17 Aug Evidence Does Not Support Gabapentinoids in Non-Specific Chronic Low Back Pain
MedicalResearch.com Interview with:
Harsha Shanthanna MBBS, MD, MSc
Associate Professor, Anesthesiology
Chronic Pain Physician
St Joseph’s Healthcare,McMaster University
Diplomate in National Board, Anesthesiology (India)
Fellow in Interventional Pain Practice (WIP)
European Diplomate in Regional Anesthesia and Pain
MedicalResearch.com: What is the background for this study?
Response: Pregabalin (PG) and gabapentin (GB) are increasingly used for nonspecific Chronic Low Back Pain (CLBP) despite a lack of evidence. There have been concerns expressed over their increased prescribing for various non cancer pain indications in recent years. Their use requires slow titration to therapeutic doses and establishing maintenance on a long-term basis. With prolonged treatment, the potential gain over possible adverse effects and risks could become unclear.
We searched Cochrane, MEDLINE and EMBASE databases for randomized control trials reporting the use of gabapentinoids for chronic lower back pain treatment of 3 months or more in adult patients.
MedicalResearch.com: What are the main findings?
Response: We found that there were only 8 studies. Three studies comparing gabapentin with placebo showed that the improvement in pain was minimal. Three other studies compared pregabalin to other types of analgesic medication and showed greater improvement in the other analgesic group. Studies that used pregabalin as an adjuvant therapy were not pooled due to heterogeneity, but the largest of them showed no benefit of adding pregabalin to tapentadol among its 432 participants. In addition, we found that gabapentin was associated with increased risks for dizziness, fatigue, mental difficulties and visual disturbances, whereas pregabalin was associated with elevated risk for dizziness.
MedicalResearch.com: What should readers take away from your report?
Response: Despite their widespread use, our systematic review with meta-analysis found that there are very few randomized controlled trials that have attempted to assess the benefit of using gabapentin or pregabalin in patients of chronic low back pain. The existing evidence does not support the use of gabapentinoids for predominant chronic low back pain.
For physicians: Physicians should note that gabapentinoids do have a role in the treatment of neuropathic pain. I think it is clinically appropriate to consider a trial of therapy in clbp patients with predominant radicular leg pain (neuropathic). Long term treatment should be based on reasonable evaluation of pain and functions and adverse effects, to avoid risk of poly-pharmacy and adverse effects. Existing evidence does not support their use in non-specific chronic low back pain.
MedicalResearch.com: What recommendations do you have for future research as a result of this study?
Response: We conclude that that existing evidence on the use of gabapentinoids in CLBP is limited and recommend that they should be used with caution. Future research should focus on conducting large, high quality studies with long term follow up.
MedicalResearch.com: Thank you for your contribution to the MedicalResearch.com community.
Citation: Shanthanna H, Gilron I, Rajarathinam M, et al. Benefits and safety of gabapentinoids in chronic low back pain: A systematic review and meta-analysis of randomized controlled trials. PLoS Med 2017 14(8): e1002369. doi: 10.1371/journal.pmed.1002369
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