What is the relationship between orthopedic pain and pregabalin (lyrica)?

From the Guidelines

Pregabalin is a recommended treatment for orthopedic pain with neuropathic components, with a typical starting dose of 75mg twice daily, which can be gradually increased to 150mg twice daily if needed, with a maximum daily dose of 600mg divided throughout the day 1.

Key Points

• Pregabalin works by binding to calcium channels in the nervous system, reducing the release of excitatory neurotransmitters and thereby decreasing pain signals.
• It is particularly useful for conditions like sciatica, post-surgical orthopedic pain, or arthritis with neuropathic elements.
• Common side effects include dizziness, drowsiness, and weight gain, which often improve with continued use.
• Pregabalin should be taken with or without food, and should not be stopped abruptly as this may cause withdrawal symptoms.
• If orthopedic pain doesn't have a neuropathic component, traditional pain management approaches like NSAIDs, physical therapy, or other analgesics may be more appropriate.
• Always combine medication with other pain management strategies like physical therapy, proper body mechanics, and appropriate rest for comprehensive orthopedic pain management.

Considerations

• The American Academy of Neurology recommends pregabalin as a first-line treatment for neuropathic pain, including diabetic neuropathy and postherpetic neuralgia 1.
• The CDC clinical practice guideline for prescribing opioids for pain recommends considering nonpharmacologic therapy and nonopioid pharmacologic therapy, including pregabalin, before initiating opioid therapy 1.
• A study published in the Annual Review of Medicine found that pregabalin has a therapeutic equivalency to other medications for the treatment of neuropathic pain, including gabapentin and duloxetine 1.

From the FDA Drug Label

Pregabalin is a prescription medicine used in adults, 18 years of age and older to treat: pain from damaged nerves (neuropathic pain) that happens with diabetes pain from damaged nerves (neuropathic pain) that follows healing of shingles fibromyalgia (pain all over your body) pain from damaged nerves (neuropathic pain) that follows spinal cord injury

The FDA drug label does not mention ortho pain specifically, but it does mention neuropathic pain which can be related to orthopedic conditions. However, there is no direct information about the use of pregabalin for ortho pain.

• Pregabalin is used to treat various types of neuropathic pain, but its use for orthopedic pain is not explicitly mentioned in the label.
• The label does mention that pregabalin can be used to treat pain from damaged nerves, but it does not specify orthopedic conditions.
• There is no information in the label about the efficacy or safety of pregabalin for ortho pain 2, 2, 2.

From the Research

Ortho Pain and Pregabalin

• Orthopedic pain management involves a variety of treatments, including pharmacologic, physical, and psychological methods 3
• Pregabalin is a first-line treatment for neuropathic pain according to international guidelines, but its efficacy and misuse risk have led to it being considered a second-line treatment in some guidelines 4
• Studies have compared the efficacy of pregabalin with other medications, such as gabapentin, in treating neuropathic pain, with mixed results 5, 6
• In the context of orthopedic injuries, pain management should be tailored to the individual patient and may involve escalating treatment with the lowest dose of the safest medication available, as well as adjunctive nonpharmacologic therapies 7
• Pregabalin has been shown to be effective in reducing mechanical allodynia, but its efficacy on neuroma pain is different and may require combination therapy with other medications, such as morphine 5
• A retrospective cohort study found no significant difference in meaningful pain reduction between gabapentin and pregabalin, but pregabalin may have better tolerability and lower pill burden compared to gabapentin 6