Does gabapentin help sciatic nerve pain: Gabapentin, Pregabalin, and Back Pain: FDA Safety Alert
Gabapentin, Pregabalin, and Back Pain: FDA Safety Alert
People with radiating chronic spine pain may be prescribed gabapentin or pregabalin to treat their nerve-related neck, back and/or leg pain. If you’re taking either of these medications, please note: In December 2019, the U.S. Food and Drug Administration (FDA) released a safety alert that gabapentin (brand names: Neurontin, Gralise, Horizant) and pregabalin (brand names: Lyrica and Lyrica CR) may increase the risk for serious breathing problems if you’re also taking a central nervous system (CNS) depressant or have respiratory problems. CNS depressants are drugs that include tranquilizers and sedatives.
While all prescription and OTC drugs carry risk for side effects, the FDA has released a special safety alert specifically for gabapentin and pregabalin. Photo Source: iStock.com.
What Should I Know About this Drug Safety Alert?
After reviewing case reports and existing medical literature, observational studies, clinical trials, and animal studies, the FDA released a drug safety warning linking gabapentin and pregabalin to serious breathing problems.
It’s important to know that this safety alert is not for all users of gabapentin and pregabalin. This drug warning is for people taking gabapentin or pregabalin who also have respiratory risk factors that include:
- Taking gabapentin or pregabalin with a central nerve system (CNS) depressant or opioid medication
- Having an existing respiratory condition, such as chronic obstructive pulmonary disease (COPD)
The FDA also said that elderly users of these medications are at a higher risk of experiencing serious breathing problems.
CNS depressants are sometimes prescribed to treat insomnia, acute stress, anxiety, or muscle spasms. These medications work by slowing brain and nervous system activity. Central nervous system depressants include:
- Benzodiazepines are tranquilizers, such as diazepam (Valium), alprazolam (Xanax), clonazepam (Klonopin), triazolam (Halcion), estazolam (Prosom)
- Non-benzodiazepine sedative hypnotics help induce sleep, such as zolpidem (Ambien), eszopiclone (Lunesta), zaleplon (Sonata)
- Barbituates treat seizure or anxiety, such as mephobarbital (Mebaral), phenobarbital (Luminal), pentobarbital sodium (Nembutal)
Where Gabapentin and Pregabalin Fit in the Spine Pain Treatment Plan
The FDA has approved gabapentin and pregabalin for several conditions, from seizures and restless leg syndrome to diabetes and fibromyalgia. Although not specifically approved to treat chronic back and neck pain, your doctor may also prescribe these drugs if you have nerve-related spine pain.
Gabapentin and pregabalin, which are sometimes called gabapentinoids, belong to a class of prescription drugs called anticonvulsants, which is why they are often prescribed for seizure management. These medications also have neuropathic properties—that is, they treat nerve pain.
If you experience chronic nerve pain in your spine, it might feel like weakness, shooting pain, burning, and/or tingling throughout your back and neck. Sometimes pain radiates into an extremity, such as an arm or leg (eg, sciatica). Gabapentinoids can help ease those sensory symptoms in some people. Gabapentin may even be prescribed to treat nerve pain after spinal cord injury.
Respiratory Warning Signs People Should Understand
If you or a loved one take pregabalin or gabapentin, the FDA urges you to be aware of the following respiratory warning signs that warrant immediate medical attention:
- Slowed, shallow breathing
- Bluish skin (often on the lips or extremities)
- Confusion-related symptoms: disorientation, dizziness, lightheadedness
- Excessive fatigue or sleepiness
- Change or lack of responsiveness (a person doesn’t react normally, answer to his or her name, or is unable to awake from sleep)
If you experience any of these symptoms, seek emergency medical attention (ie, don’t wait to see your personal doctor), as they may be life threatening.
The side effects above warrant urgent medical attention, but it’s important to also report to your doctor if you experience any of these more common, less urgent side effects of gabapentinoids: drowsiness, blurry vision, difficulty coordinating and concentrating, and swelling in your hands, legs, and feet.
What Can I Expect as a Result of this Safety Alert?
The FDA will require new warnings about the respiratory risks associated with gabapentin and pregabalin to be included on the prescription information provided with these drugs.
In its research evaluation, the FDA also discovered an increase in prescription rates for gabapentin and pregabalin. Because these drugs are often prescribed with an opioid drug—and because they also bear addiction and abuse potential on their own—the FDA is also requiring the manufacturers of these medications to conduct clinical trials that assess the abuse potential for gabapentin and pregabalin.
Note that the FDA does not currently schedule gabapentin as a controlled substance; however, pregabalin is a Schedule V controlled substance, meaning that although it has a lower risk of abuse, there is some risk for dependence.
Be Drug Smart: What You Should Do with this Information
Medications are an effective way to help manage your spine pain affecting your neck or back, but it’s important to recognize that all medicines bear the risks of side effects. In most cases, these side effects are minimal. You can do your part to reduce adverse medication affects by always taking a drug as prescribed and telling your doctor about all drugs, medicines, and supplements you’re taking to help prevent potentially serious interactions.
This FDA safety alert for gabapentin and pregabalin draws attention to potential breathing problems associated with these medications, which may be life threatening. If you take these drugs and experience respiratory problems or other concerning symptoms, seek immediate medical attention.
In Chronic Sciatica, Gabapentin Quells Nerve Pain Better than Pregabalin
This post comes from Fred Nelson, MD, an orthopaedic surgeon in the Department of Orthopedics at Henry Ford Hospital and a clinical associate professor at Wayne State Medical School. Some of Dr. Nelson’s tips go out weekly to more than 3,000 members of the Orthopaedic Research Society (ORS), and all are distributed to more than 30 orthopaedic residency programs. Those not sent to the ORS are periodically reposted in OrthoBuzz with the permission of Dr. Nelson.
Orthopaedic surgeons may not be at the forefront of dealing with nonoperative nerve pain, but many of our patients who are not candidates for surgery suffer from spine-related nerve pain in their limbs, such as sciatica. Both gabapentin (GBP, Neurontin) and pregabalin (PGB, Lyrica) are used to treat chronic sciatica (CS).
Gamma-aminobutyric acid (GABA) is an important pain-related neurotransmitter, although neither GBP nor PGB affect the GABA receptor. Instead, both drugs associate with the ligand of the auxiliary α2δ-1 and α2δ-2 subunits of certain voltage-dependent calcium channels in nerves. Among other uses, Neurontin is prescribed to treat diabetic peripheral neuropathy, and Lyrica is commonly used to treat fibromyalgia.
Investigators reporting in JAMA Neurology sought to help guide practitioners in the initial choice of drug. Eighteen patients with MRIs corroborating single-sided nerve-root sciatic pain of at least 3 months duration were evaluated in an interim analysis as part of a randomized, double-blind, double-dummy crossover trial of PGB vs GBP (8 weeks of exposure to each drug with a 1-week washout in between). The primary outcome was pain intensity measured with a 10-point visual analog scale (VAS) at baseline and 8 weeks. Secondary outcomes included disability as measured with the Oswestry Disability Index and the severity and frequency of adverse events.
Relative to baseline, both drugs showed significant VAS pain reductions and disability-score improvements, However, head-to-head, GBP showed superior VAS pain reduction (mean [SD], GBP: 1.72 [1.17] vs PGB: 0.94 [1.09]; P = 0.035), regardless of the order in which it was given. There were no between-drug differences in disability scores, but adverse events for PGB were more frequent (PGB, 31 [81%] vs GBP, 7 [19%]; P = 0.002), especially when PGB was taken first.
The authors conclude that GBP was superior with fewer and less severe adverse events, and they suggest that gabapentin should be commenced before PGB to permit optimal crossover of medicines.
Robertson K, Marshman LAG, Plummer D, Downs E. Effect of Gabapentin vs Pregabalin on Pain Intensity in Adults WIth Chronic Sciatica: A Randomized Clinical Trial. JAMA Neurol. 2018 Oct 15. doi: 10.1001/jamaneurol.2018.3077. [Epub ahead of print] PMID: 30326006
Gabapentin for Back Pain: Is It Right for Me?
Although it has many uses, gabapentin most effectively treats neuropathic (nerve-related) pain (2).
Research shows that back problems caused by a herniated disk or spinal stenosis are usually treatable with gabapentin (7).
Spinal herniation occurs when a disk between adjacent spinal vertebrae slips out of place and pinches a nerve (8). Spinal stenosis is a degenerative condition typically seen in people over 60 that causes a narrowing of the lower spinal canal (9). Like spinal herniation, stenosis painfully pinches the nerves (9).
Subjects in one study reported a significant improvement in their disk hernia pain after taking gabapentin for three months (7). Another study that examined far lateral lumbar disc herniations, disc pain that extends outwards, found similar results and recommended gabapentin as a first-step medication for hernia pain (10).
Individuals with lumbar spinal stenosis treated with gabapentin have exhibited increased walking distance while wearing steel braces, as well as reduced lumbar spine pain (7). Subsequent research has replicated these findings (11).
Gabapentin can help relieve sciatica, intense pain that runs along the sciatic nerve from the lower back through the hips and buttocks (12). Sciatica affects one side of the body and is usually caused by disk herniation or spinal stenosis (12).
Early research has found that prescribing gabapentin at the onset of sciatica symptoms can help prevent central sensitization of the nerves (13). If it’s not prevented, then central sensitization can result in long-term alterations in the body’s perception of pain, including feeling pain in response to normally painless stimuli (14).
In addition to preventing central sensitization from developing, gabapentin’s primary use in cases of sciatica is in helping to control short-term severe sciatic pain (15). Additional research is needed to better understand the long-term efficacy of gabapentin for sciatica (15).
Gabapentin performs similarly to more interventional treatment methods like steroid injections in cases of sciatica, but avoids some of the adverse effects that these interventions carry like injection site damage (16, 17).
Other Neuropathic Pain
Gabapentin can effectively treat chronic lower back pain caused by diabetes and shingles (18).
High blood sugar levels associated with diabetes can lead to nerve pain called diabetic neuropathy (19). Although this condition usually results in pain in the feet and legs, it can also affect the hips, buttocks, or thighs (19). Cochrane reviews show that gabapentin can effectively reduce this kind of neuropathic pain (18).
In people over 50, shingles commonly cause postherpetic neuropathy, a burning pain that lasts after shingles’ symptoms disappear (20). Studies show that extended-release gabapentin may successfully treat post-shingles pain (18, 21).
Post-surgery Back Pain
Current research suggests that gabapentin is safer than opioids for reducing postoperative pain (2).
