New study: Gabapentin, Lyrica don't work for postsurgical pain
A recent review of studies of the use of gabapentinoids (Lyrica and gabapentin) for acute pain management following surgery found their effects on pain were clinically insignificant. The review included 281 randomized controlled studies involving 24,682 participants. The study was published in the journal Anesthesiology in June.
The studies looked at patients who were given gabapentinoids perioperatively—during the period leading up to and post surgery. There was less than a 10% difference in pain intensity between the groups receiving the drugs and the control group, an outcome considered not clinically meaningful. This was true at all time points evaluated, from six hours post-operative to 72 hours, as well as for subacute and chronic pain.
The group receiving gabapentinoids had less postoperative nausea and vomiting but more dizziness and visual disturbances. The study authors concluded that “no clinically significant analgesic effect for the perioperative use of gabapentinoids was observed. There was also no effect on the prevention of postoperative chronic pain and a greater risk of adverse events. These results do not support the routine use of pregabalin or gabapentin for the management of postoperative pain in adult patients.”
Lyrica and Gabapentin Rarely Work for Chronic Pain
Lyrica (pregabalin) and gabapentin (Neurontin) are in a class of drugs called gabapentinoids. The FDA has approved gabapentin only for the treatment of postherpetic neuralgia (post-shingles pain) and pregabalin for postherpetic neuralgia, fibromyalgia and neuropathic pain associated with diabetes or spinal cord injuries. However, both are frequently prescribed for all kinds of pain, including sciatica, back pain, burn injury and arthritis, despite the lack of evidence that they are effective for those conditions.
A 2019 review published in JAMA Internal Medicine found that "(1) evidence supporting gabapentin for diabetic neuropathy pain is “mixed at best”; (2) evidence supporting gabapentin for nondiabetic neuropathies is very limited; (3) evidence does not support gabapentinoids for radiculopathy or low back pain; (4) gabapentin has minimal benefit for fibromyalgia pain, based on minimal evidence; (5) evidence does not support gabapentinoids for acute herpes zoster pain; and (6) in almost all studies for other painful indications, gabapentinoids were ineffective or “associated with small analgesic effects that were statistically significant but of questionable clinical importance.”
Gabapentinoid Prescriptions have tripled despite lack of safety and effectiveness
Ever since opioids have fallen out of favor due their risks of addiction and overdose, prescriptions for gabapentinoids for pain management have skyrocketed, more than tripling between 2002 and 2015. But gabapentinoids have their own risks of addiction and overdose. Especially troubling has been an increase in use among patients who also take opioids and/or benzodiazepines as all three suppress breathing, increasing the risk of accidental overdose.
Gabapentinoids have significant and sometimes life-threatening side effects
A study of almost 192,000 participants who received at least two consecutive prescriptions for a gabapentinoid found that 8.9% experienced an unintentional overdose. The same study found that 5.2% of participants were treated for suicidal behavior or died from suicide. Increased suicidal behavior was found in patients age 55 or younger, with the highest rates in patients aged 15-24.
Other commonly reported side effects include dizziness, sleepiness, balance problems, blurred vision, coordination problems, nausea, vomiting, diarrhea, headaches, increased pain (including pain in extremities, back pain and joint pain), depression, anxiety, insomnia, memory problems and fatigue. Most patients stop taking gabapentinoids due to intolerable side effects.
Better options for postsurgical pain management
Acupuncture
A 2016 review of studies of the effectiveness of acupuncture in the treatments of postoperative pain found that acupuncture reduced postoperative pain and reduced opioid use. Other studies have found that acupuncture is more effective than injected morphine for acute pain with far less side effects. Acupuncture could easily be incorporated into hospital settings as a treatment modality.
Low Level Laser Therapy (Photobiomodulation)
Low level laser therapy (LLLT), also known as photobiomodulation, or red/infrared light therapy, has shown effectiveness in decades of research for reducing pain and inflammation and speeding wound healing. LLLT exposes skin to red and near infra-red light for brief periods of time. A 2019 review found several studies reporting good results for postsurgical pain, though study authors reported more research is needed to determine optimal protocols. This is another therapy that could easily be incorporated into hospital settings. Home use devices are increasingly available and affordable. It has few side effects, if any, when properly dosed.
Medical Marijuana
A 2018 article in General Surgery News was titled, “Cannabis and Surgical Pain: Worth a Look” The article points out the extensive evidence that marijuana reduces pain more effectively than opioids and its use leads to a reduction in opioid use. As of this article’s publication, nearly 50 randomized controlled trials have evaluated the effectiveness of cannabis and cannabinoids for pain relief and five meta-analyses have summarized those trials. All have found a significant decrease in pain intensity, and shorter-term pain intensity. Marijuana is also known to reduce inflammation and endocannabinoids (Cannabis compounds produced by the body) are known to be released after bodily injury.
Other Options
The three options listed above are just a few of the many safe, effective treatments for acute and chronic pain. For more information on postsurgical, acute and chronic pain management, see the Alternative Pain Treatment Directory’s articles, products and providers. Also, sign up for our newsletter to stay up to date on the latest pain treatment news.
The author, Cindy Perlin, is a Licensed Clinical Social Worker, certified biofeedback practitioner and chronic pain survivor. She is the founder and CEO of the Alternative Pain Treatment Directory and the author of The Truth About Chronic Pain Treatments: The Best and Worst Strategies for Becoming Pain Free. She's located in the Albany, NY area, where she has been helping people improve their health and emotional well-being for over 27 years.
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