Optimizing Treatment for Patients With Chronic Sciatica: Gabapentin vs Pregabalin

Primary outcome was pain intensity measured by the 10-point visual analog scale
Primary outcome was pain intensity measured by the 10-point visual analog scale

In patients with chronic sciatica, gabapentin was associated with a greater reduction in leg pain intensity and fewer side effects compared with pregabalin, according to a study published in JAMA Neurology.

In this prospective, cohort study, patients (N=18) were randomized to receive gabapentin 400–800mg 3 times daily then pregabalin 150–300mg twice daily or vice versa; each treatment regimen was taken for 8 weeks with a 1-week washout period in between. "While gabapentin and pregabalin are both currently used to treat chronic sciatica, a position of equipoise appears to exist regarding which to choose," explained the study authors. The primary outcome of the study was change in pain intensity, as assessed by the 10-point visual analog scale, from baseline to week 8; secondary outcome measures included disability and adverse event severity and frequency.

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Results showed that both treatments were associated with a significant reduction on the visual analog pain intensity scale (gabapentin: mean [SD] 7.54 [1.39] to 5.82 [1.72]; <.001) and pregabalin (mean [SD] 7.33 [1.30] to 6.38 [1.88]; P=.002) and on the Oswestry Disability Index, used to measure disability (gabapentin (mean [SD], 59.22 [16.88] to 48.54 [15.52]; <.001) and pregabalin (mean [SD] 59.22 [13.24] to 50.44 [16.58]; P<.001); this effect was not impacted by the order in which the regimens were given.

Regardless of treatment sequence, there was a greater mean visual analog score reduction associated with gabapentin (mean [SD] 1.72 [1.17]) vs pregabalin (mean [SD] 0.94 [1.09]; =.035), however, no significant difference was observed in Oswestry Disability Index reduction when compared head-to-head.

With regard to safety, adverse events were more frequent with pregabalin compared with gabapentin (81% vs 19%; =.002), particularly when pregabalin was administered first.

"Our study…represents the first prospective randomized cohort of patients with chronic sciatica to comprehensively assess the head-to-head efficacy of pregabalin and gabapentin, the associated frequency and severity of adverse events, and the impact of pregabalin-gabapentin interchange," write the authors. They added that "gabapentin should be commenced before pregabalin to permit optimal crossover of medicines."

For more information visit JAMAnetwork.com.