Pregabalin and gabapentin are increasingly used for nonspecific chronic low back pain (CLBP), despite a lack of evidence. NHS guidelines have highlighted concerns about their off-label use and the potential for misuse. There have also been concerns about their increased prescribing for various non-cancer pain indications.
Researchers searched MEDLINE, EMBASE and Cochrane databases for randomised controlled trials reporting the use of gabapentinoids for CLBP of >3 months’ duration in adult patients.
From the eight studies included, it was found that those comparing gabapentin with placebo showed minimal improvement of pain, and in those comparing pregabalin with other analgesic medications, greater improvements were seen in the ‘other analgesic’ group. Furthermore, compared with placebo, adverse events such as dizziness, fatigue and visual disturbances were more commonly reported by patients taking gabapentin.
Reporting in PLoS Medicine (online, 15 August 2017), the researchers conclude that existing evidence on the use of gabapentinoids in CLBP is limited, and that gabapentinoids should be used with caution
 Shanthanna H, Gilron I, Rajarathinam M et al. Benefits and safety of gabapentinoids in chronic low back pain: a systematic review and meta-analysis of randomized controlled trials. PLoS Med 2017 14(8): e1002369. doi: 10.1371/journal.pmed.1002369