A painkiller found to be no better than a placebo for sciatica

Source:

https://www.google.co.uk/amp/s/www.washingtonpost.com/amphtml/news/to-your-health/wp/2017/03/22/a-painkiller-found-to-be-no-better-than-placebo-for-sciatica/ (A painkiller found to be no better than a placebo for sciatica)

A drug frequently prescribed for pain is no more effective than a placebo at controlling sciatica, a common source of pain in the lower back and leg, according to a study published Wednesday in the New England Journal of Medicine.

The researchers at the George Institute for Global Health in Australia followed 209 sciatica patients in Sydney who were randomly assigned to receive either the drug pregabalin, more commonly known as Lyrica, or a placebo. The results showed no significant differences in leg pain intensity between the group on the placebo and that on Lyrica after eight weeks taking the drug or during the rest of the year on follow-up exams. Similarly, there were no differences for other outcomes such as back pain, quality of life and degree of disability.

After Lyrica was approved in 2004, it has become the most commonly prescribed medicine for neuropathic pain, which is caused by damage to the nervous system. The drug was ranked as the 19th-highest-earning pharmaceutical in 2015, with worldwide sales rising annually at a rate of 9 percent and sale revenue of more than $3 billion in 2015 in the United States.

“We have seen a huge rise in the amount of prescriptions being written each year for patients suffering from sciatica. It’s an incredibly painful and disabling condition, so it’s no wonder people are desperate for relief and medicines such as pregabalin have been widely prescribed,” Christine Lin, one of the authors of the study and an associate professor at the George Institute for Global Health, said in a news release.

Lyrica is frequently prescribed as an off-label drug because it has shown to be effective in treating some kinds of neuropathic pain. Some guidelines for treating sciatica also recommend prescribing Lyrica

Sciatica can be particularly debilitating and is a symptom of a problem with the sciatic nerve, the largest nerve in the body. In most cases, the cause behind the pain remains unclear. The pain, often accompanied by weakness, numbness and tingling, usually radiates on one side of the body and can spread from the lower back to the lower leg including the calf, foot and toes. Sciatic symptoms eventually subside on their own, with some help from exercise, surgery or medicine.

According to the researchers, at any one time, around 12 percent of the world's population has lower back pain and around 5 to 10 percent of those with lower back pain have sciatica.

The randomized double-blind placebo study also found significantly more side effects in people who took Lyrica than those who were on the placebo. Nearly two-thirds of the participants were very satisfied or satisfied with their drug regimen — regardless of whether they were taking Lyrica or a placebo.

“It seems people associate a drop in pain being due to taking a capsule, rather than something which would happen naturally over time. General practitioners who are prescribing Lyrica should take note of these findings, and talk with their patients about other ways of managing and preventing pain,” Lin said.

Researchers from the Musculoskeletal Division at the George Institute conducted the study because they were concerned about the rising use of Lyrica for sciatica and back pain despite scarce data on its effectiveness and tolerability in this patient group.

Lyrica became the best-selling drug for Pfizer, the global pharmaceutical corporation based in the United States, after the company's patent for the statin Lipitor expired in 2012. In 2015, Lyrica sales were one of the main reasons behind why Pfizer remained the world's biggest seller of drugs that treat conditions or diseases associated with the central nervous system.

Pfizer issued a statement about the study saying, “Lyrica is currently approved in more than 130 countries and regions globally. The efficacy and safety of Lyrica for its approved indications has been demonstrated in large-scale, double blind, randomized, placebo controlled pivotal trials. Lyrica continues to be an important treatment option for the conditions for which it is approved.”

Doctors should be more cautious when prescribing Lyrica to patients with sciatica, said Chris Maher, one of the study's authors and director of the Musculoskeletal Division at the George Institute, in an interview.

“Our next step is to educate doctors that the medicine doesn't work, present the results at different conferences and raise more awareness,” he said.

Correction: This article originally stated that side effects included suicidal thoughts. The study did not find a higher incidence of suicidality in patients taking Lyrica.

 

Good stuff.

I was prescribed hydrocodone for my shoulder. Got 100 pills to start and a refill on top of that. They worked, to an extent. I found myself taking them for reasons other than simply pain. I noticed that I fell asleep more quickly. I noticed that my mood improved. Now, of course, being in less pain can help you fall asleep and can increase your mood. That was true, to an extent. But I found that I was taking them inconsistently. I wasn't taking them when I had a peak flare up. I was taking them when I knew that an important work event was happening the following day and I wanted to ensure I got enough sleep. I was taking them prior to leisure activities on the weekend. I would take them before going to a baseball game or the beach, BEFORE the pain. That wasn't a good path to go down, and I realized it. Some people don't realize. I changed course, and only took them when the flare ups were worst. Even then, they are a dead end. Especially when you KNOW that your pain is TMS and not structural. They damage your organs, they are addictive, and they make you more sensititive to future pain. They are a great tool, but more so for post-surgery healing than for chronic pain. I am not one to rag on pharmaceutical companies. There are enough people doing that. I am appreciative of modern medicine, but also believe that people should seek treatments with the least risks before settling on something as serious as pain killers. "Trust, but verify". Your doctor wants you to get better, but doesn't have an open mind to anything considered "non-scientific". Take the information that they give you, and consider the pros and cons. But the decision is ultimately ours to make.

 

This is why I always say that stuff needs to be tested in randomized, double-blinded, placebo-controlled studies. So many of the treatments for chronic pain are lacking in this type of research. Anecdotally, I've never seen anyone helped much with chronic pain from Lyrica. Although I have to wonder how this drug ever got rammed through the FDA (rhetorical question), especially when:

1) They don't even know how it works (It's true! Look it up.)
2) Effectiveness was always known to be limited (and nonresponsive in many people).
3) It takes weeks to work (if it even does work) and then you're hooked on it and have to taper off.
4) Side effects in many cases are much worse than the pain disorder its treating.

LOL @ Chiropractor trolls peddling their services in the comments section - more quackery!

I should also add this study was published in the New England Journal of Medicine, which is probably the most prestigious medical journal in the world, so this should be pretty damaging.

 

Thank you for posting this. I hope this comes up when people search this site for Lyrica. I was on the lowest dosage of Lyrica/Pregabalin for the first 5 months I had chronic pain. It did seem to work and I felt increasing nerve pain in the 1-2 hours before the next dosage as the effect wore off (although only before the pre-dinner one). But now I know, as debilitating as my pain was, it was TMS. I weaned myself off Pregabalin as soon as I could because it has terrible long term side effects. It's also one of those drugs that's addictive, although they don't use 'addictive' in the literal, so one has to wean off it slowly.

 

A personal friend who studied the "studies" for drugs in graduate school explained the drug company testing to me.
She said that they test high numbers of people because they need high numbers to get the % of people helped by the drug.
This is why they can't test just 100 - 500 people, because the success rate would be too low.
Many anti-depressants get on the market with only a 7% success rate. Can you imagine buying a car with a 7% success rate of being drivable? Unreal!

 

Thanks for the comments, folks. It's nice to know my post are reaching you.

That's doesn't surprise me at all. It's saddening to know they aren't forced to disclose success rates. Full "transparency" would help move towards a shift in thinking. However, I know all too well, it isn't in the best interests of Pharmaceutical companies.