Pregabalin is often used for sciatic case therapy. However, recent research has found that pregabalin should not be given for sciatica. Pregabalin is not only ineffective, but it also has undesirable side effects, such as dizziness or suicidal ideation.

Image Source:

What is Pregabalin?

Pregabalin is a type of drug that effectively relieves neuropathic pain (such as postherpetic neuralgia or diabetic neuropathy). In practice, pregabalin is often prescribed for sciatic leg pain cases, even though there is no scientific evidence that shows it's benefits for sciatica. Recent research has shown that pregabalin administration is considered ineffective in reducing sciatica, instead of exposing patients to undesirable side effects.

What is Sciatica?

Sciatica is pain radiating down the leg from the lower back caused by suppression of the sciatic nerve (n. Ischiadicus). The Ischiadicus is the longest nerve in the human body that runs from the lower back to the legs.
Disc herniation (40% of cases) is the most common cause of sciatica in the lumbosacral region (L4-S2) to cause compression, which irritates the sciatic nerve. This emphasis causes pain that radiates from the lower back to the back or side legs can also be accompanied by tingling sensation (paresthesia), to weakness (paresis or plegia).

In terms of epidemiology, sciatica covers <5% of low back pain in primary care, with a prevalence of 5.3% in men and 3.7% in women. Other publications note that the sciatica incidence varies from 1.6% -43%, mainly found in men.

The results of a cohort study report that 55% of sciatic patients still experience symptoms after 2 years, 53% after 4 years, 25% of which are cases of relapse. The more chronic (> 12 weeks) of sciatica, the pain is less responsive to therapy. Therefore appropriate sciatica management in the acute/subacute phase is very important. 

Effectiveness and Safety of Pregabalin for Sciatica

The double-blind randomized controlled trial study in 2017 in Sydney, Australia, which included 209 patients, have shown that pregabalin is equivalent to placebo in reducing the intensity of sciatic pain, only increasing patient exposure to side effects. In the study, 108 patients received pregabalin with doses titrated between 150-600 mg/day, and 101 patients received a placebo for 8 weeks. Pain intensity was assessed on a scale from 0 (no pain) to 10 (most painful) at the 8th and 52nd weeks.

Pregabalin is considered ineffective in relieving sciatica for the following reasons:

1. The pain relief effect is no different compared to placebo
At 8 weeks, the pain intensity scale in the pregabalin and placebo groups was 3.7 and 3.1, respectively, and at 52 weeks were 3.4 and 3.0, respectively. No significant differences were found between the two groups.

2. Equivalent to Placebo in Reducing Disability, Back Pain, and Quality of Life
Either at the 8th week or the 52nd, no significant differences were found between the placebo and pregabalin groups in secondary outcomes (disability, back pain intensity, and quality of life scores).

3. The incidence of Adverse Events is higher than that of a placebo
In the pregabalin group, there were 227 events in 68 patients. The number was significantly different compared to the placebo group (124 events in 43 patients). The most commonly reported side effect in both groups was dizziness - although it was more often reported in the pregabalin group.

4. Suicide Risk
in the United Kingdom, A cohort study found that the use of antiepileptic drugs (including pregabalin) has linked with an increased risk of suicide in depressed patients and in patients receiving antiepileptic drugs that are not for epilepsy nor bipolar disorder treatment. This result has led to concerns that pregabalin for sciatica will lead to an increased risk of suicide in patients. However, there are no studies related to the risk of suicide in sciatic patients who get pregabalin.

Pregabalin is considered useless in the sciatica treatment, but rather harmful because it exposes patients to the risk of undesirable side effects. Recent randomized controlled trials report that pregabalin is equivalent to placebo in reducing the intensity of sciatic pain, and is no different in reducing disability, back pain, or improving quality of life. Conversely, pregabalin increases the incidence of adverse events significantly.