Gabapentin and opioids both require prescriptions and alter brain function (22). But, gabapentin is significantly less addictive and causes milder withdrawal symptoms than opioids (22).
Gabapentin can provide significant pain relief following spinal disk surgery (23). Subjects who used a combination of gabapentin and epidural steroid injections reported better pain relief than those who relied on injections and non-steroidal anti-inflammatory drugs (NSAIDs) (24).
Studies indicate that gabapentin is largely ineffective for treating back pain caused by chronic conditions like arthritis (25, 26).
Gabapentin is also ineffective for treating non-specific lumbar pain, regardless of if the pain is radicular or non-radicular (27, 28).
Research shows that discomfort caused by fibromyalgia, a nerve disease that manifests as widespread musculoskeletal pain, can be treated with gabapentin (29, 30).
Gabapentin is most effective in relieving neuropathic pain conditions caused by disk herniation, spinal stenosis, diabetic neuropathy, and postherpetic neuralgia. It provides limited sciatica and fibromyalgia relief, and is ineffective for reducing arthritis-related chronic low back pain.
Medication for Sciatica
Sciatic nerve pain that travels down from the lower back into the buttock and leg, commonly known as sciatica, can cause distressing symptoms, affecting the activities of daily life. When self-care and at-home remedies are ineffective, you may want to consider taking medications to relieve your sciatica symptoms.
Read more about Sciatica Symptoms
Sciatica Treatment Video
The first-line treatment for sciatica usually consists of nonsurgical methods that can typically be used at home and do not need a doctor’s prescription. Watch: Sciatica Treatment Video
If you’re overwhelmed by the myriad choices of pain-relieving medications, here’s a guide to help you understand which drugs work best to relieve sciatic nerve pain.
Over-the-counter medications for relieving sciatica pain
Several over-the-counter (OTC) medications may provide sciatica pain relief. If you have other medical conditions, such as stomach, heart, or kidney problems, it’s a good idea to consult with your doctor before taking any medication to reduce the risk of side effects.
Oral medications may reduce inflammation
Non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen and naproxen help reduce inflammation in the body, providing pain-relieving effects.1,2 If the OTC dosage does not improve your sciatica symptoms, check with your doctor if a prescription-strength is suitable for you.
NSAIDs are typically not recommended for patients with underlying medical conditions, such as chronic kidney disease.3 These drugs are known to irritate the tissues in the stomach, so they are always advised to be taken with food.
Topical medications may provide immediate, localized pain relief
Several ointments, gels, and creams can help relieve nerve pain by altering the blood flow, reducing inflammation, and creating a numbing effect. Common topical medications that may help relieve sciatica include preparations of4:
- Methyl salicylate
- Trolamine salicylate
- Cannabidiol (CBD)
Since topical medications act locally, they may provide immediate pain relief. Some preparations may cause skin irritation, so trying out a small amount initially is recommended.
See Understanding CBD (Cannabidiol) for Back Pain
Medicated patches may provide extended pain relief
Adhesive patches containing lidocaine, a local anesthetic medication, can be worn inside your clothing and may provide a continuous numbing effect, reducing sciatica pain.
Tips to use topical medication to relieve sciatica pain
Sciatica pain originates in your lower spine and travels down your sciatic nerve into your thigh and leg.
- When you use topical medication, apply the cream/gel or lidocaine patch to your rear pelvis—where your sciatic nerve roots are located.
- Treating this area, rather than your thigh or calf where the pain may be more, will help control and numb the pain at its origin and also calm the nearby nerves.
When you experience pain relief after using topical medication, try to perform simple lower back stretches. Stretches and targeted exercises can help prevent sciatica from recurring, by relieving the sciatic nerve compression, strengthening your tissues, and improving the flexibility in your lower back.
Prescription medications for sciatica pain relief
If OTC medications do not provide relief from your sciatica symptoms, talk to your doctor about prescription medications.
- They may be prescribed for a short period (2 to 6 weeks) when OTC medications fail and before more invasive treatments, such as epidural steroid injections, are tried.
- The use of these medications may be considered controversial among some doctors due to their potential side effects or lack of proven effectiveness.
The dosage is monitored and controlled depending on the type of drug used and the severity of symptoms.
Muscle relaxants may reduce back pain and stiffness in acute sciatica
Muscle relaxants, such as cyclobenzaprine, relax tight, tense muscles, and reduce spasms. Muscle spasms may develop as a result of the underlying medical condition that causes sciatica, such as a disc problem or inflammation of the lumbar and/or pelvic muscles. These drugs may help relieve back stiffness that results from muscle spasms and may be more beneficial in treating acute sciatica.
See Muscle Relaxants: List of Common Muscle Relaxers
Due to their potential side effects and the risk of abuse and dependency, these drugs are used with caution and may not be suitable for people with liver, kidney, and/or heart problems.
Oral steroids may reduce sciatic nerve root inflammation
Oral steroids, such as methylprednisolone and prednisone help reduce inflammation. Doctors may prescribe oral steroids to treat acute sciatica due to an inflamed spinal nerve root.5 Steroids are generally prescribed for short bursts of therapy.
For chronic sciatica, doctors may prescribe antiepileptic and antidepressant medications, which have shown to improve nerve pain. To reduce the risk of potential side effects, treatment is typically started with a low dose and increased gradually to determine the lowest effective dose.2,6
Sciatica typically resolves in 4 to 6 weeks without long term complications.7 Medications are an effective option to reduce acute sciatica pain and are usually recommended for short term use. Your doctor can help select which drug(s) is appropriate for your specific underlying cause of sciatica, age, and general health and tolerance. For long term pain relief and to prevent recurrences, talk to your doctor about more specific treatments for the cause of your pain, such as physical therapy, manual manipulation, and massage therapy.
Read more about Sciatica Treatment
Medications for Back Pain and Neck Pain
Myths About Sciatica Treatment Options
- 1.Berry JA, Elia C, Saini HS, Miulli DE. A Review of Lumbar Radiculopathy, Diagnosis, and Treatment. Cureus. 2019;11(10):e5934. Published 2019 Oct 17. doi:10.7759/cureus.5934
- 2.Nakashima H, Kanemura T, Ando K, et al. Is Pregabalin Effective Against Acute Lumbar Radicular Pain ?. Spine Surg Relat Res. 2018;3(1):61–66. Published 2018 Jun 29. doi:10.22603/ssrr.2018-0003
- 3.Safaeian P, Mattie R, Hahn M, Plastaras CT, McCormick ZL. Novel Treatment of Radicular Pain With a Multi-Mechanistic Combination Topical Agent: A Case Series and Literature Review. Anesth Pain Med. 2016;6(2):e33322. Published 2016 Mar 1. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4886452/
- 4.McAllister R.K., Burnett C.J. (2015) Topical Analgesic Medications. In: Sackheim K. (eds) Pain Management and Palliative Care. Springer, New York, NY doi: https://link.springer.com/chapter/10.1007/978-1-4939-2462-2_15
- 5.Ko S, Kim S, Kim J, Oh T. The Effectiveness of Oral Corticosteroids for Management of Lumbar Radiating Pain: Randomized, Controlled Trial Study. Clin Orthop Surg. 2016;8(3):262–267. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4987309/
- 6.Frontera, Walter R., J. K. Silver, and Thomas D. Rizzo. Essentials of physical medicine and rehabilitation : musculoskeletal disorders, pain, and rehabilitation. Philadelphia: Elsevier, 2019. Print.
- 7.Davis D, Maini K, Vasudevan A. Sciatica. [Updated 2020 Jan 25]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK507908/
Gabapentin May Top Pregabalin for Sciatica Pain
Gabapentin tops pregabalin for pain reduction in patients with chronic sciatica, results of a head-to-head comparison show. But at least one expert has concerns about this conclusion.
In addition, gabapentin has fewer and less severe side effects, particularly those related to the central nervous system, compared with pregabalin.
“Clinicians need to be aware that these drugs are not the same; that there’s a difference between the two medications that could impact patients,” lead author Kelvin Robertson, BPharm and PhD candidate, Department of Pharmacy, Medical Services Group, Townsville Hospital, and adjunct senior lecturer, School of Medicine and Dentistry, James Cook University, Australia, told Medscape Medical News.
The study was published online October 15 in JAMA Neurology.
First Head-to-Head Comparison
The two anticonvulsants are both analogs of γ-aminobutyric acid (GABA).
“They are both very similar in chemical structure and mode of action. They both work on GABA, so they both basically stop pain signals getting to the brain. They also work on calcium channel blockers, so they regulate calcium channels in the nerve cells, and that decreases contraction of nerves and leads to less pain.”
Both drugs are used to treat sciatica.
The study was “the first of its kind globally to compare these drugs head-to-head” in patients with chronic sciatica, said Robertson. This type of pain radiates into a leg to at or below the knee and lasts at least 3 months.
The single-center study included 18 adults with sciatica who had not previously received gabapentin or pregabalin.
Study participants received pregabalin first, then gabapentin, or vice versa, in a double-blinded fashion.
The starting dose of pregabalin was 150 mg once daily, which was titrated up to a maximum of 300 mg twice daily. Those taking gabapentin started at 400 mg once daily, which was titrated up to a maximum of 800 mg three times daily.
Patients took the medication three times a day. Those receiving pregabalin, typically dosed twice daily, received a placebo for the mid-day dose.
After a 4-week titration period, the maximum tolerated dose was maintained for 4 weeks before the first study medication was stopped for a 1-week washout period.
Participants received standard neurosurgical care and could use concomitant medications, including analgesics.
“These patients are in pain; we thought that it was unethical to have them stop all of their background therapies,” said Robertson.
“We mitigated any risk of this having bias in our results by making sure that every patient coming into our trial was stable on their background therapy for at least 30 days before enrollment, and that during the trial, there were no changes to their background therapies, and if there were, this had to be relayed to the investigative team,” he added.
Differing Side Effect Profile
The primary outcome was leg pain intensity using a visual analog scale (VAS). Participants were asked to rate their average leg pain during the last 24 hours on a 10-point scale, with zero representing no leg pain and 10 representing the worst pain imaginable.
The key secondary outcome was the Oswestry Disability Index (ODI) questionnaire, in which scores range from 0 to 100, with higher scores indicating greater disability.
The original recruitment target was 38 patients, with an interim analysis planned at 50% sample size. However, the trial was stopped after predetermined criteria were met.
Of the 20 patients enrolled at that point, two from the gabapentin-first group were ultimately excluded from the analysis.
The results showed a significant mean VAS reduction for gabapentin (7.54 to 5.82; P < .001) and pregabalin (7.33 to 6.38; P = .002).
