Hamilton, Ontario—Adults complaining of nonspecific chronic low back pain are increasingly prescribed gabapentinoids.
A new study published in PLOS Medicine suggests, however, that evidence for the use of the drug class is limited for that condition. A meta-analysis led by Canadian researchers from McMaster University warns that the risk of adverse effects is significant, without much benefit in terms of pain relief.
The study points out that prescriptions for the drug usually requires prolonged use and are associated with increased costs, as well as adverse effects. Background information points to recent guidelines from the National Health Service (NHS), England, expressing concerns about their off-label use, in addition to the risk of misuse.
The researchers analyzed the results of eight randomized controlled trials that investigated the use of gabapentinoids, including pregabalin and gabapentin, in adult chronic low back pain (CLBP) patients. Study authors searched electronic databases of MEDLINE, EMBASE, and Cochrane from their inception until December 20, 2016, searching for randomized control trials reporting the use of gabapentinoids for the treatment of CLBP in adult patients. Study selection and data extraction was performed independently by paired reviewers.
Results indicate that, in three studies comparing gabapentin to placebo, gabapentin showed no significant improvement of pain; and in the three studies comparing pregabalin to other analgesics, pregabalin actually was worse for pain relief.
Although no deaths or hospitalizations were reported in any included studies of the drugs, commonly reported adverse events included dizziness, fatigue, confusion, and visual disturbances. At the same time, functional and emotional outcomes among patients taking gabapentinoids for CLBP showed no significant improvements.
“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 authors conclude. “The existing evidence does not support the use of gabapentinoids for predominant chronic low back pain, and calls for larger, high quality trials to more definitively inform this issue.”
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