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Lyrica vs Gabapentin: Which is Better for Sciatica Pain?

by Dr. Sharon Orrange on April 12, 2017 at 3:57 pm

Sciatica is the term for pain radiating from the low back down the back/side of your leg, sometimes with tingling. The most common cause of sciatica is a bulging or herniated disc. It affects up to 40% of adults at some point in their lives—and there is conflicting information out there on the best option for relief.

Similar to any chronic low back pain, the first place to start is with NSAIDs like naproxen (Aleve) or ibuprofen (Advil or Motrin) along with physical therapy. When NSAIDs and physical therapy aren’t enough for pain relief another medication is often added. This is where it gets tricky—as it turns out many of them don’t work well. Few treatments have been well studied for sciatica . . . and a recent study on Lyrica for acute sciatica was met with disappointing results. So, after NSAIDS, what’s the next best choice?

  • Lyrica (pregabalin). While Lyrica has been shown to help for nerve pain in diabetics (diabetic neuropathy), a recent study on acute sciatica was discouraging. Starting at a dose of 75 mg twice a day (150 mg daily) then increasing to the maximum dose of 600 mg per day, this study showed that Lyrica for 8 weeks did not relieve sciatic pain compared with a placebo. Additionally, Lyrica was associated with higher rates of side effects and adverse events than the placebo. What about Lyrica for those struggling with chronic sciatica (defined as pain for more than 3 months)? Most patients with chronic sciatica initially responded to Lyrica therapy but that response faded over time and was no better than placebo. So, Lyrica for sciatica—not so much.
  • Neurontin (gabapentin). There are no head to head comparisons of Lyrica and gabapentin for sciatica. However, gabapentin has been studied for chronic sciatica and has shown greater efficacy in pain reduction compared with a placebo. Worth a try.
  • Gabapentin + amitriptyline. Adding amitriptyline (Elavil) to gabapentin (Neurontin) has been studied in folks with chronic sciatica. In addition to NSAIDs, folks were given either amitriptyline (10-50 mg per day), gabapentin (900 mg per day), or both. Dizziness and vertigo along with feeling sleepy were common complaints in those taking gabapentin, though it did help improve pain. Gabapentin in combination with amitriptyline was even more effective in 56% of people, though more than ⅓ stopped the gabapentin due to side effects.

Hope this helps.

Dr O.

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