When unadjusted mean differences in VAS reduction were compared head-to-head, gabapentin proved superior (1.72 vs 0.94; P = .035).
As for disability, there was a significant reduction on the ODI for both gabapentin and pregabalin. When unadjusted mean differences were compared head-to-head, though, there was no significant difference (P = .63).
Frequency and severity of adverse events were measured on a 10-point scale, 10 being the worse possible score. There were 38 adverse events reported in 67% of patients.
There were significantly more adverse events associated with pregabalin than gabapentin (81% vs 19%, P = .002).
For both drugs, adverse events were predominantly related to the central nervous system, such as drowsiness, dizziness, and vertigo.
However, gabapentin was associated with less severe adverse events than pregabalin (mean severity, 4.57 vs 6.35; P = .01).
It’s not clear why outcomes for the two drugs were different. Robertson is hoping that further research with a larger sample will help determine “exactly what’s happening here in terms of one drug producing more side effects compared with the other when they’re basically structurally similar.”
It’s possible that pregabalin interacts with other neurotransmitters, which is causing more side effects, said Robertson.
The new results may have an impact on prescribing, he said. In Australia, pregabalin is on the pharmacy formulary, whereas access to gabapentin is more restricted.
“Now that we have shown that gabapentin is superior, we will be pressing to have it more freely available to patients in the community.”
Concerns Raised and Addressed
Christine Lin, PhD, associate professor, Institute for Musculoskeletal Health, Sydney School of Public Health, University of Sydney, Australia, who has done extensive research in this area, commented on the study for Medscape Medical News.
Lin raised concerns about this new study, including its very small sample size and design. She noted that it is a comparison of two drugs that only provides data on whether there was a difference, and not whether either drug was effective.
The data presented in the article “don’t quite support” the authors’ conclusion that gabapentin was superior in pain reduction compared with pregabalin, said Lin.
For instance, the study does not report the average difference in pain reduction, she said.
“This is important because while the authors have reported a difference between groups statistically, they did not report how big or small this difference was for the average reader to make a judgment on whether the size of the difference is big enough to be worthwhile in clinical practice.
“We also don’t know how precise the data are, so how confident we can be at the average difference between the groups,” she said.
Lin explained that the authors reported a mean pain reduction of 1.72 on the 10-point pain scale in the gabapentin group versus 0.94 in the pregabalin group, with a significant difference between groups (P = .035), but notes this was based on the average difference between the groups (1.72 – 0.94 = 0.78).
Lin pointed out that the authors considered a 1.5-point difference to be worthwhile. “What they found was below that, so it is not correct to claim that gabapentin was superior to pregabalin,” she said.
Robertson noted that the clinical significance was based on “an individual level,” not the difference between the drugs. The 1.5 threshold was reached for patients on gabapentin but not on pregabalin using the VAS scale, he said.
Lin also noted that the trial was set up to compare gabapentin versus pregabalin, and not gabapentin or pregabalin versus no treatment or placebo.
“While we saw a favorable change with both gabapentin and pregabalin, this is what we call a ‘within-group change’ — the difference at the start versus at the end of treatment,” she said.
“This is not a reliable way of detecting whether a treatment truly has provided a benefit.”
For example, she added, study participants may have experienced natural recovery.
A placebo-controlled trial would be very difficult to conduct in patients with chronic sciatica in severe pain, such as those in the current study, said Robertson. A crossover design allowed the researchers to “examine the interchange” between the drugs, he said.
‘Alarming’ Picture Emerging
Another study by Lin’s group showed that pregabalin was not significantly better than placebo in patients with sciatica and led to more side effects (N Engl J Med. 2017;376:1111-1120).
In addition, a meta-analysis showed that anticonvulsants are not effective for treating low back pain or lumbar radicular pain, and again, have a relatively high risk for adverse events (CMAJ. 2018;190:E786-E793).
Most clinical trials, especially those with such a small sample size as in the current study, aren’t set up to detect differences in side effects, particularly serious ones, because they’re relatively rare, said Lin.
But from larger studies, “an alarming picture” is emerging that shows that gabapentin and pregabalin have serious side effects, including the potential for misuse, especially when combined with opioids, and suicidal ideation, said Lin.
Funding for the study was provided by a grant from the Townsville Hospital Study, Research, and Education Trust. Robertson has reported no financial disclosures. Lin was the senior author of the New England Journal of Medicine study that found no difference in treatment effect between pregabalin and gabapentin. The medicines used in her study were provided by Pfizer, but she and the other investigators retained autonomy over the trial design, conduct, analysis, and reporting.
JAMA Neurol. Published online October 15, 2018. Abstract
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Sciatica – Diagnosis and treatment
During the physical exam, your doctor may check your muscle strength and reflexes. For example, you may be asked to walk on your toes or heels, rise from a squatting position and, while lying on your back, lift your legs one at a time. Pain that results from sciatica will usually worsen during these activities.
Many people have herniated disks or bone spurs that will show up on X-rays and other imaging tests but have no symptoms. So doctors don’t typically order these tests unless your pain is severe, or it doesn’t improve within a few weeks.
- X-ray. An X-ray of your spine may reveal an overgrowth of bone (bone spur) that may be pressing on a nerve.
- MRI. This procedure uses a powerful magnet and radio waves to produce cross-sectional images of your back. An MRI produces detailed images of bone and soft tissues such as herniated disks. During the test, you lie on a table that moves into the MRI machine.
- CT scan. When a CT is used to image the spine, you may have a contrast dye injected into your spinal canal before the X-rays are taken — a procedure called a CT myelogram. The dye then circulates around your spinal cord and spinal nerves, which appear white on the scan.
- Electromyography (EMG). This test measures the electrical impulses produced by the nerves and the responses of your muscles. This test can confirm nerve compression caused by herniated disks or narrowing of your spinal canal (spinal stenosis).
If your pain doesn’t improve with self-care measures, your doctor might suggest some of the following treatments.
The types of drugs that might be prescribed for sciatica pain include:
- Muscle relaxants
- Tricyclic antidepressants
- Anti-seizure medications
Once your acute pain improves, your doctor or a physical therapist can design a rehabilitation program to help you prevent future injuries. This typically includes exercises to correct your posture, strengthen the muscles supporting your back and improve your flexibility.
In some cases, your doctor might recommend injection of a corticosteroid medication into the area around the involved nerve root. Corticosteroids help reduce pain by suppressing inflammation around the irritated nerve. The effects usually wear off in a few months. The number of steroid injections you can receive is limited because the risk of serious side effects increases when the injections occur too frequently.
This option is usually reserved for when the compressed nerve causes significant weakness, loss of bowel or bladder control, or when you have pain that progressively worsens or doesn’t improve with other therapies. Surgeons can remove the bone spur or the portion of the herniated disk that’s pressing on the pinched nerve.
Lifestyle and home remedies
For most people, sciatica responds to self-care measures. Although resting for a day or so may provide some relief, prolonged inactivity will make your signs and symptoms worse.
Other self-care treatments that might help include:
- Cold packs. Initially, you might get relief from a cold pack placed on the painful area for up to 20 minutes several times a day. Use an ice pack or a package of frozen peas wrapped in a clean towel.
- Hot packs. After two to three days, apply heat to the areas that hurt. Use hot packs, a heat lamp or a heating pad on the lowest setting. If you continue to have pain, try alternating warm and cold packs.
- Stretching. Stretching exercises for your low back can help you feel better and might help relieve nerve root compression. Avoid jerking, bouncing or twisting during the stretch, and try to hold the stretch for at least 30 seconds.
- Over-the-counter medications. Pain relievers such as ibuprofen (Advil, Motrin IB, others) and naproxen sodium (Aleve) are sometimes helpful for sciatica.
Alternative therapies commonly used for low back pain include:
- Acupuncture. In acupuncture, the practitioner inserts hair-thin needles into your skin at specific points on your body. Some studies have suggested that acupuncture can help back pain, while others have found no benefit. If you decide to try acupuncture, choose a licensed practitioner to ensure that he or she has had extensive training.
- Chiropractic. Spinal adjustment (manipulation) is one form of therapy chiropractors use to treat restricted spinal mobility. The goal is to restore spinal movement and, as a result, improve function and decrease pain. Spinal manipulation appears to be as effective and safe as standard treatments for low back pain, but might not be appropriate for radiating pain.
Preparing for your appointment
Not everyone who has sciatica needs medical care. If your symptoms are severe or persist for more than a month, though, make an appointment with your primary care doctor.
What you can do
- Write down your symptoms and when they began.
- List key medical information, including other conditions you have and the names of medications, vitamins or supplements you take.
- Note recent accidents or injuries that might have damaged your back.
- Take a family member or friend along, if possible. Someone who accompanies you can help you remember what your doctor tells you.
- Write down questions to ask your doctor to make the most of your appointment time.
For radiating low back pain, some basic questions to ask your doctor include:
- What’s the most likely cause of my back pain?
- Are there other possible causes?
- Do I need diagnostic tests?
- What treatment do you recommend?
- If you’re recommending medications, what are the possible side effects?
- For how long will I need to take medication?
- Am I a candidate for surgery? Why or why not?
- Are there restrictions I need to follow?
- What self-care measures should I take?
- What can I do to prevent my symptoms from recurring?
Don’t hesitate to ask other questions.
What to expect from your doctor
Your doctor is likely to ask you a number of questions, such as:
- Do you have numbness or weakness in your legs?
- Do certain body positions or activities make your pain better or worse?
- How limiting is your pain?
- Do you do heavy physical work?
- Do you exercise regularly? If yes, with what types of activities?
- What treatments or self-care measures have you tried? Has anything helped?
Aug. 01, 2020
Uses, safety, and side effects
Gabapentin is an anticonvulsant medication that helps control seizures in people with epilepsy. Some forms of gabapentin can also treat restless legs syndrome or certain types of nerve pain.
Gabapentin appears to work by altering electrical activity in the brain and influencing the activity of chemicals called neurotransmitters, which send messages between nerve cells.
Brand names for gabapentin include Horizant, Gralise, and Neurontin. The medication is available in capsule, tablet, or liquid form.
In this article, we describe the uses, dosages, and side effects of gabapentin. We also look into the associated risks and other safety considerations.
Gabapentin’s primary use is to prevent or control seizures. It works by calming down nerve activity to reduce seizure intensity or occurrence.
Children and adults can take the drug. The Neurontin brand can treat one form of epilepsy in children as young as 3 years old.
Some people take other medications with gabapentin to control epilepsy symptoms.
Gabapentin can also help reduce post-herpetic neuralgia, a burning or stabbing nerve pain that is a common complication of shingles.
