A systematic review and meta-analysis of the effectiveness and adverse events of gabapentin and pregabalin for sciatica pain

Aim: This SR aims to assess the effectiveness of pregabalin and gabapentin on pain and disability caused by acute sciatica and the adverse events associated with their clinical use. Design: Systematic review. Databases: Electronic databases of Cochrane Central Register of Controlled Trials, MEDLINE,...

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Bibliographic Details
Published in:Atención primaria 2022-01, Vol.54 (1), p.102144
Main Authors: María Soledad Giménez-Campos, Pedro Pimenta-Fermisson-Ramos, Jose Israel Díaz-Cambronero, Rafael Carbonell-Sanchís, Eduardo López-Briz, Vicente Ruíz-García
Format: Article
Language:Spanish
Subjects:
Ciática
Eventos adversos
Gabapentina
Pregabalina
Revisión sistemática
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Summary:Aim: This SR aims to assess the effectiveness of pregabalin and gabapentin on pain and disability caused by acute sciatica and the adverse events associated with their clinical use. Design: Systematic review. Databases: Electronic databases of Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, and Clinical Trials.gov were searched from their inception until March 1st of 2021. Selection criteria: Randomized trials (RCT) with adults > 18 years old with acute sciatica for a minimum of 1 week and a maximum of 1 year (at least moderate pain). Data treatment: The outcomes were pain, disability and adverse events. Data was summarized using odds ratio and mean difference. GRADE was used to calculate the level of evidence. Results: Eight RCT involving 747 participants were included. The effect of pregabalin was assessed in 3 RCT and in one three-arm trial (pregabalin vs limaprost vs a combination of limaprost and pregabalin). Two trials assessed the effect of gabapentin compared with placebo and one compared with tramadol. One study assessed the effect of gabapentin vs pregabalin in a crossover head-to-head trial.A statistically significant improvement on leg pain at 2 weeks and leg pain with movement at 3 and 4 months was found in a RCT comparing gabapentin with placebo. There were no statistically differences on the remaining time periods assessed for leg pain, low back pain and functional disability. Conclusions: This SR provides clear evidence for lack of effectiveness of pregabalin and gabapentin for sciatica pain management. In view of this, its routine clinical use cannot be supported. Resumen: Objetivo: Esta revisión sistemática evalúa la efectividad de pregabalina y gabapentina sobre el dolor y la discapacidad producidas por el dolor agudo causado por ciática, y los eventos adversos asociados al uso clínico. Diseño: Revisión sistemática. Bases de datos: Se buscó en Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, y en Clinical Trials.gov desde su inicio hasta el 1 de marzo del 2021. Criterios de selección: Ensayos clínicos aleatorizados (ECA) sobre adultos > 18 años con ciática aguda establecida entre una semana como mínimo y un año como máximo (al menos con dolor moderado). Tratamiento de datos: Los resultados fueron dolor, discapacidad y eventos adversos. Los datos fueron resumidos usando odds ratio y diferencia de medias. Para calcular el nivel de evidencia se empleó GRADE. Resultados: Se incluyeron 8 ECA con un total de 74
ISSN:0212-6567