Are Anticonvulsants Effective for Low Back Pain?

Are Anticonvulsants Effective for Low Back Pain? – MPR – Diana Ernst, RPh – July 2018

Here’s another review showing that anticonvulsants (anti-epileptics like Lyrica and gabapentin) are not effective for pain, even though they are increasingly prescribed for it.

For no other purpose than to avoid using opioids, pain patients are being prescribed all kinds of drugs off-label because they may be effective for some kinds of pain is some people some of the time.

Pain management doctors are forced to practice medicine based on hope, not evidence, when the most effective drugs for this condition are prohibited due to their potential damage to patients who may potentially abuse them and potentially develop an addiction.  

Anticonvulsants appear to be ineffective in the treatment of low back pain (LBP) and may be associated with an increased risk for adverse events, according to a study published in the Canadian Medical Association Journal.  

“Clinically, the prescription of anticonvulsants for back and neck pain, including radicular pain in primary care, has increased by 535% in the last 10 years,” write the authors of this systematic review and meta-analysis, “This trend may be due to prescribers seeking an alternative to opioids.”  

For this review, the authors searched 5 large databases for studies that compared the use of anticonvulsants (i.e., topiramate, gabapentin, pregabalin) in adult patients with LBP, sciatica, or neurogenic claudication with placebo.

They were able to identify 9 placebo-controlled studies which examined the effects of these anticonvulsants for LBP and lumbar radicular pain in 859 patients.

The results showed that anticonvulsants were found to be ineffective at reducing pain or disability associated with LBP or lumbar radicular pain in 14 of the 15 comparisons.

Based on the findings from this systematic review the authors concluded that

“evidence to date does not support the use of anticonvulsants for chronic low back pain or lumbar radicular pain.”

But not so fast…

Only 3 months later, the same publication and the same author report on another study that finds gabapentin, one of the anticonvulsants found ineffective in July, is “associated with a reduction in leg pain intensity” in October.

Optimizing Treatment for Patients With Chronic Sciatica: Gabapentin vs Pregabalin – Diana Ernst, RPh – October 2018

In patients with chronic sciatica, gabapentin was associated with a greater reduction in leg pain intensity and fewer side effects compared with pregabalin, according to a study published in JAMA Neurology.

In this prospective, cohort study, patients (N=18) were randomized to receive gabapentin 400–800mg 3 times daily then pregabalin 150–300mg twice daily or vice versa; each treatment regimen was taken for 8 weeks with a 1-week washout period in between. “While gabapentin and pregabalin are both currently used to treat chronic sciatica, a position of equipoise appears to exist regarding which to choose,” explained the study authors.

The primary outcome of the study was change in pain intensity, as assessed by the 10-point visual analog scale, from baseline to week 8; secondary outcome measures included disability and adverse event severity and frequency.

Regardless of treatment sequence, there was a greater mean visual analog score reduction associated with gabapentin (mean [SD] 1.72 [1.17]) vs pregabalin (mean [SD] 0.94 [1.09]; P =.035), however, no significant difference was observed in Oswestry Disability Index reduction when compared head-to-head.

“Our study…represents the first prospective randomized cohort of patients with chronic sciatica to comprehensively assess the head-to-head efficacy of pregabalin and gabapentin, the associated frequency and severity of adverse events, and the impact of pregabalin-gabapentin interchange,” write the authors. They added that “gabapentin should be commenced before pregabalin to permit optimal crossover of medicines.”

I’ve now seen studies saying “yes” and studies saying “no” on the effectiveness of this class of drugs (gabapentoids) and this makes me painfully aware of how science has been corrupted by money.

After all, these drugs are being prescribed at historically high levels and someone is making a huge profit – enough to fund whatever studies help sell their drugs… or pay the fines for illegally promoting them for off-label purposes:

“Pfizer paid $2.3 billion dollars in 2009 to settle criminal and civil charges in the U.S. for the “off-label” marketing of Lyrica and other medications.” (Cymbalta and Lyrica in Legal Battles)

To worsen the scenario of so many patients being prescribed drugs that are ineffective for their pain, there’s proof that these drugs can damage the brain:

According to the US Food and Drug Administration (FDA), these antiepileptic drugs (AEDs) do in fact “increase the risk of suicidal thoughts or behavior in patients taking these drugs for any indication.”

AED may in fact may prevent the formation of new brain synapses, reducing the so-called “brain plasticity.”

In other words, these drugs cause brain damage.

Bet your doctor didn’t tell you this. Only about 30% who take these drugs can stay on them, the rest discontinue them due to side effects.

from Gabapentin/Neurontin And Pregabalin/Lyrica Aug 2016

And, last but not least,

Here comes another round of addiction hysteria, this time about medications doctors are prescribing on the slim chance they could help suffering pain patients for whom they are no longer allowed to prescribe opioids. (FDA Investigating Misuse, Abuse of Gabapentinoids)