Lyrica vs. Gabapentin: Which is Better for Sciatica Pain?

Dr. Sharon Orrange
Dr. Orrange is an Associate Professor of Clinical Medicine in the Division of Geriatric, Hospitalist and General Internal Medicine at the Keck School of Medicine of USC.
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Sciatica — the pain that travels from your low back down your leg — is extremely common. It affects up to 40% of adults, but there’s a lot of conflicting information out there on which medications work best to relieve pain. Lyrica (pregabalin), Neurontin (gabapentin), and Neurontin + Elavil (amitriptyline) are all popular pain relievers, but here’s what research says about which ones actually work.

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. Similar to any chronic low back pain, the first place to start is physical therapy and over-the-counter NSAIDs (non-steroidal anti-inflammatory drugs) like naproxen (Aleve) and ibuprofen (Advil or Motrin). But when that’s not enough, what’s the next best choice?

This is where it gets tricky. As it turns out, many prescription pain relievers don’t work well for sciatica pain and few have actually been studied well.

Lyrica (pregabalin)

While Lyrica has been shown to help for nerve pain in diabetics (diabetic neuropathy), a recent study on acute sciatica was discouraging. First, it showed that Lyrica for eight weeks did not relieve sciatic pain better than a placebo. Patients in the study started with a dose of 75 mg twice a day (150 mg daily) and then increased that dose to a maximum of 600 mg per day. 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 three months? In another study, 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 good.

Neurontin (gabapentin)

There are no head to head research studies comparing Lyrica to gabapentin for sciatica pain. However, gabapentin has been studied for chronic sciatica and has shown greater effectiveness in reducing pain compared to placebo.

So, Neurontin for sciatica? Worth a try.

Neurontin (gabapentin) + Elavil (amitriptyline)

Lastly, adding Elavil (amitriptyline) to Neurontin (gabapentin) 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 gabapentin did help improve pain. Gabapentin in combination with amitriptyline was most effective in 56% of the patients, though more than a third stopped taking gabapentin due to side effects.

So, Neurontin + Elavil for sciatica? Worth a try.

Hope this helps.

Dr O.

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