by 42 participants in the pregabalin group and 19 events reported by 13 participants in the placebo group
The take home message is that pregabalin is no more effective than placebo for reducing leg pain intensity in patients with sciatica, but will likely give patients more side effects.
Based on that, we do not recommend the use of pregabalin in patients with sciatica. We want doctors, clinicians and patients to be aware of our findings to ensure that patients are being managed by best evidence practice. For anyone taking pregabalin for their sciatica it is best to speak to your doctor who can advise what to do next.
Author Stephanie Mathieson is a Research Fellow at School of Public Health, Sydney Medical School, University of Sydney. The PRECISE study was part of her recently completed PhD at The George Institute for Global Health that investigated medicines for back pain and sciatica.
A randomized trial reported in the New England Journal of Medicine found that pregabalin is not more effective than placebo in treating sciatica, and resulted in more adverse effects.
According to some estimates, the annual prevalence of sciatica is as high as 45%, although rates vary widely because of inconsistent definitions and terms used to describe the condition. There is also a lack of consensus and a dearth of evidence regarding effective treatments for sciatica.
“We know that people can benefit from advice to stay active and be reassured that they will recover from sciatica, but beyond that we don’t know what treatments are effective other than epidural injections and surgery,” Christine Lin, PhD, an associate professor at the University of Sydney, and senior research fellow
“It could be that the drug is not targeting the right pain pathway for this condition, or it could be that sciatica has a reasonable natural recovery, and the drug is unable to give more pain relief in addition to the natural recovery,” said Dr Lin.
Pregabalin was found to lead to improvement in several types of neuropathic pain, including diabetic peripheral neuropathy, postherpetic neuralgia, and central neuropathic pain.
“Its analgesic and antiepileptic properties have been attributed to binding to α 2–δsubunits of voltage-gated calcium channels, which results in decreased neurotransmitter release,” wrote the authors of the current study.
To further investigate the effectiveness of pregabalin for sciatica treatment, Dr Lin and colleagues conducted a double-blind, placebo-controlled trial
At the end of 8 weeks, the mean unadjusted leg pain intensity score was 3.7 in the pregabalin group vs 3.1 in the placebo group (adjusted mean difference, 0.5; 95% confidence interval [CI], -0.2 to 1.2; P =.19). At 52 weeks, the mean unadjusted score was 3.4 in the pregabalin group vs 3.0 in the placebo group (adjusted mean difference, 0.3; 95% CI, -0.5 to 1.0; P =.46).
There were no significant differences at either time in secondary outcomes of disability, back-pain intensity, or quality of life. Adverse events were more commonly reported in the pregabalin group compared with the placebo group (227 vs 124), and dizziness occurred more frequently in the pregabalin group.
Summary and Clinical Applicability
Pregabalin is not effective for sciatica treatment and is associated with a significant number of adverse effects.