Gabapentinoids ineffective for lower back pain, review finds

A review published in the Canadian Medical Association Journal has backed up guidance stating that anticonvulsants are ineffective for treating lower back pain.

Woman sitting, lower back pain

Anticonvulsant medications, such as gabapentin and pregabalin, are not effective for treating lower back pain and carry a risk of adverse events, the results of a systematic review and meta-analysis show[1]

The research, published in the Canadian Medical Association Journal (3 July 2018), identified nine trials comparing topiramate or gabapentinoids with placebo, involving a total of 859 people with non-specific back pain, sciatica or neurogenic claudication.

The team found primarily moderate-to-high quality evidence that gabapentinoids do not improve pain or disability in lower back pain. There was moderate-quality evidence that topiramate led to short-term pain relief. There was also strong evidence that gabapentinoids increased the risk of adverse events versus placebo.

In recent years, use of anticonvulsant medications in lower back pain has increased, despite a lack of support from evidence-based guidelines, the researchers explained.

“Our findings are in line with recent US and UK guidelines for low back pain, which do not recommend the use of anticonvulsants,” the researchers said.

They also suggested that guidance from the National Institute for Health and Care Excellence, which recommends use of gabapentin for sciatica, should be reviewed in light of their findings.


[1] Enke O, New H, New C et al. Anticonvulsants in the treatment of low back pain and lumbar radicular pain: a systematic review and meta-analysis. CMAJ 2018;190(26):e786–793. doi: 10.1503/cmaj.171333

Last updated
Clinical Pharmacist, CP, September 2018, Vol 10, No 9;10(9):DOI:10.1211/PJ.2018.20205304

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