Gabapentinoid use presents significant risk for adverse events and provides few benefits for patients with chronic low back pain (CLBP), according to findings from a systematic review published in PLoS Medicine.1
Researchers obtained data from 8 randomized trials to evaluate the safety and efficacy outcomes of gabapentinoid use in patients with CLBP. Three out of 8 studies compared gabapentinoid with placebo, and 5 studies compared pregabalin with either placebo or another analgesic medication (eg, buprenorphine, tapentadol, or celecoxib). Pain relief and safety were the primary outcomes.
Gabapentinoid use was associated with low pain relief (95% CI, −.5 to .07) in 3 studies, compared with placebo. In the 3 studies comparing pregabalin with other pain-relieving medications, the other analgesic medications were associated with better pain relief (95% CI, .20 to .64).
Fatigue (95% CI, 1.12 to 3.05), dizziness (95% CI, 1.17 to 3.37), visual disturbances (95% CI, 1.94 to 16.91), and mentation difficulties (95% CI, 1.54 to 7.25) were the most common adverse events among patients receiving gabapentinoid vs placebo.
Functional improvement was observed between the treatment and control group in 5 studies; however, these improvements did not reach statistical significance. No between-group differences for emotional functioning were observed in 2 studies.
The investigators concluded that there was a lack of significant benefit of gabapentinoid use in patients with CLBP and that these findings “are important for practitioners across several specialties who treat patients with CLBP and have to decide on the relative merits and demerits of treatment with gabapentinoids.”
- Shanthanna H, Gilron I, Rajarathinam M, et al. Benefits and safety of gabapentinoids in chronic low back pain: a systematic review and meta-analysis of randomized controlled trials. PLoS Med. 2017;14:e1002369.