According to a 2017 review, oral gabapentin, at a minimum daily dosage of 1,200 milligrams, can reduce moderate or severe nerve pain that results from shingles or diabetes.
Extended-release gabapentin (Horizant) tablets can treat restless legs syndrome (RLS), a condition characterized by uncomfortable sensations in the legs and a strong or irresistible urge to move the lower limbs.
A study from 2016 suggests that gabapentin combined with oxycontin, an opioid painkiller, can control pain and increase the quality of life for people with severe cancer pain. However, doctors do not typically prescribe gabapentin for this purpose.
The right dosage of gabapentin depends on several factors, including:
- the type and brand of gabapentin
- the strength of the product
- the condition
- the person’s kidney function
- their weight, age, and general health
The number of daily doses, the hours that should pass between the doses, and the length of time that a person takes gabapentin will vary among individuals.
A person should take some forms of gabapentin with food, but for other forms it is unnecessary.
Anyone prescribed the Horizant brand of gabapentin for RLS should take it only in the evening or at night.
Some brands or dosages require a person to break the tablets in half. Always use the other half with the next dose, or as soon as possible.
Never break or chew extended-release gabapentin tablets — always swallow them whole.
It is vital to take only the recommended dose of gabapentin and not to continue using it for longer than prescribed. If a person misses a dose, they should follow the instructions on labeling or call a pharmacist for advice.
Share on PinterestSide effects of gabapentin can include dizziness and feeling sleepy.
Image credit: Rachel Demsick, 2013
Gabapentin can cause side effects. According to a 2017 review, these effects were slightly more common in people taking gabapentin than a placebo.
The most common side effects, occurring in 10 percent of participants on gabapentin, were:
- water retention (swelling of the arms, hands, legs, and feet)
- problems walking
Serious side effects were not common and were the same in those taking the placebo.
Children and older adults may be most susceptible to adverse reactions to gabapentin. Possible side effects include:
- back or chest pain
- upset stomach
- increased appetite and weight gain
- blurry vision
- changes in mood
- a cough
- a fever
- flu-or cold-like symptoms
- hoarseness and dry mouth
- memory loss
- mouth ulcers
- shortness of breath
- a sore throat and swollen glands
- urinary problems
- uncontrollable eye-rolling
In children, some of the more common adverse reactions are:
- anxiety, depression, or other mood changes
- behavioral problems
- changes in performance at school
- lack of concentration
Individuals taking gabapentin should talk to their doctors about any side effects that occur, especially if they are severe, ongoing, or get worse.
Seek emergency medical treatment if symptoms of a severe or allergic reaction occur. These include:
- breathing difficulties
- extreme dizziness
- severe weakness
- swelling of the face, lips, tongue, or throat
- yellowing of the skin or eyes (jaundice)
People can report adverse drug reactions to the United States Food and Drug Administration (FDA) at 1-800-FDA-1088 or at https://www.fda.gov/safety/medwatch.
People taking gabapentin should be aware of the following:
Risk of suicidal thoughts or behaviors
Some people experience thoughts of suicide or exhibit suicidal behavior when taking gabapentin or other anticonvulsants.
If a person or their loved one notices changes in mood or behavior, they should contact a doctor immediately.
Interactions with other medications and substances
Gabapentin can interact with other prescription or over-the-counter medications, vitamins, and herbal supplements.
Be sure to give the doctor a full list of current medications and supplements before taking gabapentin.
Results of a 2017 review suggest that the following are the main substances that interact with the drug:
- caffeine, which is present in tea, coffee, and cola
- ethacrynic acid, a diuretic
- losartan, a medication for high blood pressure
- magnesium oxide, a mineral supplement and antacid
- mefloquine, an antimalarial drug
- morphine, an opioid pain medication
- phenytoin, an anti-seizure medication
If gabapentin causes sleepiness, speak to the doctor before taking other medications that can also cause drowsiness, including:
- antianxiety medications
- cold and flu medications
- muscle relaxers
- narcotics (pain medications)
- sleeping pills
Presence of other health conditions
To ensure that gabapentin is safe to take, a person should tell their doctor if they currently have or have ever experienced:
- breathing problems
- depression or other mental health disorders
- dialysis treatment
- drug and alcohol misuse issues
- heart disease
- kidney disease
- liver disease
- seizures (if taking gabapentin for conditions unrelated to seizures)
Risks during pregnancy and when breastfeeding
People who are pregnant, or intend to become pregnant, should tell their doctor before taking gabapentin.
Pregnant women should only take the drug if it is absolutely necessary. However, it is also essential to control seizures while pregnant.
Do not start or stop taking gabapentin for seizure control before talking to the doctor, who will assess the potential risks and benefits.
Gabapentin passes into breast milk, but its effects on babies are unknown. It is best to discuss this issue with a doctor before breastfeeding.
Potential for a drug allergy
Individuals with gabapentin allergies should not take the drug.
Also, the medication may contain other ingredients that can trigger allergy symptoms in some people. Discuss all drug and food allergies with a doctor before taking gabapentin.
Other safety considerations
Because gabapentin can cause drowsiness, anyone taking the drug should exercise caution while driving or using machinery.
Do not take antacids within 2 hours of taking gabapentin, as antacids reduce the body’s ability to absorb the drug.
People should also avoid alcohol or limit their intake while on gabapentin because there is a risk of adverse reactions.
Doctors prescribe gabapentin to control seizures, treat RLS, and reduce nerve pain.
Several types of gabapentin are available, and different forms can treat different medical issues.
The right dosage will vary, depending on the condition and other factors. A doctor can best advise about drug interactions and other safety considerations.
Although gabapentin has the potential to cause several adverse reactions, many people experience no serious side effects.
90,000 Gabapentin for chronic neuropathic pain in adults
Essence of the question
There is moderate quality evidence that oral gabapentin at doses of 1200 mg per day or more has a significant effect on pain in some people with moderate to severe neuropathic pain following shingles or diabetes.
Neuropathic pain occurs due to nerve damage.It is different from pain that travels along healthy nerves from damaged tissue (for example, from a fall, cut, or knee arthritis). Drugs other than those used for pain associated with tissue damage, such as pain relievers, are often used for neuropathic pain. Drugs sometimes used for depression or epilepsy may be effective in some patients with neuropathic pain. One of these is gabapentin. We define the outcome as good if a patient with high pain levels as a result of taking the drug gets rid of the pain without the side effects that cause the patient to stop taking the drug.
In January 2017, we searched for clinical trials using gabapentin for the treatment of neuropathic pain in adults. We found 37 eligible studies with 5914 participants randomized to receive gabapentin, placebo, or other drugs. The studies lasted from 4 to 12 weeks. Most studies reported positive outcomes that patients with neuropathic pain noted as important.The results were obtained mainly in patients with shingles or diabetic nerve damage.
For patients with shingles, gabapentin reduced pain by half in 3 out of 10 people; and in 2 out of 10 patients on a placebo. Pain was reduced by a third or more in 5 out of 10 people taking gabapentin and 3 out of 10 people taking placebo. For patients with shingles, pain was reduced by half in 4 out of 10 people taking gabapentin; and in 2 out of 10 patients taking placebo.Pain decreased by a third or more in 5 out of 10 people taking gabapentin and 4 out of 10 people taking placebo. There was no reliable evidence for other types of neuropathic pain.
Side effects were more common with gabapentin (6 out of 10) compared with placebo (5 out of 10). Dizziness, drowsiness, water retention, and trouble walking were reported in 1 in 10 people taking gabapentin. Serious side effects were rare and there was no difference between the gabapentin and placebo groups.Several more people stopped taking gabapentin due to side effects.
Taking gabapentin helps some people with chronic neuropathic pain. It is impossible to know in advance who gabapentin will help and who will not. Available data suggest that short-term testing is the best way to determine effectiveness in a particular case.
Quality of evidence
The evidence was mostly of average quality.This means that this study provides a good indication of the likely effect. The likelihood that the effect will be significantly different is moderate.
Pregabalin in the treatment of acute and chronic sciatic neuralgia
Sciatica (sciatic nerve neuralgia) is characterized by pain in the posterior or posterolateral region of the leg, numbness, sometimes accompanied by loss of sensitivity, weakness and impaired reflexes. Sciatica significantly limits physical activity and reduces the quality of life of patients.
Despite the high prevalence of sciatica, there are few drugs that have been shown to be effective.
Pregabalin has been shown to be effective in the treatment of neuropathic pain, in particular postherpetic neuralgia and diabetic peripheral polyneuropathy.
The aim of this study was to determine the efficacy and safety of pregabalin in patients with sciatic neuralgia.
A randomized, double-blind, placebo-controlled study was performed. Patients were randomized into two groups: pregabalin 150 mg daily followed by dose titration to a maximum of 600 mg or placebo. Therapy was prescribed for 8 weeks.
The primary endpoint of the study was the intensity of pain in the leg on a 10-point scale (0 – no pain, 10 – maximum intensity) at 8 weeks.Pain intensity was also assessed at week 52.
The degree of disability, the intensity of back pain, and the quality of life were selected as secondary endpoints.
The PRECISE study included 209 patients, of whom 108 received pregabalin and 101 placebo. After randomization, 2 patients from the pregabalin group were excluded from the analysis.
- At 8 weeks, the average intensity of leg pain was 3.7 points in the pregabalin group and 3.1 in placebo group (difference, 0.5; 95% CI, −0.2-1.2; P = 0.19).
- At week 52, the mean leg pain intensity was 3.4 in the pregabalin-treated patients and 3.0 in the control group (mean difference, 0.3; 95% CI, −0.5-1.0; P = 0.46).
- There were no statistically significant differences between groups in achieving the secondary endpoints at 8 and 52 weeks.
- During the follow-up period, 227 adverse events were recorded in the pregabalin group, compared with 124 in the control group.Dizziness occurred significantly more often in patients. receiving pregabalin.
In patients with sciatica, pregabalin therapy for 8 weeks does not significantly reduce the intensity of leg pain compared with placebo.
The incidence of side effects was significantly higher with pregabalin.
Source: Stephanie Mathieson, Christopher G. Maher, Andrew J.McLachlan, et al. N Engl J Med 2017; 376: 1111-1120.
Treatment of sciatic nerve neuralgia (sciatica)
Sciatica usually refers to a set of symptoms that occur when the sciatic nerve is affected. The main one is very intense, unbearable pain that spreads over the entire back of the thigh and buttocks, that is, in those places where this nerve passes. Sometimes it even covers the area from the lower ribs to the lower leg. This is not surprising, because this nerve is the longest in the human body.
