Anticonvulsants in the treatment of low back pain and lumbar radicular pain: a
systematic review and meta-analysis
#MMPMID29970367
Enke O
; New HA
; New CH
; Mathieson S
; McLachlan AJ
; Latimer J
; Maher CG
; Lin CC
CMAJ
2018[Jul]; 190
(26
): E786-E793
PMID29970367
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BACKGROUND: The use of anticonvulsants (e.g., gabapentin, pregabalin) to treat
low back pain has increased substantially in recent years despite limited
supporting evidence. We aimed to determine the efficacy and tolerability of
anticonvulsants in the treatment of low back pain and lumbar radicular pain
compared with placebo. METHODS: A search was conducted in 5 databases for studies
comparing an anticonvulsant to placebo in patients with nonspecific low back
pain, sciatica or neurogenic claudication of any duration. The outcomes were
self-reported pain, disability and adverse events. Risk of bias was assessed
using the Physiotherapy Evidence Database (PEDro) scale, and quality of evidence
was assessed using Grading of Recommendations Assessment, Development and
Evaluation (GRADE). Data were pooled and treatment effects were quantified using
mean differences for continuous and risk ratios for dichotomous outcomes.
RESULTS: Nine trials compared topiramate, gabapentin or pregabalin to placebo in
859 unique participants. Fourteen of 15 comparisons found anticonvulsants were
not effective to reduce pain or disability in low back pain or lumbar radicular
pain; for example, there was high-quality evidence of no effect of gabapentinoids
versus placebo on chronic low back pain in the short term (pooled mean difference
[MD] -0.0, 95% confidence interval [CI] -0.8 to 0.7) or for lumbar radicular pain
in the immediate term (pooled MD -0.1, 95% CI -0.7 to 0.5). The lack of efficacy
is accompanied by increased risk of adverse events from use of gabapentinoids,
for which the level of evidence is high. INTERPRETATION: There is moderate- to
high-quality evidence that anticonvulsants are ineffective for treatment of low
back pain or lumbar radicular pain. There is high-quality evidence that
gabapentinoids have a higher risk for adverse events. PROTOCOL REGISTRATION:
PROSPERO-CRD42016046363.
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