Today's post from vancouversun.com (see link below) will come as no surprise to may neuropathy patients who have been both disappointed by the ineffectiveness of pregabalin (Lyrica) and damaged by its side-effects. The fact is that it rarely works for neuropathic pain. However, because of aggressive marketing, it's the world's number one treatment for nerve pain! To be fair to Pfizer, they did withdraw their own recommendation for Lyrica for many disease-related neuropathies in March 2013 but that was forced by litigation and so much protest that it was inevitable. The FDA's warnings about the drug were that last straw. So why is it still so widely prescribed, despite the inherent dangers of side effects? Who knows! Apparently the marketing goes on and unscrupulous drugs company reps will prioritise getting rid of current supplies as quickly as possible. If you are prescribed Lyrica (pregabalin) for your neuropathic symptoms, please have a serious discussion with your doctor and maybe try to arrange an alternative. This article highlights the dangers if you don't.
Erin Ellis, Vancouver Sun 01.18.2016
A report by the Therapeutics Initiative at UBC suggests Lyrica only helps about one in 10 of the people to whom it is prescribed.JB REED / BLOOMBERG NEWS
A pain medication that rarely works as promised had a 17-fold increase in prescriptions over a decade, says the latest research from the Therapeutics Initiative at the University of B.C.
Its report says only about one in 10 patients will gain relief from pregabalin (trade name Lyrica), which is used to treat peripheral neuropathy — usually foot pain caused by diabetes — and other discomfort. Therapeutics Initiative is think-tank that reviews the usefulness of prescribed drugs and offers advice to B.C.’s doctors and pharmacists.
The latest work released Tuesday concludes that pregabalin, and two other painkillers studied, gabapentin and duloxetine (Cymbalta), all have little effect on pain despite extensive marketing campaigns promoting them.
Co-author Dr. Tom Perry, a clinical assistant professor in the department of anesthesiology, pharmacology and therapeutics at UBC, says doctors often tell patients to take these medications in higher doses and for a longer time than the evidence supports. Patients should know within days whether the medications are working for them, he says.
“These drugs are intended to make someone feel better; if you’re not feeling better, why take it?”
Perry and co-author Aaron Tejani, a clinical assistant professor in Pharmaceutical Sciences, looked information on gabapentin, pregabalin and a number of other medications gathered by Cochrane Reviews which evaluate scientific research from around the world. They found expectations of the drugs’ effectiveness far outstripped the evidence and likely drives an increasing number of prescriptions.
In B.C., pregabalin prescriptions rose 17 fold from 2005 through 2014, compared with a 1.8-fold increase in people receiving gabapentin.
Gabapentin is now available as a generic drug, but was formerly trademarked medication called Neurontin manufactured by Pfizer. The pharmaceutical giant agreed to pay $430 million in U.S. fines in 2004 after marketing it for unapproved uses such as migraine headaches and pain.
Combined costs of gabapentin, pregabalin, and duloxetine were over $52 million in British Columbia during 2014, says the Therapeutics Initiative report, of which Pharmacare paid over $13 million, mostly for gabapentin.
Pregabalin, also manufactured by Pfizer for neuropathic pain, is not covered under B.C.’s publicly funded Pharmacare following a recommendation by a national drug advisory committee in 2005. As a result, patients either pay for it out-of-pocket or through private health insurance,
Worse than simply buying a medication that’s not working, Perry says pregabalin is often prescribed to older adults who may become drowsy or lose their balance because of it.
Therapeutics Initiative is funded by the B.C. Ministry of Health through a grant to UBC.
eellis@vancouversun.com
http://www.vancouversun.com/health/common+drug+diabetic+foot+pain+effective+researchers/11662999/story.html
Today's post from sciencedaily.com (see link below) takes another look at pregabalin (lyrica) and although this article reveals its shortcomings when treating lower back pain, people with neuropathy who take lyrica should not be disheartened or suprised if it doesn't work for you. Apart from the fact that Pfizer themselves have withdrawn recommendations for taking lyrica for both diabetic and HIV-related neuropathy (which should be warning enough), many doctors still prescribe it for all nerve damage related symptoms. There is growing evidence to show that it is frequently ineffective and that's not to mention the potential side effects, which have led people to take Pfizer to court and have resulted in the company withdrawing its own positive support for certain conditions. Gabapentin (also not without its critics) or cymbalta may be a better option in most cases where it has failed but people living with diabetic and HIV-related neuropathy should really have a serious talk with their doctors before even beginning with Lyrica (pregabalin) - it's possibly not the wisest option!
