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Neuropathic pain drug no good for sciatica

The increasingly popular painkiller pregabalin (Lyrica) is no better than placebo for sciatica, say Australian researchers.

Their study of 209 patients randomised to pregabalin or placebo over eight weeks showed that not only was the drug ineffective for pain, it also caused almost twice as many adverse events.

Senior author Associate Professor Christine Lin from Sydney’s George Institute says there’s been an exponential rise in the amount of pregabalin scripts written for sciatica since its PBS listing in 2013, but that until now there’s been no solid evidence that the drug actually works.

“Our results have shown pregabalin treatment did not relieve pain, but did cause side effects such as dizziness.”

She says that ironically, most people in both groups reported satisfaction with their treatment. Indeed, over the course of the trial levels of pain did lessen, but the decreases were the same in both arms.

“It seems people associate a drop in pain being due to taking a capsule, rather than something that would happen entirely naturally over time.”

Dr Lin says there are currently no drugs proven to work for sciatica, and even epidural injections only provide a small benefit in the short term.

“What we do know is that most people with sciatica recover over time. It’s also important to avoid bed rest and to stay as active as possible.”

Related: Misusing opioids for chronic pain

However, pregabalin’s maker Pfizer has pushed back against the study’s findings.

A Pfizer spokesperson told trade publication Pharma In Focus that less than a third of study participants had the characteristics of neuropathic pain.

The spokesperson added that the vast majority of patients were being treated for acute rather than chronic sciatica, even though the acute form generally clears without the need for treatment.

The study findings comes amidst alarm at the high rate of pregabalin prescribing in Australia, a large proportion of which is likely to be off-label.

Last year, a Pharmaceutical Advisory Board report found that around half a million people were given the drug between March 2014 and February 2015, considerably more than had been predicted.

Nearly half of patients discontinued pregabalin after just one prescription, suggesting that the drug was being prescribed for acute rather than chronic neuropathic pain as indicated.

Around 45% of patients started pregabalin without being on a prior drug regimen, although the drug is not indicated as a first line treatment.

You can read the study abstract here.