Evidence does not support the use of gabapentinoids for chronic low back pain

August 15, 2017

Existing evidence on the use of gabapentinoids in chronic low back pain (CLBP) is limited, and demonstrates significant risk of adverse effects with no benefits on pain relief, according to a meta-analysis published in PLOS Medicine by Harsha Shanthanna from McMaster University, Canada, and colleagues.

Gabapentinoids, including pregabalin and gabapentin, are increasingly used for non-specific CLBP. In the new study, researchers analyzed findings from 8 randomized controlled trials that investigated the use of gabapentinoids in adult CLBP patients.

In 3 studies comparing gabapentin to placebo, gabapentin showed no significant improvement of pain; and in the 3 studies comparing pregabalin to other analgesics, pregabalin actually fared worse in pain relief. There were no deaths or hospitalizations reported in any included studies of the drugs, but commonly reported adverse events included dizziness, fatigue, confusion, and visual disturbances. Functional and emotional outcomes among patients taking gabapentinoids for CLBP showed no significant improvements.

"Despite their widespread use, our systematic review with meta-analysis found that there are very few randomized controlled trials that have attempted to assess the benefit of using gabapentin or pregabalin in patients of chronic low back pain," the authors say. "The existing evidence does not support the use of gabapentinoids for predominant chronic low back pain, and calls for larger, high quality trials to more definitively inform this issue."
-end-
Funding:

The article processing charges for the article were supported through funds from a Canadian Institute of Health Research (CIHR) Randomized Controlled Trials Mentoring Program grant, awarded to Dr. Shanthanna in 2014.

Competing Interests:

The authors have declared that no competing interests exist.

Citation:

Shanthanna H, Gilron I, Rajarathinam M, AlAmri R, Kamath S, Thabane L, et al. (2017) Benefits and safety of gabapentinoids in chronic low back pain: A systematic review and meta-analysis of randomized controlled trials. PLoS Med 14(8): e1002369. https://doi.org/10.1371/journal.pmed.1002369

Author Affiliations:

Department of Anesthesiology, St Joseph's Healthcare, McMaster University, Hamilton, Ontario, Canada
Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
Departments of Anesthesiology & Perioperative Medicine and Biomedical & Molecular Sciences,
Queen's University, Kingston, Ontario, Canada
Department of Neuroanesthesia, National Institute of Mental Health and Neuro Sciences, Bangalore, India
Biostatistics Unit, St Joseph's Healthcare, Hamilton, Ontario, Canada
Department of Medicine, McMaster University, Hamilton, Ontario, Canada
Department of Surgery, McMaster University, Hamilton, Ontario, Canada

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