Summary:
Pregabalin is not effective in controlling the pain associated with lumbar spinal stenosis, the most common type of chronic lower back pain in older adults, a study concludes. Pregabalin, which is marketed by Pfizer under the name Lyrica, is approved to treat chronic pain associated with shingles, spinal cord injury, fibromyalgia, and diabetic peripheral neuropathy. However, it is also commonly prescribed as an "off label" treatment for chronic low back pain syndromes like lumbar spinal stenosis.
A new study out in the journal Neurology shows that pregabalin is not effective in controlling the pain associated with lumbar spinal stenosis, the most common type of chronic lower back pain in older adults.
"Chronic low back pain is one of the most common reasons why older adults go to the doctor and lumbar stenosis is the leading indication for surgery in this age group," said John Markman, M.D., director of the Translational Pain Research Program in the University of Rochester Department of Neurosurgery and lead author of the study. "While physicians have increasingly looked for medication alternatives to opioid pain medication like gabapentin and pregabalin to help these patients manage their pain, until now there has been no credible evidence as to whether or not these treatments are effective for this problem."
Pregabalin, which is marketed by Pfizer under the name Lyrica, is approved to treat chronic pain associated with shingles, spinal cord injury, fibromyalgia, and diabetic peripheral neuropathy. However, it is also commonly prescribed as an "off label" treatment for chronic low back pain syndromes like lumbar spinal stenosis.
Lumbar spinal stenosis is brought about by a narrowing of the spinal canal caused by the degeneration of the vertebrae, discs, muscles, and ligaments that comprise the spinal column. This results in a compression of nerve roots that can trigger pain, tingling, and numbness in the lower back, buttocks, and legs. The pain is most commonly experienced when a person is upright or walking and can be lessened by bending forward at the waist, which is often why one sees older adults hunched over with a cane or a walker.
While some narrowing of the spinal canal occurs with normal aging and does not always cause pain, more severe compression of nerves limits mobility and leads patients to try stronger pain medications and epidural steroid injections in an attempt to control the pain that is associated with walking and standing.
Patients also often decide to undergo surgery that removes a portion of the bone or disc to give the nerve roots more room. The procedure -- called a lumbar laminectomy -- is the most common reason for spine surgery in people over the age of 60. While the surgery is initially highly successful, the pain often returns after a number of years. Also, for some patients, surgery is not an option.
For a long time, physicians have attempted to expand the arsenal of medications available to treat this condition. In fact, it is estimated that more than two thirds of the pain treatment regimens currently being used for lumbar spinal stenosis consist of drugs like pregabalin that are not approved by the Food and Drug Administration for the condition.
The new study employed a novel approach to evaluating the effectiveness of pain treatments. Because the pain associated with the lumbar spinal stenosis is present when a person is upright or walking, the researchers asked individuals with the condition to report their pain levels while walking on a treadmill. They found there was no significant difference in the levels of pain experienced by those taking the drug and those that received a placebo.
"Given the cost and potential side effects associated with pregabalin, it is critical that we understand the efficacy of this drug," Markman said. "This study convincingly demonstrates a lack of relief with pregabalin for the walking pain associated with lumbar spinal stenosis."
Story Source:
The above story is based on materials provided by University of Rochester Medical Center. Note: Materials may be edited for content and length.
Journal Reference:
J. D. Markman, M. E. Frazer, S. A. Rast, M. P. McDermott, J. S. Gewandter, A. K. Chowdhry, K. Czerniecka, W. H. Pilcher, L. S. Simon, R. H. Dworkin. Double-blind, randomized, controlled, crossover trial of pregabalin for neurogenic claudication. Neurology, 2014; DOI: 10.1212/WNL.0000000000001168
http://www.sciencedaily.com/releases/2014/12/141210162318.htm
