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Correction: anticonvulsants can be helpful for some neuropathy (just not back pain)

 •  • by Paul Ingraham
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Weekly nuggets of pain science news and insight, usually 100-300 words, with the occasional longer post. The blog is the “director’s commentary” on the core content of a library of major articles and books about common painful problems and popular treatments. See the blog archives or updates for the whole site.

I recently published an important correction in my back pain book. I had excessively demonized the drugs gabapentin (Neurontin) and pregabalin (Lyrica). My error came from a bias-powered oversimplification of their legal history and inadequate attention to the evidence on efficacy for neuropathy. It suited my narrative to make them look worse than they actually are.

My original text correctly focused on some profit-motivated corruption, proper Big Pharma nonsense. Pfizer has been both sued and heavily fined over various fraudulent practices in promoting these drugs for back pain and sciatica — “off-label” prescription, using them for conditions they haven’t actually been shown to help. This is one of the more extreme cases of the pharmaceutical industry living up to its reputation for evil-doing. Corruption is the only reason these drugs were ever given to patients for those purposes.

I got so outraged by this story that I went a little too far, declaring that gabapentin and pregabalin were also “useless” for neuropathy in general — their original purpose. That was simply false, and it took about three years for a reader to call me on it. It always amazes me how long that takes. I get plenty of unconstructive criticism (read: hate mail), but the good stuff is harder to come by. For three long years, apparently no reader had the knowledge, confidence, and five spare minutes needed to file this bug report.

I also made this mistake because I am always a bit overeager to demonstrate that I am willing to criticize both mainstream and alternative medicine (even though my willingness is already extensively on the record). So I chased an opportunity to demonstrate my fair-mindedness… right into error. It was all too easy to exaggerate a little, fail to fact check… and, boom, I was “fair-minded” but inaccurate. Embarrassing! And so I owe my readers an apology. Fortunately, it’s never too late to admit a mistake.

Gabapentin and pregabalin drugs are indeed efficacious for some kinds of neuropathy, for some people, some of the time (see Wiffen, Derry). They aren’t amazing on average, but they are certainly worth trying.

But please! Do not accept a prescription of anticonvulsants for back pain or sciatica. If you get one, you need a new doctor, not a new medication. That key point does not need correction.