From the Research
Pregabalin is the preferred treatment for S1 radiculopathy due to its superior efficacy in reducing pain in the short-term follow-up compared to gabapentin, as shown in the most recent and highest quality study 1. S1 radiculopathy typically presents with pain that radiates from the lower back down the posterior thigh and calf into the lateral or plantar aspect of the foot, often described as shooting or electric in nature. Patients may experience numbness or tingling in the lateral foot and the small toe. Muscle weakness can affect the gastrocnemius and soleus muscles, resulting in difficulty with plantar flexion of the foot (pushing the foot downward), which may manifest as trouble walking on tiptoes or weakness when pressing the gas pedal while driving. The Achilles reflex is often diminished or absent in S1 radiculopathy. Other symptoms include sensory changes in the S1 dermatome, gait abnormalities, and sometimes bowel or bladder dysfunction in severe cases. The condition typically results from compression or irritation of the S1 nerve root, commonly due to a herniated disc, spinal stenosis, or foraminal narrowing.
Diagnosis and Treatment
Initial treatment usually involves conservative measures such as pain management with NSAIDs, physical therapy focusing on core strengthening and proper body mechanics, and sometimes epidural steroid injections for significant pain.
- Key points to consider in treatment:
- Pregabalin has been shown to be more effective than gabapentin in reducing pain in the short-term follow-up 1
- Gabapentin may still be considered as an alternative treatment option, especially in cases where pregabalin is not tolerated or available 2, 3, 4
- Surgical intervention may be considered for cases with progressive neurological deficits or when conservative treatment fails to provide relief
Evidence-Based Recommendations
The most recent and highest quality study 1 suggests that pregabalin is the preferred treatment for S1 radiculopathy due to its superior efficacy in reducing pain in the short-term follow-up compared to gabapentin. This study provides strong evidence for the use of pregabalin in the treatment of S1 radiculopathy, and its findings should be considered in clinical practice. Other studies 2, 3, 5, 4 provide additional evidence for the use of gabapentin and other treatment options, but the most recent and highest quality study 1 takes precedence in guiding clinical decision-making.