Pregabalin, gabapentin... They should not be used for chronic low back pain

Gabapentin analogs (including pregabalin and gabapentin) are increasingly being used superindicated for the treatment of chronic low back pain, but a systematic review and meta-analysis in the journal Public Library of Science-Medicine concluded that the available evidence does not support such use.

Pregabalin and gabapentin are anticonvulsants with a clear role in the management of long-term conditions such as epilepsy, postherpetic neuralgia, and neuropathic pain. Pregabalin is also licensed for the treatment of generalized anxiety disorder. However, both drugs are also increasingly used for almost any type of pain (super-indication applications).

Canadian researchers found that despite the widespread use of gabapentin analogs, few randomized controlled trials have evaluated the benefits of their use in patients with chronic low back pain.

Eight randomized controlled trials were included in the meta-analysis. In three studies, gabapentin did not provide significant pain relief relative to placebo. In three studies, pregabalin was worse than other analgesics in terms of pain relief. Studies did not show significant improvement with gabapentin analogs.

Both gabapentin and pregabalin were associated with a higher risk of dizziness compared with placebo or other analgesics. Gabapentin also had a higher risk of fatigue, confusion and visual disturbances compared to placebo.

In 2014, Public Health England and NHS England issued guidance warning that pregabalin and gabapentin can lead to dependence and may be abused; doctors should prescribe pregabalin and gabapentin appropriately to minimize the risk of abuse and dependence, and should be able to identify and manage problems caused by abuse.

A study in the journal Addiction found that prescribing of pregabalin and gabapentin in England and Wales increased by about 24% per year, from 1 million in 2004 to 10.5 million in 2015. The study suggests that the recent increase in prescriptions is closely linked to an increase in overdose deaths among heroin addicts. The researchers found that the number of deaths involving gabapentin increased dramatically from less than 1 per year before 2009 to 137 in 2015, with 79% of those deaths also involving opioids.

Des Spence, a general practitioner in Glasgow, said gabapentin prescriptions have increased greatly in the past five years and that people are commonly using them and relying on them.