Back Pain

24 March 2017

Popular painkiller for back pain 'no better than placebo'

A new trial found that the prescription painkiller pregabalin was of little or no help to patients with the back and leg pain known as sciatica.

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Painkillers are painkillers, aren't they?

Nothing could be further from the truth, however, and many South Africans use the incorrect type of painkillers for particular kinds of pain. This practice is very common, and potentially dangerous.

The above may also be the case with the widely prescribed pain drug pregabalin (brand name: Lyrica) may be no better than a placebo when it comes to treating the back and leg pain known as sciatica, a new clinical trial suggests.

According to a recent press release, pregabalin is indicated in the treatment of two of the most common causes of neuropathic pain – diabetic peripheral neuropathy (DPN) and post-herpetic neuralgia (PHN)

The study, published in the New England Journal of Medicine, found that sciatica patients improved to the same degree whether they were given pregabalin or placebo capsules.

Compression of the sciatic nerve

Sciatica is a nerve injury that causes excruciating pain from the lower back, through the hips and down each leg, and happens when the sciatic nerve is being pinched due to a herniated disc, spondylolisthesis or foraminal stenosis. Sciatica has been reported to occur in 1 to 10% of the population, most commonly in people aged 25 to 45 years.

Pregabalin is prescribed to treat various forms of nerve-related pain. In the United States, it's officially approved for nerve pain related to diabetes or shingles, and certain other conditions. Pregabalin has also been approved in South Africa by the Medicines Control Council.

Doctors also commonly prescribe pregabalin for sciatica. But the new study calls that practice into question.

"We do not recommend the use of pregabalin in people with sciatica," said researcher Christine Lin, of the George Institute for Global Health and the University of Sydney in Australia.

Not everyone agreed, however.

Patients who don't improve

Dr Houman Danesh is director of integrative pain management at Mount Sinai Hospital in New York City. He said doctors should "be aware" of the study findings. But he was not ready to dismiss pregabalin as a sciatica option.

Most of the study patients had "acute" sciatica – which means they'd had symptoms for less than three months. Most people in the acute phase will, fortunately, improve with time.

"So these are the patients who are probably on their way to getting better anyway," Danesh said.

It might be better, he said, to focus on patients who don't improve and progress to chronic sciatica.

The study's findings are based on more than 200 sciatica patients who were randomly assigned to take either pregabalin or placebo capsules for up to eight weeks. The starting dose of pregabalin was 150 mg per day. That dose was adjusted up to 600 mg daily, the study said.

At the outset, the intensity of their leg pain was just over a six, on a scale of 0 to 10. That's "severe" pain, Lin said.

Other options

At the end of the eight-week treatment period, patients in both groups were faring better. The average pain score in the placebo group had dipped to 3.1, versus 3.7 among pregabalin patients – a difference that was not statistically meaningful.

After one year, their pain was still hovering around a three.

Pregabalin patients did, however, have more side effects while they were taking the drug. The main problem was dizziness, which affected 40% of people taking the drug.

Other options for dealing with sciatica are:

  • Common painkillers (such as ibuprofen or naproxen)
  • Injections of anti-inflammatory corticosteroids
  • Certain antidepressants and anti-seizure medications that have been shown to ease nerve pain
  • Time – waiting it out
  • Surgery
  • Combination treatments like pregabalin with an antidepressant
  • Non-drug approaches like acupuncture
  • Staying as active as possible and avoiding prolonged bed rest

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Ask the Expert

Backache expert

Susan qualified as a Physiotherapist in 1990, and completed her master’s degree in Physiotherapy in 2013 at the University of Pretoria. She has a special interest in human biomechanics, as well as the interaction between domestic and work-related ergonomics.

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