Sciatica sucks! Sadly, so does sciatica treatment with pregabalin (Lyrica). That’s the conclusion of a new study published in the New England Journal of Medicine (March 23, 2017). Even though the drug didn’t reduce pain, it did cause side effects. The outcome of this eight-week trial was definitely disappointing.
What’s Sciatica Like?
The pain can be excruciating and debilitating. It usually starts in the lower back, runs past your butt to the hip area and then travels down the leg to the calf.
Symptoms of Sciatica:
The sciatic nerve can be irritated by compression from a bulging spinal disk or a bone spur. Sometimes the cause may not be obvious. But the pain cannot be ignored. Some people complain that it is sharp, like a knife. Others say it is a dull, achy pain.
Many patients with sciatica report a burning sensation that gets worse after sitting for awhile. If there is numbness or if the leg muscle suddenly becomes weak, seek prompt medical attention!
Sciatica Treatment Is Disappointing:
Nerve (neuropathic) pain is a challenge for physicians. Nonsteroidal anti-inflammatory drugs just aren’t that effective. A review by the highly regarded Cochrane Collaboration concluded that the trials of NSAIDs for sciatica treatment offered “low- to very low-level evidence using the GRADE criteria.” What they meant was that the 10 trials that were reviewed were not great. Some studies were too small. Others produced inconsistent results or introduced bias into the results (Cochrane Database of Systematic Reviews, Oct. 15, 2016).
The Cochrane bottom line on NSAIDs like diclofenac, ibuprofen, naproxen, etc for sciatica treatment:
“The efficacy of NSAIDs for pain reduction was not significant.”
That doesn’t mean the drugs don’t have side effects. NSAIDs can cause high blood pressure, edema, atrial fibrillation, heart attacks, strokes, cardiac arrest, ulcers, kidney damage, liver damage and perforation of the stomach, small intestine and large intestine.
Steroid Injections in the Spine:
Results of corticosteroid injections for sciatica have also been disappointing. A review in the journal American Family Physician (Feb. 2016) was titled:
“Epidural Steroid Not Better Than Placebo Injection for Sciatica and Spinal Stenosis Pain and Function.”
That title pretty much tells the story.
Other Sciatica Treatments:
Opioid narcotics, muscle relaxants and tricyclic antidepressants like amitriptyline or doxepin all have their downsides. That is why there was hope that Lyrica (pregabalin) would turn out to be an effective sciatica treatment.
“Trial of Pregabalin for Acute and Chronic Sciatica”
This study was undertaken because there is evidence that pregabalin helps ease some kinds of neuropathic pain. The FDA has approved Lyrica for the ongoing nerve pain that sometimes occurs after a shingles attack (postherpetic neuralgia). The drug also has FDA approval for diabetic nerve pain, fibromyalgia and “neuropathic pain associated with spinal cord injury.” The hope was that it would also work for the pain of sciatica.
The study was carried out in Australia. More than 200 patients were randomized to take either pregabalin or placebo for 8 weeks. At the end of that time, and also after a year, there was no significant difference between groups with regard to their pain score.
Lyrical (Pregabalin) Side Effects:
People taking pregabalin did experience significantly more side effects. They included dizziness, drowsiness, falls and back pain. An accompanying editorial suggests that most acute sciatica attacks resolve on their own, which could explain why the people getting placebo did as well as those on pregabalin.
The authors of the pregabalin study summed up their results (New England Journal of Medicine, March 23, 2017):
“In conclusion, our results show that pregabalin did not relieve sciatic pain or improve related clinical measures, as compared with placebo, over the course of 8 weeks. Pregabalin was associated with higher rates of adverse events than placebo.”
If you would like to learn more about the pros and cons of Lyrica, here is a link. Many people do not realize that stopping Lyrica suddenly can trigger withdrawal symptoms.
There are not a lot of good studies of natural treatments for nerve pain. Here is one article that you may find interesting: