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Commonly Prescribed Painkiller Not Effective in Controlling Low Back Pain

Researchers see no effect on walking pain of lumbar spinal stenosis

A study published in the December 10 edition of Neurology has shown that off-label pregabalin (Lyrica, Pfizer) is not effective in controlling the pain associated with lumbar spinal stenosis (LSS), the most common type of chronic low back pain in older adults.

“Chronic low back pain is one of the most common reasons why older adults go to the doctor, and lumbar stenosis is the leading indication for surgery in this age group,” said lead author John Markman, MD, director of the Translational Pain Research Program at the University of Rochester. “While physicians have increasingly looked for medication alternatives to opioid pain medication like gabapentin and pregabalin to help these patients manage their pain, until now there has been no credible evidence as to whether or not these treatments are effective for this problem.”

Pregabalin is approved to treat chronic pain associated with shingles, spinal cord injury, fibromyalgia, and diabetic peripheral neuropathy. However, it is also commonly prescribed as an off-label treatment for chronic low back pain syndromes, such as LSS.

In LSS, degeneration of the vertebrae, discs, muscles, and ligaments that comprise the spinal column leads to narrowing of the spinal canal. This, in turn, causes compression of nerve roots, which can trigger pain, tingling, and numbness in the lower back, buttocks, and legs. The pain of LSS is most commonly experienced when a person is upright or walking and can be lessened by bending forward at the waist, which is often why one sees older adults hunched over with a cane or a walker.

While some narrowing of the spinal canal occurs with normal aging and does not always cause pain, more-severe nerve compression limits mobility and prompts patients to try stronger pain medications and epidural steroid injections in an attempt to control the pain that is associated with walking and standing.

In addition, patients often decide to undergo lumbar laminectomy, which removes a portion of the bone or disc to give the nerve roots more room. This procedure is the most common reason for spine surgery in people over the age of 60. While this surgery is initially highly successful, the pain often returns after a number of years. Moreover, for some patients, surgery is not an option.

For a long time, physicians have attempted to expand the arsenal of medications available to treat LSS. In fact, it is estimated that more than two-thirds of the pain regimens currently being used for LSS consist of drugs that are not approved by the FDA for the condition, such as pregabalin.

The new study used a novel approach to evaluate the effectiveness of pain treatments. Because the pain associated with LSS is present when a person is upright or walking, the researchers asked individuals with the condition to report their pain levels while walking on a treadmill. A total of 26 subjects participated in the study. The researchers found that there was no significant difference in the levels of pain experienced by individuals treated with pregabalin and those receiving placebo.

“Given the cost and potential side effects associated with pregabalin, it is critical that we understand the efficacy of this drug,” Markman said. “This study convincingly demonstrates a lack of relief with pregabalin for the walking pain associated with lumbar spinal stenosis.”

Source: University of Rochester Medical Center; December 10, 2014.

 

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