People who have suffered from sciatica generally consider it to be the most painful thing they have ever experienced. Indeed, such a disease completely deprives a person of the ability to move, which means that it requires urgent and effective treatment. In such cases, it is most reasonable to contact clinics that specialize specifically in the treatment of the musculoskeletal system, such as the Revita health center.
Symptoms of sciatic nerve inflammation
Let’s see what sciatica is.It most often occurs after sitting on a cold object, when the muscle that normally covers the nerve shifts. After a few hours, this leads to inflammation and the appearance of a number of symptoms. These include not only the strongest pain, but also a decrease in the sensitivity of the skin on the outer surface of the lower leg, a feeling of “creeping”.
In addition, the patient cannot straighten up the leg bent at the knee and hip joints. With prolonged absence of treatment, even foot drooping may develop, the inability to strain certain muscles.Sciatica can also develop due to compression of the roots of the spinal cord, for example, with a herniated disc or protrusion. By the way, the specialists of the Revita Health Center successfully treat herniated discs. Often, inflammation of the sciatic nerve develops due to infections or toxic substances in the body.
How is sciatic nerve inflammation treated in Western medicine
In traditional medicine, sciatica therapy involves mainly temporary relief of pain, and at the same time it is difficult for the patient to tolerate.The methods of oriental medicine, on the contrary, are gentle and aimed at completely eliminating the disease.
The standard approach to patients with sciatica is as follows:
- Doctors recommend exercise therapy, but exercise is difficult for a person with acute pain. He will be forced to overcome her
- It is considered beneficial to return to work or other daily activities, but, again, you will have to endure all the unpleasant sensations without feeling relief
- Prescribed medications, but their effectiveness against sciatica has not been proven by clinical studies.Most of the patients did not notice significant improvements in well-being during the week of taking these drugs. These are amitriptyline, duloxetine, gabapentin and pregabalin. All of them are potent drugs and therefore create a huge burden on the liver
- In most cases, non-steroidal anti-inflammatory drugs (NSAIDs) are prescribed to reduce pain and inflammation. But they cause complications from the gastrointestinal tract and the cardiovascular system
- Injections of glucocorticosteroids are given, which disrupt hormonal balance and novocaine blockade (injections for temporary pain relief).
- Radiofrequency denervation is performed, that is, the innervation of this area is completely stopped, in fact, depriving a person of a nerve
Oriental medicine methods – salvation for sciatica
Warming up with wormwood cigars
The Revita health center has a slightly different approach to the treatment of this ailment. It is based on the proven methods of oriental doctors.The most famous of these is acupuncture, or acupuncture. This method is based on the latest scientific research and centuries of experience in Chinese medicine. It consists in the action of special needles on biologically active points of the body. In accordance with the ideas of ancient Chinese scientists, there are 14 lines in our body – meridians. The vital energy qi flows through them, controlling the work of certain internal organs or parts of the body. Biologically active points are located on these meridians.During the procedure, an acupuncturist inserts needles at different depths depending on the level of damage to the nerve trunk and rotates to stop pain and inflammation. Then it leaves them for 30-40 minutes.
Surprisingly, most of the patients with sciatica confirm that this method eased their condition after the first session, and by the end of the course completely relieved them of all symptoms. The point is not only in the movement of internal energy. Research in recent years has shown that acupuncture stimulates the brain to produce endorphins and dopamine, which have a pain relieving effect.It also improves blood circulation in the damaged area, and anti-inflammatory and nutrients get there along with the blood. Thus, the nourishment of the injured nerve is also resumed. At Revita Wellness Center, acupuncture sessions are conducted by an experienced traditional Chinese medicine specialist Zhao Peiyun.
Manual therapy is another oriental technique recognized all over the world by the branch of official medicine. In our country, it has been successfully used to treat radiculopathies, including sciatica, since the eighties of the last century.Its main principle is the elimination of muscle block. It entails compression not only of the muscles themselves, but also of the vessels, and restricts movement in the joint. Then, when the nerve is already inflamed, the muscles react to it with a spasm, that is, contraction, which aggravates the condition.
The chiropractor removes this spasm, which relieves pressure on the diseased nerve and allows the muscles to work again. First, the chiropractor carefully probes the boundaries of the affected area of the body, in this case the hips.Then begins a forceful action within these boundaries: stretching and twisting. This procedure causes temporary tension with complete relaxation of the muscles by the end of the session.
Valery Avdeenko specializes in manual and muscle-fascial therapy at the Revita center. Patients feel noticeable relief after the first visit to Valery Petrovich. However, in some cases, such procedures may not help. This happens for one reason: many patients forget that a course of manual therapy can only be carried out after acupuncture or Chinese acupressure.
Chinese acupressure, or acupressure, is effective not only for treatment, but also for early diagnosis. A malfunction in the work of any part of the body, for example, a joint disease, in itself may not show any symptoms. But at the same time, it often turns out to be the root cause of nerve inflammation. If there is such a failure, pressing the corresponding point causes painful sensations, or, conversely, its numbness. This allows you to identify the very cause of the disease and further eliminate it.In addition to pressure on the points, various techniques are used in Chinese acupressure: tapping, circular movements, pinching.
In the Revita clinic, such techniques are mastered by a Chinese medicine specialist with many years of experience, Dr. Zhao Peiyun. Acupressure effectively relieves pain and relaxes the superficial muscles. But in order to reduce the tension of deeper muscles and finally get rid of the disease, it is imperative to combine acupressure with other oriental techniques.
Long-term experience of oriental medicine clinics around the world has proved: the effectiveness and speed of treatment increase significantly if several methods are used in combination with each other
Warming up with wormwood cigars
In addition to those listed, moxotherapy is very popular among the methods of influencing biological points.This is a deep heating of points with smoldering wormwood cigars. Heating an area of skin triggers a reflex response from an associated organ or, in the case of sciatica, a muscle. In addition, deep penetration of heat accelerates anti-inflammatory processes, helping the body to defend itself against inflammation in a natural way. It should also be mentioned that wormwood cigars have a powerful bactericidal effect and improve blood circulation not superficially, but in the depths of tissues. Moxibustion ideally complements acupuncture and acupressure in preparation for deeper impact.Together, these methods give amazing results, but each of them requires a high qualification of a doctor, which can only be counted on in the leading modern centers of oriental medicine.
There are other, equally effective ways to cure sciatica. This, for example, massage gua sha with stone scrapers, which removes stagnant blood. Also use vacuum therapy, herbal medicine with Tibetan rights. Today, the choice of oriental methods for combating radiculopathies is very wide, so the main thing is to trust your health to really qualified and experienced specialists.
Advantages of oriental medicine over traditional methods
Why, with all the variety of medical organizations, is it worth giving preference to those of them that specialize in oriental techniques?
There are several reasons for this:
- Unlike drugs, oriental therapies are always effective in treating sciatica. This is evidenced by dozens of reviews of grateful patients
- Since no substances are injected into the body, these methods have no contraindications.Procedures can be performed on pregnant, elderly, malnourished patients
- According to the latest statistics, such procedures have no side effects
- Thanks to the study of reflexogenic zones and points, the doctor has the opportunity to act precisely on the affected area
- Sciatica therapy using oriental techniques not only does not cause complications from other systems, but also improves overall well-being, stimulates immunity, normalizes blood circulation
But it is important to remember that the result of any therapy depends not only on the doctor, but also on the patient’s attitude to his illness.All these methods may not help if a person comes to the clinic too late. In no case should you overcome the pain, wait for it to pass by itself, because sciatica in some cases becomes chronic and torments people for many months.
To prevent this from happening, treatment must be systematic and comprehensive. Having started the prescribed course of procedures, it is not recommended to stop it in the middle, because then all the efforts of the doctors will be wasted, and the pain will return.
Pinching of the sciatic nerve: symptoms | Health Blog
Pinched nerve – what is it?
Pinching can occur on any nerve in our body.When altered surrounding tissue (inflammation, tumors, etc.) presses on the nerve endings, they constantly transmit painful sensations. Even if the nerve is healthy, the patient will feel severe pain. And with a long absence of treatment, the nerve often becomes inflamed, which leads to constant unbearable pain.
The sciatic nerve, the largest nerve in the human body, is formed from the fusion of several roots L4-S3 in the lower back – the lumbosacral spine, then goes to the buttock, along the back of the thigh and to the lower leg.Therefore, damage even in one area will lead to pain in the entire limb. And with an advanced disease, sensitivity and mobility begin to be lost, which is especially unpleasant if both legs are affected.
Possible causes of pinching
The nerve can be affected at any level of its location. This can happen for many reasons:
- Herniated disc is the most common cause. Even a slight deformation of the annulus fibrosus can pinch the nerve roots that form the sciatic nerve;
- Osteochondrosis, curvature of the spine, marginal bone growths of the vertebral bodies;
- Displacement of the vertebrae (listez) after back injuries and as a result of degenerative processes;
- Neoplasms of the spine, small pelvis, gluteal region;
- Inflammation of the pelvic organs;
- Thrombosis of nearby vessels;
- Muscle inflammation and edema: after hypothermia, trauma, excessive physical exertion;
- Piriformis syndrome;
- Pregnancy in which the uterus with the fetus presses too hard on adjacent tissues.
The disease can develop faster due to obesity and lack of minerals and against the background of endocrine disorders such as diabetes mellitus. In addition, the sciatic nerve can be damaged after previous infections and poisoning.
Symptoms of a pinched sciatic nerve
The main symptom of sciatic nerve damage will be pain. At this stage, the most difficult thing is to correctly determine the cause of the disease, but this must be done: if it is started, then the treatment and rehabilitation will take much longer.
What indicates the initial stage of pinching?
- Drawing or burning pain that affects only part of the lower back, buttocks, back of the thigh;
- Feeling creepy on the leg;
- Increased discomfort when changing position, laughing, coughing, sudden movements.
- Discomfort and pain when sitting and leaning forward.
At the initial stage of the disease, you are unlikely to pay attention to these symptoms.They will be invisible, the pain will subside from time to time. Goose bumps and numbness in the legs can be attributed to an uncomfortable position.
A completely different nature of the symptoms appears at later stages. It is at this moment that most patients notice discomfort with prolonged immobility and periodic sharp pain in the leg. If you do not start to fight the disease at this time, then symptoms will appear more serious:
- Sensation of intense burning of the skin and deep layers of the muscles of the back of the leg,
- Severe limitation of the mobility of the leg and lower back,
- Weakness of the affected leg,
- In some cases, patients note redness or blanching of the leg area with an increase or vice versa with a decrease in sweating in this area …
In addition, if the pinching caused another disease, its symptoms will also show up to the full. That is why the disease often goes unnoticed: against the background of a hernia or fracture, numbness and redness of the legs seem to be just another symptom, not serious and not worthy of attention.
