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

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. Systematic review. 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. 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). 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. 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. 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. 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. Revisión sistemática. 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. 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). 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. Se incluyeron 8 ECA con un total de 747 participantes. El efecto de la pregabalina fue evaluado en 3 ECA y en un ensayo de 3 brazos (pregabalina vs. limaprost vs. una combinación de limaprost y pregabalina). Dos ensayos ev