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Anticonvulsants in the treatment of low back pain and lumbar radicular pain: a systematic review and meta-analysis

Canadian Medical Association journal (CMAJ), 2018-07, Vol.190 (26), p.E786-E793 [Peer Reviewed Journal]

Joule Inc. or its licensors ;2018 Joule Inc. or its licensors. ;COPYRIGHT 2018 Joule Inc. ;Copyright Joule Inc Jul 3, 2018 ;2018 Joule Inc. or its licensors 2018 ;ISSN: 0820-3946 ;EISSN: 1488-2329 ;DOI: 10.1503/cmaj.171333 ;PMID: 29970367

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  • Title:
    Anticonvulsants in the treatment of low back pain and lumbar radicular pain: a systematic review and meta-analysis
  • Author: Enke, Oliver, MBBS MSc ; New, Charles H., MBBS ; New, Heather A., MBBS MPH ; Mathieson, Stephanie, PhD ; Latimer, Jane, PhD ; Maher, Christopher G., PhD ; Lin, C.-W. Christine, PhD ; McLachlan, Andrew J., PhD
  • Subjects: Analgesics ; Anticonvulsants ; Back pain ; Clinical trials ; Drug therapy ; Evidence-based medicine ; Internal Medicine ; Low back pain ; Medical research ; Medicine, Experimental ; Meta-analysis ; Patient outcomes ; Primary care ; Quality ; Statistical analysis ; Systematic review
  • Is Part Of: Canadian Medical Association journal (CMAJ), 2018-07, Vol.190 (26), p.E786-E793
  • Description: ABSTRACT 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
  • Publisher: Canada: Joule Inc
  • Language: English
  • Identifier: ISSN: 0820-3946
    EISSN: 1488-2329
    DOI: 10.1503/cmaj.171333
    PMID: 29970367
  • Source: ProQuest One Psychology
    Open Access: DOAJ Directory of Open Access Journals
    Freely Accessible Journals
    Open Access: PubMed Central
    AUTh Library subscriptions: ProQuest Central
    Alma/SFX Local Collection
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