Pregabalin Not Effective Treatment for Back Pain

Pregabalin does not effectively control lumbar spinal stenosis, according to research published in the journal Neurology.

Researchers from the University of Rochester analyzed the effects of pregabalin on the induction of neurogenic claudication in a randomized trial of 29 patients. The participants were randomly assigned to receive either pregabalin followed by an active placebo, such as diphenhydramine, or an active placebo followed by pregabalin for a treatment period of 10 days. The study periods were separated by a 10 day washout period, which included a 3 day taper phase after the first trial period. The researchers analyzed participants’ performances on a 15 minute treadmill test using the time to first moderate pain symptoms the patients experienced. At the end of the treadmill test, distance walked and validated self reports of pain were also assessed.

No differences were found in the time to first moderate pain experienced between the pregabalin and active placebo group or the active placebo then pregabalin group.

“Chronic low back pain is one of the most common reasons why older adults go to the doctor and lumbar stenosis is the leading indication for surgery in this age group,” lead author John Markman, MD, explained in a press release. “While physicians have increasingly looked for medication alternatives to opioid pain medication like gabapentin and pregabalin to help these patients manage their pain, until now there has been no credible evidence as to whether or not these treatments are effective for this problem.”

Pregabalin (marketed by Pfizer as Lyrica) is often used as a chronic pain treatment for shingles, spinal cord injury, fibromyalgia, and diabetic peripheral neuropathy, but is also used as an off label treatment for chronic low back pain syndromes like lumbar spinal stenosis. The pain from lumbar spinal stenosis is most often felt while a person is upright or walking, and is caused by the degeneration of the vertebrae, discs, muscles, and ligaments that make up the spinal column. Older adults often are hunched over or walking with a cane or walker due to this pain, which is described as tingling or numbness in the lower back, buttocks, and legs.

“Given the cost and potential side effects associated with pregabalin, it is critical that we understand the efficacy of this drug,” Markman continued. “This study convincingly demonstrates a lack of relief with pregabalin for the walking pain associated with lumbar spinal stenosis.”