Cookie policy: This site uses cookies (small files stored on your computer) to simplify and improve your experience of this website. Cookies are small text files stored on the device you are using to access this website. For more information please take a look at our terms and conditions. Some parts of the site may not work properly if you choose not to accept cookies.

Join

Subscribe or Register

Existing user? Login

Pain management

Draft NICE guidance advises against the use of gabapentinoids and benzodiazepines for sciatica

The National Institute for Health and Care Excellence guideline, currently out for consultation, advises that gabapentinoids, other antiepileptics, oral corticosteroids or benzodiazepines should not be offered for the management of sciatica.

Pregabalin lyrics gabapentinoid ss18

Source: Shutterstock.com

Gabapentinoids should not be offered to patients with sciatica, according to draft guidance

Gabapentinoids, oral corticosteroids and benzodiazepines should not be offered to patients with sciatica, according to a draft update from the National Institute for Health and Care Excellence (NICE).

The guideline, originally published in 2016, covers the assessment and management of low back pain and sciatica and the 2020 update, which is currently out for consultation, advises that gabapentinoids, other antiepileptics, oral corticosteroids or benzodiazepines should not be offered to patients for the management of sciatica. It also says opioids should not be offered for the management of chronic sciatica.

It advises that any patient taking opioids, gabapentinoids or benzodiazepines for sciatica should be made aware of problems associated with withdrawal.

Finally, it says that prescribers should be aware that there was limited evidence of benefit for the use of non-steroidal anti-inflammatory drugs in sciatica.

The NICE committee said that the updates were based on evidence that indicated that gabapentinoids and oral corticosteroids did not improve sciatica symptoms and both increased the risk of adverse events in the long term. The recommendations also took into account the reclassification of gabapentinoids as a Schedule 3 controlled drug in 2019.

Benzodiazepines were not associated with a risk of adverse events, but there was evidence of a poorer response to placebo in terms of pain reduction, the committee said.

They also said that there was no evidence on the use of other antiepileptics or opioids for sciatica. 

Emma Davies, advanced pharmacy practitioner in pain management at Cwm Taf Morgannwg University Health Board, said the recommendations were “sound” on the basis of existing evidence and how NICE makes its assessments.

“I think they are careful in weighing up the limited potential benefits and the very obvious risks of all the medicine groups involved,” she explained.

“My concern, as always, is that NICE do not have the power or influence to actually mandate service changes. So, while I agree that people should get self-management support, psychologically informed practice etc., it is hard to achieve this in practice and too often it is only available when all medical and surgical possibilities are exhausted.

“This needs to change and should include a lot more high-profile public messaging and education … pharmacy teams in community need to upskill in this area and be better able to have conversations about back pain and sciatica that do not encourage or result in the sale of medication.”

The final updated guideline is expected to be published on 22 September 2020.

Citation: The Pharmaceutical Journal DOI: 10.1211/PJ.2020.20208192

Have your say

For commenting, please login or register as a user and agree to our Community Guidelines. You will be re-directed back to this page where you will have the ability to comment.

Recommended from Pharmaceutical Press

  • BNF and British National Formulary for Children

    BNF and British National Formulary for Children

    Now available as a 1 year print subscription to both the BNF and British National Formulary for Children, ensuring you have the latest medicines information as it publishes and at a greatly reduced price.

    £138.50Buy now
  • BNF and British National Formulary for Children

    BNF and British National Formulary for Children

    Now available as a 2 year print subscription to both the BNF and British National Formulary for Children, ensuring you have the latest medicines information as it publishes and at a greatly reduced price.

    £262.50Buy now
  • Patient Care in Community Practice

    Patient Care in Community Practice

    Patient Care in Community Practice is a unique, practical guide for healthcare professionals or carers. Covers a range of non-medicinal products suitable for use at home.

    £22.00Buy now
  • Clinical Pharmacokinetics

    Clinical Pharmacokinetics

    A practical guide to the use of pharmacokinetic principles in clinical practice. Includes case studies with questions and answers.

    £33.00Buy now
  • Strategic Medicines Management

    Strategic Medicines Management

    A practical guide to influencing the availability of medicines, and policies of their use. Focuses on the strategic elements of medicines management.

    £33.00Buy now
  • Print
  • Share
  • Comment
  • Save
  • Print Friendly Version of this pagePrint Get a PDF version of this webpagePDF

Jobs you might like

Newsletter Sign-up

Want to keep up with the latest news, comment and CPD articles in pharmacy and science? Subscribe to our free alerts.