Intended for healthcare professionals

Practice Therapeutics

Pregabalin and gabapentin for pain

BMJ 2020; 369 doi: (Published 28 April 2020) Cite this as: BMJ 2020;369:m1315
  1. Stephanie Mathieson, research fellow1 2,
  2. Chung-Wei Christine Lin, professor1 2,
  3. Martin Underwood, professor3 4,
  4. Sam Eldabe, professor5
  1. 1Institute for Musculoskeletal Health, Sydney, Australia
  2. 2Sydney School of Public Health, University of Sydney, Australia
  3. 3Warwick Clinical Trials Unit, University of Warwick, Coventry, UK
  4. 4University Hospitals Coventry and Warwickshire, Coventry, UK
  5. 5James Cook University Hospital, Middlesbrough, UK
  1. Correspondence to S Mathieson stephanie.mathieson{at}

What you need to know

  • Pregabalin and gabapentin can be effective as first line treatment for some people with neuropathic pain such as post-herpetic neuralgia and diabetic peripheral neuropathy

  • They are not effective for low back pain, sciatica, spinal stenosis, or episodic migraine, and their off-label use for these conditions is not advised

  • Ask patients to report side effects such as dizziness, sleepiness, and gait problems, which may require the drugs to be tapered and stopped

A 65 year old woman presents with continuous dull back ache and leg pain over the past four years. She underwent lumbar decompression surgery three months ago, but the pain persists. She has no neurological deficits. She is on treatment for hypertension and chronic kidney disease and cannot take non-steroidal anti-inflammatory drugs. She has tried paracetamol, codeine, tramadol, and amitriptyline for her pain in the past with little benefit. You offer a trial of pregabalin and ask her to follow up if she feels dizzy or is not able to tolerate the drug.

What are pregabalin and gabapentin?

Pregabalin and gabapentin, collectively gabapentinoids, are primarily anticonvulsant drugs. Over the past decade, they have been increasingly prescribed for pain.1 They are recommended for neuropathic pain in adults23 (table 1), but are commonly used off-label for other pain disorders such as low back pain, sciatica, and migraine.910 Pregabalin was one of the highest selling drugs globally in 2017.11 In 2018, more than 14 million prescriptions of pregabalin and gabapentin were issued in England.12 This increase in gabapentinoid prescribing may be driven by a desire to avoid opioid analgesics.13

View this table:
Table 1

Approved indications for pregabalin and gabapentin

Pregabalin and gabapentin were reclassified as Class C drugs in the UK in April 2019 following an increase in the number of deaths caused by gabapentinoid misuse and addiction.14 Under the UK’s Misuse …

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