Association Between Chiropractic Spinal Manipulation & Gabapentin Prescriptions for Radicular Low Back Pain…Conservative care first!

Radicular low back pain is type of neuropathic pain, characterized by a nerve root lesion leading to radiating ipsilateral lower extremity symptoms. Gabapentin is an anticonvulsant and anti-epileptic medication which may work to alleviate neuropathic pain by binding to a subunit of voltage gated calcium channels, subsequently inhibiting ectopic nerve discharges. Typically, gabapentin is used for several types of neuropathic pain such as diabetic neuropathy, as well as increasing off-label uses, such as treating radicular low back pain.

However, systematic reviews have demonstrated clear evidence that there is a lack of effectiveness for the use of gabapentin for radicular low back pain. In addition to the lack of evidence supporting its use, there are potentially adverse effects of gabapentin include somnolence, dizziness, ataxia, and fatigue. As a result, several clinical practice guidelines do not recommend the use of gabapentin for the treatment of low back pain or radicular low back pain.

Despite the lack of evidence supporting its use, gabapentin continues to be prescribed for low back pain. A survey in the US found that in 2018, 20% of patients who visited a medical doctor for low back pain were recommended to take gabapentin in the preceding 12 months .  Another study found that 99% of gabapentin prescriptions were for off-label indications, most commonly degenerative spinal disorders and other back problems.

Spinal manipulative therapy (SMT) is commonly provided to patients experiencing radicular low back pain. Other studies have found that when someone with low back pain initiates care with a chiropractor, the odds of receiving medication such as opioids or benzodiazepines are reduced (we posted a review on this last month). To date, there has been no research to explore the association between receiving chiropractic care compared to usual medical care for low back pain and subsequent gabapentin use.

The present study aimed to examine if undergoing SMT following a radicular low back pain diagnosis, influences the likelihood of subsequently receiving a gabapentin prescription. The authors hypothesized that adults receiving SMT following a radicular low back pain diagnosis would have reduced odds of receiving a gabapentin prescription compared with those receiving usual, non-chiropractic medical care over a 1 year follow-up.

Comment from Dr. Thistle:

“Once again, these ‘big data’ studies are providing some compelling evidence that seeing a chiropractor for low back (with or without radicular symptoms) can help reduced the use of these prescription medications that: 1) aren’t that effective anyway, and 2) come with a lot of potential side effects!“

RESEARCH REVIEW: Association Between Chiropractic Spinal Manipulation & Gabapentin Prescriptions for Radicular Low Back Pain

This paper was published in BMJ Open 2023 – FULL TEXT HERE

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