Evidence map›Paper›PMID 29970367›Full record

SynthesisCMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne2018

Anticonvulsants in the treatment of low back pain and lumbar radicular pain: a systematic review and meta-analysis.

Oliver Enke, Heather A New, Charles H New, Stephanie Mathieson, Andrew J McLachlan, Jane Latimer, Christopher G Maher, C-W Christine Lin

Open access · goldAbstract readMeta-AnalysisSystematic Review
PubMed Full text at PMC Publisher
In one paragraph

Synthesis in CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 73 papers, 6 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
73citing papers in PubMed, 6 pooled it
13.7field-weighted citation impact, top 1% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

73 citing papers in PubMed, 6 syntheses or guidelines pooled it, 185 citations in OpenAlex.

  1. Guideline
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  4. How effective are physiotherapy interventions in treating people with sciatica? A systematic review and meta-analysis.European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society · 2023
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  10. Ten-year outcomes of medical cannabis for chronic low back pain: opioid reduction, pain relief, and functional improvement in 1,000 patients.European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society · 2026
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13 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

8 authors at 4 institutions in 1 country.

Oliver EnkeThe University of Sydney (Enke, H.A. New, C.H. New), Sydney Medical School Nepean, Kingswood, Australia; Westmead Hospital (H.A. New), Westmead, Australia; The University of Sydney (Mathieson, Latimer, Maher, Lin), Sydney School of Public Health; The University of Sydney and Concord Hospital (McLachlan), Faculty of Pharmacy and Centre for Education and Research on Ageing, Sydney, Australia dr.oliver.enke@gmail.com.
Heather A NewThe University of Sydney (Enke, H.A. New, C.H. New), Sydney Medical School Nepean, Kingswood, Australia; Westmead Hospital (H.A. New), Westmead, Australia; The University of Sydney (Mathieson, Latimer, Maher, Lin), Sydney School of Public Health; The University of Sydney and Concord Hospital (McLachlan), Faculty of Pharmacy and Centre for Education and Research on Ageing, Sydney, Australia.
Charles H NewThe University of Sydney (Enke, H.A. New, C.H. New), Sydney Medical School Nepean, Kingswood, Australia; Westmead Hospital (H.A. New), Westmead, Australia; The University of Sydney (Mathieson, Latimer, Maher, Lin), Sydney School of Public Health; The University of Sydney and Concord Hospital (McLachlan), Faculty of Pharmacy and Centre for Education and Research on Ageing, Sydney, Australia.
Stephanie MathiesonThe University of Sydney (Enke, H.A. New, C.H. New), Sydney Medical School Nepean, Kingswood, Australia; Westmead Hospital (H.A. New), Westmead, Australia; The University of Sydney (Mathieson, Latimer, Maher, Lin), Sydney School of Public Health; The University of Sydney and Concord Hospital (McLachlan), Faculty of Pharmacy and Centre for Education and Research on Ageing, Sydney, Australia.
Andrew J McLachlanThe University of Sydney (Enke, H.A. New, C.H. New), Sydney Medical School Nepean, Kingswood, Australia; Westmead Hospital (H.A. New), Westmead, Australia; The University of Sydney (Mathieson, Latimer, Maher, Lin), Sydney School of Public Health; The University of Sydney and Concord Hospital (McLachlan), Faculty of Pharmacy and Centre for Education and Research on Ageing, Sydney, Australia.
Jane LatimerThe University of Sydney (Enke, H.A. New, C.H. New), Sydney Medical School Nepean, Kingswood, Australia; Westmead Hospital (H.A. New), Westmead, Australia; The University of Sydney (Mathieson, Latimer, Maher, Lin), Sydney School of Public Health; The University of Sydney and Concord Hospital (McLachlan), Faculty of Pharmacy and Centre for Education and Research on Ageing, Sydney, Australia.
Christopher G MaherThe University of Sydney (Enke, H.A. New, C.H. New), Sydney Medical School Nepean, Kingswood, Australia; Westmead Hospital (H.A. New), Westmead, Australia; The University of Sydney (Mathieson, Latimer, Maher, Lin), Sydney School of Public Health; The University of Sydney and Concord Hospital (McLachlan), Faculty of Pharmacy and Centre for Education and Research on Ageing, Sydney, Australia.
C-W Christine LinThe University of Sydney (Enke, H.A. New, C.H. New), Sydney Medical School Nepean, Kingswood, Australia; Westmead Hospital (H.A. New), Westmead, Australia; The University of Sydney (Mathieson, Latimer, Maher, Lin), Sydney School of Public Health; The University of Sydney and Concord Hospital (McLachlan), Faculty of Pharmacy and Centre for Education and Research on Ageing, Sydney, Australia.
The University of Sydney · AUNepean Hospital · AUWestmead Hospital · AUConcord Repatriation General Hospital · AU

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundThe use of anticonvulsants (e.g., gabapentin, pregabalin) to treat low back pain has increased substantially in recent years despite limited supporting evidence. We aimed to determine the efficacy and tolerability of anticonvulsants in the treatment of low back pain and lumbar radicular pain compared with placebo.

methodsA search was conducted in 5 databases for studies comparing an anticonvulsant to placebo in patients with nonspecific low back pain, sciatica or neurogenic claudication of any duration. The outcomes were self-reported pain, disability and adverse events. Risk of bias was assessed using the Physiotherapy Evidence Database (PEDro) scale, and quality of evidence was assessed using Grading of Recommendations Assessment, Development and Evaluation (GRADE). Data were pooled and treatment effects were quantified using mean differences for continuous and risk ratios for dichotomous outcomes.

resultsNine trials compared topiramate, gabapentin or pregabalin to placebo in 859 unique participants. Fourteen of 15 comparisons found anticonvulsants were not effective to reduce pain or disability in low back pain or lumbar radicular pain; for example, there was high-quality evidence of no effect of gabapentinoids versus placebo on chronic low back pain in the short term (pooled mean difference [MD] -0.0, 95% confidence interval [CI] -0.8 to 0.7) or for lumbar radicular pain in the immediate term (pooled MD -0.1, 95% CI -0.7 to 0.5). The lack of efficacy is accompanied by increased risk of adverse events from use of gabapentinoids, for which the level of evidence is high.

interpretationThere is moderate- to high-quality evidence that anticonvulsants are ineffective for treatment of low back pain or lumbar radicular pain. There is high-quality evidence that gabapentinoids have a higher risk for adverse events. PROTOCOL REGISTRATION: PROSPERO-CRD42016046363.

Indexed as

AnticonvulsantsHumansLow Back PainSpinal Nerve RootsAnticonvulsants

Identifiers

PMID29970367
PMCPMC6028270
OpenAlexW2810136901

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.