Combining Celecoxib and Pregabalin for Lumbar Radiculopathy
Yes, you can combine celecoxib and pregabalin for lumbar radiculopathy, as this targets both the inflammatory and neuropathic pain components, though evidence shows this combination provides only modest benefit with increased side effects compared to either agent alone.
Evidence for Combination Therapy
The combination of celecoxib and pregabalin has been directly studied in the perioperative setting, where patients receiving both medications (pregabalin 75 mg twice daily plus celecoxib) experienced less acute pain on postoperative day one, but morphine consumption did not differ and there were more side effects in the combination group 1. This suggests the combination is feasible but comes with a trade-off between modest pain reduction and increased adverse effects.
For neuropathic pain conditions more broadly, combination therapy targeting different pain mechanisms has shown promise, with pregabalin demonstrating additional benefit when added to existing analgesics in multiple trials 1. However, a critical caveat is that lumbosacral radiculopathy appears to be relatively refractory to standard neuropathic pain medications, with one crossover study showing no benefit from morphine, nortriptyline, or their combination specifically in this condition 1.
Recommended Treatment Algorithm
Start with celecoxib (100-200 mg daily) to target the inflammatory component of radicular pain 2, 3. NSAIDs like celecoxib are recommended as first-line treatment by the American College of Physicians due to moderate efficacy and acceptable safety profile 3, 4.
Add pregabalin (starting at 75 mg twice daily, titrating up to 150-300 mg twice daily as tolerated) for the neuropathic component 2, 3. Gabapentin shows small to moderate short-term benefits specifically for radicular pain, and pregabalin is in the same drug class 2, 3.
Monitor closely for side effects, particularly dizziness, sedation, and peripheral edema 2. The combination increases risk of central nervous system adverse events compared to monotherapy 1.
Reassess efficacy after 2-4 weeks 2. If no meaningful improvement occurs, discontinue pregabalin as lumbar radiculopathy may be relatively refractory to gabapentinoids 1, 3.
Important Caveats and Pitfalls
Research specifically in lumbar radiculopathy shows inconsistent findings for gabapentinoids, with pain reduction ranging from only 0.3 to 1.9 points on a 0-10 scale 3. One study found pregabalin added to celecoxib showed no benefit compared to celecoxib alone in chronic low back pain without radiculopathy 5.
Neither medication is FDA-approved specifically for lumbar radiculopathy 2, 3. Use time-limited courses rather than indefinite therapy, as most trials were only 2-4 weeks duration 2.
In older patients, start with lower doses and titrate more gradually, as adverse effects may be more severe 3. Adjust pregabalin dosing in patients with renal impairment 2.
Avoid systemic corticosteroids, as they are ineffective for low back pain with or without sciatica 2, 4.
Alternative Considerations
If the combination fails, consider switching to tricyclic antidepressants (amitriptyline) or duloxetine, which have moderate evidence for chronic radicular pain 2, 3. The American Academy of Neurology suggests therapeutic equivalency between tricyclic antidepressants, SNRIs, and gabapentinoids for neuropathic pain, with combination therapy potentially superior to monotherapy 3.
For refractory cases, epidural steroid injections combined with oral medications provide better short-term pain relief (at discharge and 1 month) compared to oral medications alone, though differences disappear by 3-6 months 6.