Anticonvulsants in the treatment of low back pain and lumbar radicular pain: a systematic review and meta-analysis
Anticonvulsants in the treatment of low back pain and lumbar radicular pain: a systematic review and meta-analysis
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DOI：
10.1503/cmaj.171333
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发表时间：
2018-07-03
影响因子：
14.6
通讯作者：
Lin, C. -W. Christine
中科院分区：
文献类型：
--
作者：
Enke, Oliver;New, Heather A.;Lin, C. -W. Christine
背景：抗惊厥药的使用（例如，加巴喷丁、普瑞巴林）治疗腰痛的应用近年来显著增加，尽管支持证据有限。我们的目的是确定的疗效和耐受性的抗惊厥药在治疗腰痛和腰神经根性疼痛与安慰剂相比，安慰剂。方法：在5个数据库中进行搜索研究比较抗惊厥药安慰剂在非特异性腰痛，坐骨神经痛或神经源性跛行患者的任何持续时间。结果是自我报告的疼痛，残疾和不良事件。使用物理治疗证据数据库（PEDro）量表评估偏倚风险，并使用建议评估、开发和评价分级（GRADE）评估证据质量。数据进行了汇总和治疗效果进行了量化，使用平均差异的连续性和风险比的二分outcomes.Results：九项试验比较托吡酯，加巴喷丁或普瑞巴林安慰剂在859个独特的参与者。15项比较中有14项发现，抗惊厥药物不能有效减轻腰痛或腰神经根痛的疼痛或残疾;例如，有高质量的证据表明，与安慰剂相比，加巴喷丁类药物在短期内对慢性腰痛没有影响。（合并平均差异[MD]-0.0，95%置信区间[CI] -0.8至0.7）或即刻腰椎神经根痛（合并MD-0.1，95% CI -0.7至0.5）。缺乏疗效伴随着使用加巴喷丁类药物的不良事件的风险增加，其证据水平为high.Interpretation：有中度至高质量的证据表明，抗惊厥药对治疗腰痛或腰神经根痛无效。有高质量的证据表明，gaba-喷替林类化合物具有更高的不良事件风险。
Background: The use of anticonvulsants (e.g., gabapentin, pregabalin) to treat low back pain has increased substantially in recent years despite limited supporting evidence. We aimed to determine the efficacy and tolerability of anticonvulsants in the treatment of low back pain and lumbar radicular pain compared with placebo.Methods: A search was conducted in 5 databases for studies comparing an anticonvulsant to placebo in patients with nonspecific low back pain, sciatica or neurogenic claudication of any duration. The outcomes were self-reported pain, disability and adverse events. Risk of bias was assessed using the Physio-therapy Evidence Database (PEDro) scale, and quality of evidence was assessed using Grading of Recommendations Assessment, Development and Evaluation (GRADE). Data were pooled and treatment effects were quantified using mean differences for continuous and risk ratios for dichotomous outcomes.Results: Nine trials compared topiramate, gabapentin or pregabalin to placebo in 859 unique participants. Fourteen of 15 comparisons found anticonvulsants were not effective to reduce pain or disability in low back pain or lumbar radicular pain; for example, there was high-quality evidence of no effect of gabapentinoids versus placebo on chronic low back pain in the short term (pooled mean difference [MD] -0.0, 95% confidence interval [CI] -0.8 to 0.7) or for lumbar radicular pain in the immediate term (pooled MD -0.1, 95% CI -0.7 to 0.5). The lack of efficacy is accompanied by increased risk of adverse events from use of gabapentinoids, for which the level of evidence is high.Interpretation: There is moderate-to high-quality evidence that anticonvulsants are ineffective for treatment of low back pain or lumbar radicular pain. There is high-quality evidence that gaba-pentinoids have a higher risk for adverse events.