What are the doses of Pregabalin (Lyrica) for treating back pain?

From the Guidelines

Pregabalin for back pain should be initiated at 50 mg three times daily or 75 mg twice daily, with a gradual increase to 300 mg daily in divided doses, and can be further titrated up to 600 mg daily if necessary and tolerated. According to the study published in the Mayo Clinic Proceedings 1, the recommended starting dosage for pregabalin is 50 mg three times daily or 75 mg twice daily, which can be increased to 300 mg daily after 3-7 days, and then by 150 mg daily every 3-7 days as tolerated. The maximum dosage is 600 mg daily, which can be administered as 200 mg three times daily or 300 mg twice daily. It's essential to consider lower starting dosages and slower titration in geriatric patients or those with impaired renal function. Pregabalin has been shown to be effective in reducing neuropathic pain, and its efficacy and tolerability are similar to those of gabapentin, but with more straightforward dosing due to its linear pharmacokinetics.

Some key points to consider when prescribing pregabalin for back pain include:

• Starting with a lower dose and gradually increasing as needed and tolerated
• Monitoring for common side effects such as dizziness, drowsiness, and weight gain
• Being aware that pregabalin may take 1-2 weeks to show effectiveness
• Continuing other prescribed treatments like physical therapy during this time
• Regular follow-up with a healthcare provider to monitor effectiveness and adjust dosing as needed, especially since pregabalin is a controlled substance due to its potential for dependence.

It's also important to note that pregabalin works best for neuropathic back pain rather than mechanical back pain, as it modulates calcium channels in the nervous system to reduce pain signal transmission. Overall, pregabalin can be an effective treatment option for back pain, especially when used appropriately and under the guidance of a healthcare provider.

From the FDA Drug Label

1. 6 Neuropathic Pain Associated with Spinal Cord Injury in Adults

The recommended dose range of pregabalin capsules for the treatment of neuropathic pain associated with spinal cord injury is 150 mg to 600 mg/day. The recommended starting dose is 75 mg two times a day (150 mg/day). The dose may be increased to 150 mg two times a day (300 mg/day) within 1 week based on efficacy and tolerability Patients who do not experience sufficient pain relief after 2 to 3 weeks of treatment with 150 mg two times a day and who tolerate pregabalin capsules may be treated with up to 300 mg two times a day

The recommended dose of pregabalin for back pain (specifically neuropathic pain associated with spinal cord injury) is 150 mg to 600 mg/day, starting at 75 mg two times a day (150 mg/day) and increasing to 150 mg two times a day (300 mg/day) within 1 week based on efficacy and tolerability, and up to 300 mg two times a day if necessary 2.

• Initial dose: 75 mg two times a day (150 mg/day)
• Dose range: 150 mg to 600 mg/day
• Maximum dose: 600 mg/day Note that the dose may be increased based on efficacy and tolerability.

From the Research

Pregablin Doses for Back Pain

• The optimal dose of pregabalin for back pain is not explicitly stated in the provided studies, but the following doses were used:
  • 150 mg, 300 mg, and 600 mg daily in the study by 3
  • 75 mg/day, titrated to a maximum of 150 mg twice daily in the study by 4
  • 75 mg prolonged release in combination with etoricoxib 60 mg in the study by 5
• The study by 3 found that pregabalin 300 mg and 600 mg daily were effective in reducing pain intensity in patients with postherpetic neuralgia, painful diabetic neuropathy, and mixed or unclassified post-traumatic neuropathic pain
• The study by 4 found that a fixed-dose combination of low-dose pregabalin and duloxetine was non-inferior to pregabalin monotherapy in reducing pain intensity in patients with moderate to severe neuropathic pain
• The study by 5 found that a fixed-dose combination of pregabalin prolonged release and etoricoxib was more effective than etoricoxib alone in reducing pain and improving functional status in patients with chronic low back pain

Adverse Effects

• The studies found that pregabalin was associated with adverse effects such as:
  • Somnolence and dizziness, which were more common with pregabalin than with placebo in the study by 3
  • Peripheral oedema, which was more common with pregabalin monotherapy than with the fixed-dose combination of pregabalin and duloxetine in the study by 4
• The study by 5 found that the fixed-dose combination of pregabalin prolonged release and etoricoxib was well tolerated, with no significant difference in adverse effects compared to etoricoxib alone

Efficacy

• The studies found that pregabalin was effective in reducing pain intensity in patients with:
  • Postherpetic neuralgia, painful diabetic neuropathy, and mixed or unclassified post-traumatic neuropathic pain in the study by 3
  • Moderate to severe neuropathic pain in the study by 4
  • Chronic low back pain in the study by 5
• The study by 6 found that pregabalin was slightly less efficacious than amitriptyline, the combination of tramadol/acetaminophen, and celecoxib in reducing pain intensity in patients with chronic low back pain without radiculopathy or neuropathy
• The study by 7 found that pregabalin was effective in reducing neuropathic pain in patients with chronic low back pain associated with radiculopathy, but may have adverse effects on balance at initial doses and dose increments.