Gabapentinoids are probably ineffective in chronic low back pain and have significant adverse effects

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Gabapentinoids are probably ineffective in chronic low-back pain and have significant adverse effects  

A systematic review of Gabapentin (GB) and Pregabalin found 8 studies.1 GB compared with placebo (3 studies, n = 185) showed minimal improvement of pain. Compared with placebo, the following adverse events were more commonly reported with GB: dizziness; fatigue; difficulties with mentation and visual disturbances. The number needed to harm with 95% CI for dizziness, fatigue, difficulties with mentation, and visual disturbances were 7 (4 to 30), 8 (4 to 44), 6 (4 to 15), and 6 (4 to 13) respectively. 

A US guideline suggests that most patients get better regardless of treatment but there are numerous other non-drug and drug options.2

For patients with chronic low-back pain, clinicians and patients should initially select non-drug treatment with exercise, multidisciplinary rehabilitation, acupuncture, mindfulness-based stress reduction (moderate-quality evidence), tai chi, yoga, motor control exercise, progressive relaxation, electromyography biofeedback, low-level laser therapy, operant therapy, cognitive behavioural therapy, or spinal manipulation (low-quality evidence).

References:

  1. Benefits and safety of gabapentinoids in chronic low back pain: A systematic review and meta-analysis of randomized controlled trials (2017).  Click here
  2. Noninvasive Treatments for Acute, Subacute, and Chronic Low Back Pain: A Clinical Practice Guideline From the American College of Physicians (2017). Click here

    Gems are chosen by the Goodfellow director Dr. Bruce Arroll to be either practice changing or practice maintaining. The information is educational and not clinical advice.

       
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    As published in NZ Doctor 13/12/2017