Anticonvulsants May Be Ineffective for Low Back, Lumbar Radicular Pain

The following article is part of conference coverage from the IASP 2018 conference in Boston, Massachusetts. Clinical Pain Advisor’s staff will be reporting breaking news associated with research conducted by leading experts in pain medicine. Check back for the latest news from IASP 2018.

Anticonvulsants may not effectively reduce pain or disability in patients with low back pain or lumbar radicular pain, according to results to be presented at the World Congress on Pain 2018, held September 12-16 in Boston, Massachusetts.

For this systematic review, investigators searched 5 databases from studies examining the effects of an anticonvulsant compared with placebo in participants with nonspecific low back pain, sciatica, or neurogenic claudication of any duration. Primary outcomes included self-reported pain, disability, and adverse events. The researchers used the PEDro scale to assess risk for bias and GRADE to assess quality of evidence. The review included 9 trials that compared topiramate, gabapentin, or pregabalin with placebo. The trials included a total of 859 participants.

Of 15 comparisons, 14 found that anticonvulsants did not effectively reduce pain or disability in individuals with low back pain or lumbar radicular pain. Gabapentinoids were found to be ineffective for chronic low back pain in the short term compared with placebo (high-quality evidence; pooled mean difference [MD], −0.2; 95% CI, −7.6 to 7.1), and on lumbar radicular pain in the immediate term compared with placebo (high-quality evidence; pooled MD, −1.1; 95% CI, −7.0 to 4.7).

In addition to a lack of efficacy, the systematic review found a high level of evidence indicating that gabapentinoids increased the risk for adverse events compared with placebo.

“The most important take home message of our study is that anticonvulsants such as pregabalin and gabapentin are not effective in reducing low back pain or lumbar radicular pain, but can cause unnecessary side effects, such as dizziness. So these medicines are not recommended for patients with low back pain or lumbar radicular pain,” said study lead author, Christine Lin, PhD, associate professor at the University of Sydney School of Medicine in Australia to Clinical Pain Advisor. “This review is important because anticonvulsant medications have been increasingly used to treat low back pain and lumbar radicular pain. For example, pregabalin is among the top selling drugs internationally,” she added.

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Reference

Lin C, Enke O, New H, et al. Anticonvulsants for low back pain and lumbar radicular pain: a systematic review. Presented at the World Congress on Pain 2018; September 12-16,; Boston, Massachusetts. Poster 63572.

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