Hello, I am Nadine ATTAL, neurologist and pain specialist at Ambroise Paré Hospital, Boulogne, France and very happy to moderate this forum discussion on pain management.
Mathieson and colleagues have just reported in the journal the results of a new multicenter prospective placebo controlled randomized study of pregabalin in acute and chronic sciatica (NEJM 2017 ; 376 : 1111-20). This study shows no efficacy of pregabalin versus placebo on leg pain, pain related disability or quality of life.
This negative study illustrates the difficulties of drug treatment of sciatica, particularly chronic sciatica. Prior trials have also been negative in sciatica. However sciatica is an example of neuropathic pain. As meta-analyses have generally found similar efficacy of drugs accross multiple neuropathic pain conditions (see Lancet Neurol 2015 ; 14 : 162-73), it is usually admitted that recommendations for first line drug therapy in neuropathic pain (e.g . pregabalin, gabapentin, antidepressants) may apply to sciatica. Do you think that these drugs should be proposed first line in chronic sciatica or that sciatica is a distinct clinical entity and should be treated differently ?
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