What can you do during an illness attack?
If the pinching pain comes on suddenly, you can relieve your condition with home therapy:
- Choose a body position in which the pain syndrome will be the least pronounced, usually on the back or on a healthy side with a straight leg in which pain is felt.
- Limit physical activity.
- You can take analgesics: in the form of tablets or rubbing ointment (if there are no contraindications).
Seek emergency medical attention for unbearable pain.
Remember that pinching cannot be cured at home: even if the symptom is stopped, the disease will not disappear anywhere. So after relieving the exacerbation, you have to visit a neurologist.
What should not be done if pinching worsens?
It is not recommended to actively move: in case of severe pain, it is necessary to limit physical activity as much as possible.If there is a suspicion of inflammation, then neither warm nor rub the sore spot. Try to sleep on a hard mattress on your side during this time. And, of course, you shouldn’t take prescription medications and anti-inflammatories without a doctor’s recommendation.
Diagnostics and treatment
To make a diagnosis, a neurologist requires, in addition to a visual examination, a more complete examination. It may include:
- X-ray of the lower back and pelvic bones,
- Ultrasound of the pelvic organs,
- Computer or magnetic resonance imaging of the affected area,
- General and biochemical blood test.
With their help, the doctor will be able to establish the cause of the pinching, examine the affected area in all details, and learn about the presence of an inflammatory process. If necessary, he can prescribe an ultrasound of the affected area and ENMG – a study of nerves using responses to electrical impulses. This will help you understand where exactly the nerve is affected.
For treatment, non-steroidal anti-inflammatory drugs, muscle relaxants, a complex of B vitamins are used. With unbearable pain that is not relieved by complex treatment, you can put a blockade.Physiotherapy and exercise therapy have proven themselves to be excellent.
If necessary, the doctor can prescribe additional vitamin complexes, pain relievers, antioxidants. And in parallel with the removal of the symptoms of pinching, there will be a fight against the disease that caused it. This way you can overcome the disease much faster and regain your well-being without the threat of relapse.
90,000 Online consultation
Question: Good afternoon
My name is Semyon.I live in the city of Belgorod.
For 2 years now, constant pain on the left side of the thoracic region between the left shoulder blade and the spine has been troubling. The pain started back in April 2019 after working out in the gym. I didn’t rip anything off, there was no sharp pain, there was a great load. I never bothered my back before.
A month after classes in the gym, pain appeared under the left shoulder blade. The pain was not severe at first, appeared only at night. Shortly temporarily and did not bother me much. Then, over the course of several months, it became stronger and stronger.Up to a constant aching pulling pain during the day. As if the stake was hammered. In the supine and sitting position, there was a strong burning sensation under the left shoulder blade. Unbearable burning pain in the lying position at rest and sitting. Sitting, leaning on your back, driving is impossible because of the pain. From pain I constantly wake up at night or do not sleep at all. There is no burning sensation during daytime activity, but the aching pain is very strong. After several hours of movement, the back is completely constrained. Depending on the position of the body, the pain changes its character.Pain medications are never relieved from the moment they appear. Drank during this time all that is possible from medicines. I went around 6 neurologists, a lot of chiropractors, several massage courses, Physio procedures are all possible, a hall according to Bubnovsky … No improvement. The condition is getting worse and worse.
First, last year I turned to a chiropractor for one, the second – nothing helps .. Then neurologists began to prescribe drug treatment: NSAIDs that do not relieve pain (Movalis, Diclofenac, Ketaral, Ketotifen, Arcoxia), then muscle relaxants (Medocalm, Sirdalud, Tebantin ), milgamma – for 2 months the course was changed from different drugs, 6 blockades with novacoin and diprospan, including under X-ray.The pain did not go away at all.
Droppers put painkillers 2 courses – it does not help.
A blockade with dexamethasone and lidocaine was done under X-ray. The pain has not diminished much.
Then they prescribed carbamazepine in a row, Neurontin with a dosage of up to 1800 mg for 3 months and amitriptyline for 2 months – no effect, then duloxetine for 4 months – nothing. The pain only got worse.
Physio procedures (shock wave, electrophoresis, magnet, acupuncture, massages, exercise therapy) are only worse.During this time, a huge number of chiropractors, massage therapists, osteopaths have passed. Everything is useless.
In general, we have tried everything that is possible, but the condition is getting worse and worse – no one makes a diagnosis. Nobody in Belgorod knows anything. It just gets worse and worse before our eyes. The most important thing is that it is almost impossible to sleep at all – while lying down, the back on the left begins to burn, it is all lying and sitting. When you get up and start walking, the burning sensation disappears, but there is a constant aching pain, as if a stake is hammered under the scapula, and below – the entire left side of the thoracic region – continuous pain.I constantly want to turn my shoulders, turn my shoulder blades, turn my body – while clicks and crunches constantly appear on the left in the area of the pain site. The crunch is constant. After crunching for a couple of minutes it becomes easier, then the pain returns with renewed vigor.
The most important thing is that nothing relieves pain. Nothing helps from what I have listed. And it burns – it’s generally just trouble – sitting / lying. At night, if I fall asleep, I wake up in 2-3 hours from a sharp stabbing pain in one place on the left. It is impossible to drive, it is not possible to sit.Cold, ointments with menthol and menovasin somehow remove it all for a few minutes, and that’s it …
I did an MRI of all parts of the spine for 2 years 4 times. For all the time there have been no changes. Doctors do not see anything in the MRI or in the analyzes or in the ultrasound scan.
Most importantly, no one can make a diagnosis. The treatment doesn’t help. It gets worse and worse. Now the state is such that I had to quit – because of the pain I can not work.
Help me please.
I don’t know where to go to get to the clinic, maybe to the hospital to help find the cause of the pain and undergo treatment.Thanks in advance.
I will very much wait for an answer.
Unfortunately, pain syndromes resistant to conservative therapy and interventional treatment occur. Taking into account the therapy described by you, we recommend that you apply for the implantation of a test spinal stimulator. This procedure is performed at neurosurgical centers in St. Petersburg and Moscow. In case of successful test stimulation, a permanent spinal stimulator is implanted.
Respectfully yours, MD Ivanov, leading specialist of the MEDIKA Pain Treatment Clinic
Efficacy of gabapentin in discogenic lumbosacral radiculopathy
The main cause of lumbosacral radiculopathy is a herniated disc, less often (usually at an older age) it is caused by compression of the root in the lateral pocket, the intervertebral foramen in spondylosis due to the formation of osteophytes, hypertrophy of the articular facets, ligaments or other reasons [2, 4, 5, 25].Persistent maintenance of hernia pain syndrome may be associated not so much with root compression as with secondary neurophysiological and metabolic processes that are triggered by the introduction of the disc into the epidural space and the effect of the material released from the nucleus pulposus on the nerve tissue . According to clinical and neuroimaging comparisons, the intensity of pain does not correlate with the degree of disc protrusion or mechanical deformation of the root. Experimental data show that inflammatory changes in the compressed root and (which is especially important) in the spinal ganglion can play a key role in the development of radicular pain .The result is irritation, intra- and extraneural edema of the root or blockade of conduction along it. Changes in the neurophysiological characteristics of nerve fibers, neurons of the spinal ganglia and the posterior horns of the spinal cord also play an important role [1, 3, 5].
Clinically, lumbosacral radiculopathy is characterized by persistent or paroxysmal intense pain, at least occasionally radiating to the distal zone of the dermatome (for example, when taking Lassegh), pronounced muscle-tonic syndrome, often accompanied by scoliotic deformity of the spine, changes in sensitivity (pain and temperature dr.) in the corresponding dermatome, a decrease or loss of tendon reflexes, which are closed through the corresponding segment of the spinal cord, hypotension and weakness of the muscles innervated by this root [4, 5].
In the majority of patients with discogenic radiculopathy, conservative therapy makes it possible to achieve a significant weakening and regression of pain syndrome, and only in a relatively small part of cases of uncomplicated discogenic radiculopathy, characterized by especially intense persistent pain syndrome, severe limitation of mobility, resistance to conservative therapy, surgery is indicated.In a recently published study , it was noted that, although early surgical treatment for discogenic radiculopathy leads to a more rapid relief of pain, later (after six months, a year and 2 years) it does not have any advantages over conservative therapy and does not reduce the risk of pain chronicity. On the other hand, later surgical treatment is not inferior in efficiency to earlier .
As for the conservative therapy of discogenic radiculopathy, it is subject to reasonable criticism [4, 9, 10].The fact is that the traditionally used and still popular traction of the lumbar spine has been ineffective in controlled studies . It was found  that epidural blockade with corticosteroids, although they can help reduce pain, have only a short-term effect. The practice of prolonged bed rest also turned out to be untenable: in radiculopathy, as in other types of back pain, a faster return to daily activity prevents chronic pain .
NSAIDs, muscle relaxants and some other non-drug methods, mainly affecting the nociceptive component of pain, including massage, therapeutic exercises, the effect on myofascial syndrome, some methods of manual therapy, etc., remain the basis of conservative therapy. [4, 10]. Nevertheless, the effectiveness of such therapy is limited and does not allow in a significant number of cases to quickly stop the intense pain syndrome characteristic of radiculopathy, which may be a condition for a faster recovery.This forces us to look for additional opportunities to enhance the analgesic effect, primarily due to methods acting on the neuropathic component of pain [7, 21].
Given the mixed nature of pain in discogenic radiculopathy, including nociceptive, neuropathic, and often psychogenic components, the effect on the neuropathic component of pain seems to be very promising [7, 8, 13]. Nevertheless, until now the effectiveness of drugs traditionally used for neuropathic pain (anticonvulsants, antidepressants, etc.) in patients with back pain remains insufficiently proven .
In particular, the expediency of using anticonvulsants in patients with radiculopathy and back pain in general remains a subject of discussion. Anticonvulsants proved to be an effective means of treating pain in cranial neuralgia, postherpetic neuralgia, and polyneuropathy. However, data from studies of their effectiveness in patients with back pain are inconsistent. Such inconsistency of the results is largely predetermined by the heterogeneity and variety of variants of back pain, the variability of their mechanisms, and, possibly, different periods of treatment initiation.
The aim of this study was to evaluate the effectiveness of the anticonvulsant gabapentin, which has been widely used in the last decade for the treatment of pain syndromes, in patients with discogenic lumbosacral radiculopathy, depending on the timing of treatment initiation.
Material and methods
The study included 25 patients (14 women and 11 men) with discogenic radiculopathy.
