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Gabapentinoids not effective for chronic low back pain, study concludes

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Gabapentinoids, including pregabalin and gabapentin, are increasingly being used ‘off label’ to treat chronic low back pain, but evidence suggests that these drugs have a significant risk of adverse effects with no benefits in terms of pain relief.

In a new study, Canadian researchers conducted a meta-analysis of eight randomised controlled trials that investigated the use of gabapentinoids in adult patients with chronic low back pain.

In three studies comparing gabapentin to placebo, gabapentin showed no significant improvement of pain; and in three studies comparing pregabalin to other analgesics, pregabalin actually performed worse in pain relief.

There were no deaths or hospitalisations reported in any of the studies, but commonly reported adverse events included dizziness, fatigue, confusion, and visual disturbances. Functional and emotional outcomes among patients taking gabapentinoids for chronic low back pain showed no significant improvements.

Reporting on the findings, an article in the BMJ noted that pregabalin is a controlled substance in the United States and there are calls for it to be reclassified in the United Kingdom to help tackle widespread misuse and addiction.

Pregabalin and gabapentin are anticonvulsant drugs with a well defined role in managing long-term conditions such as epilepsy, post-herpetic neuralgia, and neuropathic pain, the BMJ said. Pregabalin is also licensed for treating generalised anxiety disorder. However, both drugs are also increasingly being used off label for almost any type of pain.

“Given the lack of efficacy, risks, and costs associated, the use of gabapentinoids for chronic low back pain merits caution,” the researchers said. They called for larger, high quality trials to provide more definitive evidence.