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NICE to reconsider advice that GPs should use gabapentinoids for sciatica

New research has suggested GPs should no longer prescribe gabapentinoids for sciatica, prompting NICE to review its current guidance.

The study published in the Canadian Medical Association Journal concluded that that gabapentinoids have no effect on pain or disability for sciatica or chronic lower back pain when compared with a placebo.

This comes as the Government are reviewing recommendations to make gabapentinoids class C drugs following a consultation earlier this year.

GP leaders said the benefits of gabapentinoids have been ‘enormously overstated’, leading to the current addiction issues faced by patients.

Researchers the University of Sydney reviewed nine studies that compared gabapentinoids to placebo in 859 patients with non-specific lower back pain, sciatica or neurogenic claudication of any duration.

The researchers found ‘moderate to high-quality evidence’ that gabapentinoids had no effect on pain or disability for sciatica and no short-term reduction in pain or disability compared with placebo for chronic lower back pain with or without radiating leg pain.

The research also found that ‘gabapentinoids have a higher risk for adverse events’.

The researchers wrote that the findings were ‘in line with recent United States and United Kingdom guidelines for low back pain’. 

But they added: 'Regarding sciatica, the 2016 UK guideline recommends following neuropathic pain guidelines, which endorse the use of gabapentinoids. However, the recommendation of gabapentinoids for sciatica should be reviewed in light of emerging evidence.'

Currently, NICE recommends that GPs ‘offer a choice of amitriptyline, duloxetine, gabapentin or pregabalin as initial treatment for neuropathic pain (except trigeminal neuralgia)’.

It then instructs them to ‘offer one of the remaining three drugs' if the initial treatment is not effective.

A NICE spokesperson told Pulse that the guideline was reviewed in 2017 ‘and concluded there was insufficient evidence to prompt an update’.

But they added: ‘We will examine the new evidence to establish if it would require us to do an exceptional review of the guideline.’ 

The Government is currently reviewing recommendations to make gabapentinoids class C drugs, which could potentially see them kept in a safe with prescriptions written to specific legal requirements.

GP Committee prescribing and policy lead Dr Andrew Green said: ‘It is increasingly apparent to GPs working on the ground that the benefits of gabapentinoids were enormously overstated when they were introduced and we are now facing the problems of dependence on a massive scale.'

He continued: 'GPs and our patients need services to which these patients can be referred rapidly if they show severe symptoms or have features on presentation that suggest they are at risk of chronicity.'

Charities have previously warned that discussions about reclassifying pregabalin and gabapentin as controlled drugs have created 'fear and anxiety’ among the patients who use them responsibly.

The case against prescribing gabapentinoids

A Cochrane Review from June this year found that gabapentin ‘can provide good levels of pain relief to some people with postherpetic neuralgia and peripheral diabetic neuropathy’, but added that its effectiveness for other types of neuropathic pain ‘is very limited’.

Meanwhile, another study published in Addiction last year, that found that misuse of gabapentin was at a staggering ‘40-65% among individuals with prescriptions’.

GPs have previously been told by NHS England to prescribe Lyrica, and not pregabalin, for neuropathic pain – a decision which waslater overturned by a High Court decision.

However, Scottish-based health charity Pain Concern has said reclassifying gabapentinoids is creating ‘fear and anxiety’ among the patients who use them responsibly.

Readers' comments (10)

  • Large numbers of people are addicted to GP prescribed opiates. Large numbers of people are addicted to GP prescribed hypnotics. And now, large numbers of people are addicted to GP prescribed gabbapentinoids. There might just be a common theme here.

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  • is it the type of 'sciatica' that Charlie and President Junker suffer from?

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  • do you mean the common theme is that it's all GPs fault?... .i have to give evidence to inquest in a young gaba-addicted pts death next month, and found Pulse articles on this subject a good resource to track references to explain how gaba prescribing arose in first place for my report ,thanks Pulse

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  • Think common factor likely pain clinics who put em out in bucket loads, or did until they happened upon duloxetine......

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  • Just say no people ☝️

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  • AlanAlmond

    Wasn’t it NICE who suggested these things were prescribed in the first place? What does this say about the value of NICE guidance?

    Anyone had NICE guidance used against them in a complaint?

    Bollarks to NICE

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  • Do not give benzos, opiates and NSAIDs has cardiac risks. Now this. Physio referral takes almost a year. Just give them your reassuring word is what they are after. Cheap and not so cheerful to the patient. When the complaints come, there is zero back up for the GP and we are judged on idealistic best care in this broken poorly funded system.

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  • I have never seen gaba work well for pain and have always tried to put patients off using it but pain clinics keep prescribing it !

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  • re Truth finder
    If your physio takes 12 months you have a poor service ... sorting that should be the action not prescribing addictive drugs
    NICE guidelines show at 6 weeks you should be seeking consideration of spinal injection for sciatica not drugs
    Gabapentin was subject to massive marketing to GPs in the 2000's and at the end of the day it worked..... shame the drug doesn't !




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  • David Banner

    Sorry NICE, the pregabalin horse has bolted. The local likely lads claim nothing works finer for their sciatica. In fact it’s so good they let their mates have a few, who then pop along to the GP for their own supply having developed agonising pain themselves.

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