The diagnosis of radiculopathy was established in the presence of radicular pain syndrome (irradiation of pain to the distal part of the dermatome: spontaneous and / or when taking Lassegh) plus at least one symptom of prolapse: a decrease (loss) of the corresponding tendon reflex, a decrease in pain, temperature (cold), tactile or vibration sensitivity in the dermatome area or muscle weakness innervated by this root.
The presence of a herniated disc of the corresponding localization was established using CT or MRI of the lumbosacral region. The study included 14 patients with L5 radiculopathy and 11 patients with S1 radiculopathy. The average age of the patients was 46.8 ± 9.1 years. The severity of pain syndrome assessed by VAS ranged from 5 to 9 points (average 7.5 points).
The exclusion criteria were the presence of a tumor, infectious-inflammatory or other disease of the spine requiring specific treatment, severe deformity of the spine, compression of the spinal cord, other concomitant neurological diseases, psychiatric diseases, serious or unstable somatic diseases (severe diseases of the liver, cardiovascular system, lungs or kidneys, decompensated diabetes mellitus, cancer).
Patients were divided into 2 groups: the 1st group included 12 patients with the duration of the exacerbation of pain syndrome no more than 1 month, the 2nd group – 13 patients with the duration of the exacerbation of more than 1 month. Accordingly, in the 1st group, gabapentin treatment was started during the 1st month of exacerbation, in the 2nd group – after 1 month. and more from the onset of exacerbation.
From the 1st to the 12th day, Gabapentin was prescribed in an increasing dose. Starting from the 13th day, patients took the drug at a dose of 1800 mg.In the absence of improvement within the next 2 weeks. the dose could be increased to 3600 mg per day. The total duration of the study was 8 weeks. In both groups, patients, in addition to gabapentin, were prescribed standard therapy, which included NSAIDs, exercise therapy, physiotherapy and massage. During the previous week and during the entire study, the patients were not prescribed muscle relaxants, B vitamins, antidepressants, other anticonvulsants, and therapeutic blockade.
There were no significant differences between the groups in gender, age, therapy, including the dose of NSAIDs.
None of the patients had previously undergone surgery. The average dose of gabapentin in the 1st group was 2110 ± 370 mg / day, in the 2nd group – 2200 ± 395 mg / day.
To assess the efficacy of gabapentin, the clinical overall impression (CGI) scale was used, which included the following gradations: deterioration, no change, minimal improvement, moderate improvement, significant improvement.
The Back Pain Scale (VAS), arranged according to the principle of the visual analogue scale (VAS), provided for the assessment of the following symptoms by patients: spontaneous pain in the back, in the legs, pain when moving in the back and legs, limitation of mobility when bending forward and when extending, limitation of the ability to sit, stand, limitation of the ability to move and daily activity; the patient assessed the severity of each of these symptoms, marking it with a dot on a segment of 100 mm, while 0 on this segment corresponded to the absence of violations, and the opposite end to the maximum possible severity of the symptom; the overall score on this scale was determined by summing the length of 10 segments (in mm) and could range from 0 to 1000 .
Scale of vertebral syndrome, which is a modification of the scale by G. Waddel et al. [3, 25], provided an assessment according to a 4-point system (from 0 to 3 points) 10 indicators: the angle of flexion and extension of the lumbar spine, the angle of lateral tilt to the right and left, the angle of elevation of the straightened right and left legs, tension of the paravertebral muscles and severity scoliosis, the ability to hold both legs straight, sitting in bed from a supine position; the total score ranged from 0 to 30 points.
Neuropathic Pain Scale (NPS) , which allows assessing the severity of 10 characteristics of pain syndrome: intensity, severity, severity of burning, dull, cold and itching pain, skin sensitivity in the pain zone, pain tolerance, intensity of superficial and deep pain.
The patients’ condition was assessed at the time of inclusion in the study (MO), at the 4th (M4) and 8th weeks (M8). The primary endpoint was the dynamics of pain and limitation of mobility, assessed using the PBS, relative to baseline.Additionally, the dynamics of vertebral syndrome, neuropathic characteristics of pain, the degree of improvement on the CGI scale, as well as differences in the dynamics of symptoms depending on the timing of initiation of gabapentin therapy were assessed.
Statistical processing was carried out using descriptive methods and the ANOVA model. The assessment of changes in indicators in comparison with the baseline and the control group was carried out using a t-test (level of reliability p <0.05). Statistical processing was carried out using the standard Statistica 6 software package.
By the end of the study, the score for the SBS significantly decreased in both groups (Table 1). By the 4th week, the total score for SBS in the 1st group decreased by an average of 25%, in the second group – by 23%, by the end of the 8th week the total score for the SBS decreased in the 1st group by 44% compared to with the initial level, and in the 2nd group – by 37%. In the first 4 weeks. The use of gabapentin in the group with an earlier prescription of the drug showed a faster positive dynamics of back pain (both spontaneous and during movement) and the degree of restriction of the ability to move.By the end of the 8th week of the study, in both groups, significant positive dynamics was noted for the following indicators of the WBS: spontaneous pain in the back and legs, pain in the back and legs during movement, limitation of extension and the ability to sit, limitation of the ability to move and daily activity.
There was a trend towards a higher efficacy of early gabapentin administration (within 1 month after the onset of exacerbation) in comparison with its late administration. As a result, the indices of the 2nd group, which were initially lower than those of the 1st group, were equal to them by the end of the 8th week (Fig.one).
Evaluation of symptoms of neuropathic pain using the NPS scale (Table 2) showed that treatment with gabapentin in both groups showed positive dynamics of pain parameters such as its severity, intensity, including burning, superficial and deep pain, as well as pain tolerance. … At the same time, if initially in the first group the indices of neuropathic pain were higher (a significant difference was noted only in the total intensity of pain), then by the end of the 4th and especially the 8th week the indices in both groups were compared, which indicates a more rapid regression of pain in 1st group.
The severity of the vertebral syndrome by the end of the 8th week decreased in both groups approximately equally (Table 3). Nevertheless, according to these indicators, the tendency towards higher scores in the 1st group leveled off by the end of the study, and the corresponding indicators in both groups turned out to be similar (Fig. 2).
According to the CGI scale, with early use of gabapentin by the end of the 8th week of the study, a significant effect was noted in 3 patients (25% of patients included in the study), a satisfactory (moderate effect) – in 4 (34%), minimal improvement – in 2 (16%), no improvement – in 3 (25%).With a late start of gabapentin treatment, a significant effect was observed in 2 (17%) patients, satisfactory – in 4 (34%), minimal improvement – in 4 (34%), no effect – in 3 (26%). Thus, with the early use of gabapentin, a clinically significant result was noted in 59% of patients, while with its later administration, in 51% of patients. The effectiveness of therapy is not affected by age, the initial intensity of pain, the presence of symptoms of prolapse, the severity of the vertebral syndrome.
During the study, gabapentin was well tolerated.Drowsiness was noted in 2 (8%) patients, dizziness – in 2 (8%), slight swelling of the legs – in 1 (4%). Gabapentin tolerance rates were similar in both groups.
The obtained results confirm the efficacy and safety of gabapentin in the treatment of the neuropathic component of pain in patients with discogenic lumbosacral radiculopathy. Moreover, they testify in favor of the expediency of the earliest possible administration of gabapentin after the development of a painful episode.
Initial state of patients with pain episode duration more than 1 month. on a number of parameters (severity of pain syndrome, degree of limitation of mobility) was more favorable than in patients with relatively recent development of pain syndrome, which probably reflects a partial regression of symptoms under the influence of previous conservative therapy or the natural course of events. However, by the end of the study, for most of the parameters assessed, the condition of patients in both groups was equal, which may reflect a more rapid subsequent regression of symptoms with an early initiation of gabapentin treatment.This can hardly be explained by the tendency to spontaneous recovery, inherent in a certain proportion of cases of radiculopathy, since in this case a more favorable course would rather be expected in patients with a longer duration of exacerbation.
The use of agents affecting the α2δ-subunit of calcium channels, primarily gabapentin, in patients with radiculopathy seems especially promising in light of experimental data that show that when a nerve is damaged (ligation or transection of the spinal roots or sciatic nerve) in rats as a result of up -regulation, overexpression of the α2δ-subunit of calcium channels develops in the cells of the spinal cord and cerebrospinal ganglia, which correlates with the phenomena of allodynia .It can be assumed that a similar process occurs due to compression of the spinal root by a herniated disc. Selectively binding to the α2δ-subunit of calcium channels, gabapentin inhibits the release of excitatory neurotransmitters and thereby blocks the transmission of pain impulses at the level of the posterior horns, and possibly at higher levels of the central nervous system [8, 22]. Because of this, the earlier use of gabapentin can counteract the development of central sensitization and the formation of “pain memory” that support the pain syndrome, and thereby contribute to its regression .
To date, a number of clinical studies have been carried out on the efficacy of gabapentin for back pain. So, N. Hansen  in an open study, which included 80 patients with back pain, noted a decrease in pain syndrome by an average of 46% when prescribing gabapentin at a dose of 900 to 2400 mg per day. J. Rosenberg et al.  also found a positive effect of gabapentin on neuropathic pain syndromes. According to M. Saracoglu et al. , gabapentin was useful in patients with back pain persisting after surgery, providing sustained pain relief.But G. McCleane  in a placebo-controlled study, which included 62 patients with lumboischialgia, noted while taking gabapentin at a dose of up to 1200 mg per day for 6 weeks. reduction of irradiation of leg pain and pain on movement, did not find relief of lower back pain, improvement of mobility, or reduction of the need for analgesics. K. Yildrim et al.  in a 2-month placebo-controlled study of 50 patients with chronic radiculopathy, showed that gabapentin intake at a dose of 900–3600 mg per day reduced the intensity and radiation of pain, limiting flexion and sensory impairment.Thus, the results of K. Yildrim et al. (2003) are closest to our data.
As for other anticonvulsants, their effectiveness for back pain has not been well studied. Thus, in one of the studies , it was shown that topiramate (at an average dose of 200 mg per day) helps to reduce pain in chronic radiculopathy by 20%, but at the cost of a high frequency of side effects (86%), as a result only 16 ( 26%) of 42 patients who entered it.A small open-label study  showed a threshold therapeutic effect of lamotrigine for back pain, but this study also reported a high incidence of side effects. Only one small open-label study  investigated the efficacy of carbamazepine in sciatica patients. To date, there are also no evidence-based studies confirming the effectiveness of pregabalin, oxcarbazepine, valproic acid in lumbosacral radiculopathy or other types of back pain .
