Pregabalin of no benefit for sciatica

A randomised controlled trial of pregabalin (Lyrica) in patients with moderate to severe leg pain due to sciatica has shown the drug is no better than placebo.

The study of 209 patients, mostly those with acute pain of less than three months duration, found no significant difference in leg pain intensity between the treated and control group at eight weeks and 12 months.

Secondary outcomes such as quality of life scores, back pain intensity and extent of disability scores were also similar in both groups.

Associate Professor Christine Lin, from the George Institute for Global Health, said the findings were important because of the high rate of use of pregabalin and the potential for serious side effects.

“Pregabalin was approved in 2013 and since then its use has escalated. The number of prescriptions is 32% more than the PBS predicted.”

“One of the reason its use has increased is that there really is no other option for patients with sciatica,” she told the limbic. 

She said it was important for people with sciatica to stay active however there was little evidence of benefit from most medications and most physical therapies including physiotherapy, acupuncture and traction.

The study found no significant differences in additional medication use, health service use or lost workdays between patients receiving pregabalin or placebo.

Pregabalin was administered initially at 150mg/day and titrated up to a maximum of 600 mg/day according to the patients’ progress.

The study found pregabalin was associated with twice the rate of side effects – mostly mild events such as dizziness and back pain.

Associate Professor Lin said the study was not powered to detect any increase in suicidality as an outcome, despite the known link with pregabalin.

The findings that pregabalin had no beneficial effect in reducing the pain of sciatica is consistent with other studies.

“While there is evidence for pregabalin in certain types of nerve pain, we hope these findings will help inform prescribers and patients with sciatica.”

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