Clinical Question

Is pregabalin (Lyrica) an effective treatment for the pain of acute or chronic sciatica?

Bottom Line

Pregabalin does not relieve pain in patients with sciatica. (Level of Evidence = 1b)

Synopsis

Gabapentin (Neurontin) and its prodrug pregabalin are widely used for the treatment of neuropathic pain, including sciatica. This Australian trial recruited patients with moderate to severe sciatica, defined as pain radiating below the knee and accompanied by evidence of nerve root or spinal nerve involvement such as sensory deficits, diminished reflexes, or weakness. The pain had to have been present for between one week and one year. The average age of the 207 participants was 54 years, 85% had dermatomal pain, 37% had a neurologic deficit, and 30% had a motor deficit. The patients were randomly assigned to receive pregabalin in a dosage of 75 mg twice daily, increasing to a final target dosage of 300 mg twice daily at eight weeks, or matching placebo. The primary outcome was pain on a 10-point scale, with a difference of 1.5 points considered to be the minimal clinically important difference. Patients were followed for up to one year, and a variety of secondary outcomes were measured. Groups were balanced at the start of the study, and analysis was by intention to treat. At eight weeks and at 52 weeks, there was no significant difference in the primary outcome and no difference in secondary outcomes including disability, back pain intensity, global perception of the effect, and quality of life.

Study design: Randomized controlled trial (double-blinded)

Funding source: Government

Allocation: Concealed

Setting: Outpatient (any)

Reference:MathiesonSMaherCGMcLachlanAJet alTrial of pregabalin for acute and chronic sciatica. N Engl J Med2017;376(12):1111–1120.