The variability of the results of these studies on the efficacy of anticonvulsants for back pain can be explained, at least in part, by the heterogeneity of the studied groups of patients and the different timing of drug administration after the onset or exacerbation of pain syndrome. A feature of our study is the relative homogeneity of the studied population of patients (only patients with clinical and neuroimaging signs of discogenic radiculopathy, undoubtedly having a neuropathic pain component), complexity in assessing the effectiveness of the drug and, which is especially important, assessing the effect of the time of administration of the drug on its effectiveness.
At the same time, one should be warned against extrapolation of the obtained results to the entire group of patients with back pain, most of whom have no neuropathic component of pain (the so-called “axial back pain”). In recent years, some authors, based on the results obtained using special questionnaires, have expressed the opinion that the neuropathic component may be more widely represented than previously thought, including in those cases of chronic back pain where there are no signs of involvement spinal roots.Meanwhile, questionnaires for the detection of neuropathic pain should be considered only as a screening tool, due to insufficient specificity, they cannot be considered a method for the final diagnosis of neuropathic pain, which, in accordance with modern, more stringent criteria, requires clinical and / or instrumental confirmation of lesions of neural structures. in this case, the spinal roots or ganglia (for example, a decrease in pain, temperature, especially cold, tactile or vibration sensitivity in the corresponding dermatome or electrophysiological signs of root involvement) [15, 24].
In conclusion, it should be emphasized that our study should be considered as preliminary, since the small number of patients and the open nature limit the validity of its results. Nevertheless, the data obtained may indicate the promise of early use of gabapentin in discogenic radiculopathy.
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Midocalm – forget about pain
Perhaps no person can say that he does not know the sensation of pain.Sooner or later, everyone is faced with this unpleasant phenomenon, but nature was conceived that pain was good – it stimulated us to avoid factors dangerous to our health or to eliminate them. But even this well-oiled mechanism fails and pain loses its physiological significance when it becomes chronic. Constant pain in the back, including in the lumbar and cervical regions, joint pain – today it is by no means a sign of old age, more and more often young people become its victims.Chronic pain significantly reduces the quality of life and, in many cases, leads to a worsening of the course of the disease. Stop enduring pain – it’s time to fight back!
Pain in the back and joints is familiar to many and can darken even the most joyful and carefree days. A huge number of people become victims of pain syndrome of various localization. Thus, back pain ranks second in terms of the frequency of medical care visits, second only to acute respiratory diseases. In the USA, in 52% of cases, the reason for seeking emergency care is pain (A.S., 2012). According to the WHO, more than 60% of the world’s population experience pain in the back or joints, which leads to disability (Sitel A.B., Teterina E.B., 2006).
At the same time, almost 80% of the population complain of lower back pain. It should be noted that more and more pain is becoming an obsessive companion of middle-aged people (30–59 years), who make up 2 / 3 patients with pain in the lumbar spine. Today, even adolescents go to the doctor with complaints of back pain (Nesterov O.A., 2004). The prevalence of joint pain seems to be no less threatening. More than 30% of Ukrainians constantly or periodically experience joint pain. Moreover, in 5% of cases, such problems lead to disability (Rudyakova S.E., 2005).
Thus, according to modern world standards, pain syndrome is one of the most significant problems, which has not only medical significance, but also negative socio-economic consequences.
Unfortunately, despite the danger of complications and discomfort, many tend to ignore the pain syndrome.We are full of optimism – a little rest and the pain will go away on its own. And only after long battles face to face with the enemy does the understanding come to us – the pain is not going to go anywhere. And then, bending over in three deaths or limping, we go to the doctor.
Most often, patients complain of pain in the lumbar spine. If you believe the statistics, then every third inhabitant of the planet at least once faced this problem, about 20-40% of patients note constant pain in the lower back for many months.It is difficult to overestimate its impact on comfort and quality of life. For example, in the United States, low back pain is the 2nd most common cause of disability. In about 90% of cases, this pain is nonspecific, but only 1% of it signals the presence of a severe underlying disease, in the remaining 99%, drug therapy should be aimed mainly at combating directly with pain syndrome (Khodinka L. et al., 2003).
For chronic back pain, both medicinal and physiotherapeutic methods of treatment are used, such as remedial gymnastics, manual therapy.Among the drugs used to treat pain syndrome, it is worth noting non-steroidal anti-inflammatory drugs (NSAIDs), muscle relaxants, antidepressants. In this case, patients should be informed about the need to maintain sufficient physical activity, but avoid excessive physical and static loads, and carrying weights.
What is the cause of the pain?
The muscles of the back are under enormous stress on a daily basis, and they are not necessarily associated with sports or strenuous physical work.Even the banal daily sitting at the computer requires remarkable efforts from the back muscles, which for long hours are forced to maintain their entire body weight, fixing us in one position.
Another reason for the development of low back pain is the degenerative processes of the musculoskeletal system, accompanied by muscle spasm, which actually causes pain. In this case, the triggering mechanism for the development of pain syndrome is the drying out of the intervertebral discs, which leads, among other things, to reflex muscle tension, as a result of which a local change in metabolic processes occurs, the functioning of nerve fibers and peripheral blood circulation are disrupted.
In addition, psychosocial factors such as depression and anxiety disorders play an important role in the development of chronic back pain.
Muscle spasm also plays a leading role in various diseases of the joints. Moreover, it can be caused by pathological processes in which various components of the articular mechanism are involved.
Thus, one of the key factors in the onset of back or joint pain is muscle spasm. At the same time, the body responds to the pain caused by muscle spasm with even greater muscle contraction.At first, it has a protective character, since it leads to immobilization of the affected segment, but later it leads to a deterioration in the patient’s condition and chronicity of pain. Thus, we get a vicious circle in action: pain – muscle spasm – pain (Vorobieva O.V., 2003; Godzenko A.A., 2007). That is why one of the main targets in drug therapy is muscle spasm, the elimination of which helps to break this vicious circle.
How to Say No to Pain
Therapy aimed at reducing abnormally high muscle tone and pain relief should include muscle relaxants, which can be used in parallel with NSAIDs.This approach is supported by the recommendations for the treatment of acute nonspecific back pain adopted in the USA and the EU, as well as in the relevant reviews of the Cochrane Community (European Guidelines For The Management Of Chronic Non-Specific Low Back Pain, 2004; van Tulder MW et al. 2006; van Tulder MW et al., 2006; American College of Physicians, 2007; American Pain Society, 2007; Malanga G., Wolff E., 2008).
To avoid a worsening of the condition and an increase in the severity of back pain, provoking factors (lifting weights, prolonged stay in an uncomfortable position, intense physical activity, etc.) should be avoided.often walk, swim or exercise therapy. Remember to always warm up before exercising. And when seated, make sure that the work surface of the table is at a comfortable height, the back of the chair provides good back support and correct positioning.
Portrait of an ideal muscle relaxant
In order to get rid of chronic pain, a rather long-term treatment is needed, therefore it is very important to choose muscle relaxants, as well as, if necessary, NSAIDs with a favorable safety profile, which do not have additional effects that can negatively affect the patient’s quality of life.Therefore, an important requirement for muscle relaxants, in addition to high efficiency, is the selectivity of the central muscle relaxant action and, of course, a favorable safety profile.
At the same time, such a drug should reduce the increased muscle tone, without suppressing it so that maintaining posture and the chosen posture becomes a problem. In addition, the use of a medicinal product should not be an obstacle to the usual way of life, work.It is also important that it works well with other drugs. In this context, it should be noted that central muscle relaxants have side effects such as sedation, dizziness, loss of coordination, weakness, which undoubtedly reduces patient compliance, and hence the effectiveness of treatment. Especially significant in this aspect is the sedative effect, which significantly limits the use of this group of drugs.
Mydocalm – and pain under control
Significantly different from other centrally acting muscle relaxants Mydocalm (tolperisone), developed by specialists of the Hungarian pharmaceutical company “Richter Gedeon” and used for more than 40 years in clinical practice by specialists from over 30 countries of the world.In addition, its effectiveness has been proven in more than 100 studies (Godzenko A.A., 2007).
Mydocalm was originally used to reduce the severity of spastic syndrome, but for many years it has been successfully used for inflammatory and degenerative diseases of the musculoskeletal system. This drug effectively reduces the painful spasm and muscle tension for the patient, improves motor function (Nikonov E.L. et al., 2001). Mydocalm reduces muscle tone and stiffness, thereby increasing freedom of movement in the spine and joints.
Due to its chemical structure, tolperisone – the active ingredient of the drug Midocalm – exhibits lidocaine-like activity and has a membrane-stabilizing effect, and also inhibits the conduction of nerve impulses, which leads to blocking of spinal reflexes.
Thus, this drug promotes muscle relaxation without affecting the exercise of voluntary movements, their coordination, and also without causing the development of sedation and muscle weakness, which was shown in a double-blind, placebo-controlled study involving 72 healthy volunteers at the age of 19-27.So, along with the good tolerance of mydocalm, there were no differences between the groups taking Midocalm and placebo (Pratzel H.G. et al., 1996). Thanks to this, the patient who takes Midocalm can drive vehicles and otherwise lead a fairly active lifestyle.
It is important that during long-term therapy of various rheumatic diseases, tolperisone is able to increase the effectiveness of NSAIDs such as AERTAL (aceclofenac). Thanks to this, it becomes possible to reduce the dose of NSAIDs, which means – to reduce the likelihood of developing side effects from the digestive tract associated with the use of drugs of this group.
Thus, the use of mydocalm in the complex therapy of osteoarthritis made it possible in 60% of cases to reduce the dose of NSAIDs and avoid the development of side effects, which is very important in the treatment of this pathology, since it develops more often in patients aged 30-60 years, when the incidence of adverse events increases against the background of the use of NSAIDs (Alekseeva L.I., Bratygina E.A., Kashevarova N.G. et al., 2008).
Thus, the combination of the central muscle relaxant Mydocalm and NSAIDs can achieve significant positive results in the treatment of nonspecific chronic back pain (Waddell G.Burton A.K. 2001; Voznesenskaya T.G., 2001; Povoroznyuk V.V., 2004). Clinical efficacy and favorable safety profile of mydocalm have also been confirmed in the treatment of degenerative joint diseases (Grodzenko A.A., 2007).
The results of a study involving patients with pain syndrome caused by the development of muscle spasm against the background of rheumatic diseases indicate the successful use of tolperisone. Thus, tolperisone acts on a wide range of causes of pain formation (Alekseeva L.I., Bratygina E.A., Kashevarova N.G. et al., 2008). In addition, it has been proven that with mydocalm as part of complex therapy for osteochondrosis of the spine, the severity of symptoms, including pain syndrome, decreases faster (Sitel A.B., Teterina E.B.