What Should Pharmacists Select for Sciatica Pain?

Neuropathic pain is one of the most difficult syndromes to treat.

Pregabalin and gabapentin are effective treatment choices, and millions of patients around the world take these medications with varying degrees of relief.

One population that often has few treatment options is patients with sciatica.

Sciatica is often resistant to simple analgesic regimens. Since sciatica is neuropathic in nature, pregabalin and gabapentin may relieve some of its excruciating pain, but few studies have compared the treatments’ use.

A team of researchers recently published a review of current findings concerning the use of pregabalin and gabapentin in sciatica. Published ahead-of-print in the Journal of Clinical Neuroscience, this review indicated that non-evidenced-based use of either pregabalin or gabapentin has become common practice.

These researchers examined efficacy, adverse effects profiles, and costs associated with use of either treatment in sciatica.

They identified just 11 publications: 7 systematic reviews; 1 retrospective, cross-sectional study; 1 placebo-controlled, crossover study; 1 randomized, placebo-controlled, double-blind study; and 1 case report.

The majority of these publications indicated that gabapentin and pregabalin seem to have comparable efficacy and adverse effect profiles, but the evidence was scarce and of poor quality. In fact, any comparison of the 2 drugs was almost impossible, as no head-to-head study has been published.

In terms of expense, costs varied by up to 31 times based on the global location of care.

Formulary regulators did not seem to consider cost when selecting gabapentin or pregabalin, since they usually selected the more expensive drug for formulary inclusion.

The researchers found weak evidence that these drugs’ efficacy and adverse effects are probably similar.

The researchers concluded that lack of firm evidence supporting either pregabalin or gabapentin in sciatica has contributed to global formulary inconsistencies. Sciatica, like so many painful conditions, needs more examination.