From the Guidelines
Pregabalin should be initiated at a dose of 50 mg three times daily or 75 mg twice daily for back pain, with a gradual increase to 300 mg/d after 3-7 days, and further titration to 600 mg/d if necessary and tolerated. The dosing regimen for pregabalin is crucial for its efficacy and safety in managing back pain, particularly neuropathic pain 1. According to the prescribing recommendations, the maximum dosage of pregabalin is 600 mg/d, which can be achieved through a titration process, starting with lower doses and increasing as needed and tolerated 1.
When considering pregabalin for back pain, it's essential to differentiate between neuropathic and other types of pain, as pregabalin is specifically effective for nerve-related pain. The medication works by binding to calcium channels in the nervous system, thereby reducing the release of excitatory neurotransmitters that transmit pain signals. Common side effects of pregabalin include dizziness, drowsiness, and weight gain, which often improve over time 1.
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 side effects and adjusting the dose accordingly
- Considering the patient's renal function, as pregabalin dosing may need to be adjusted in cases of impaired renal function 1
- Using pregabalin as part of a comprehensive treatment plan that may include physical therapy, exercise, and other pain management strategies.
From the FDA Drug Label
In view of the dose-dependent adverse reactions and the higher rate of treatment discontinuation due to adverse reactions, reserve dosing above 300 mg/day for those patients who have on-going pain and are tolerating 300 mg daily 2. 6 Neuropathic Pain Associated with Spinal Cord Injury in Adults The recommended dose range of pregabalin for the treatment of neuropathic pain associated with spinal cord injury is 150 to 600 mg/day.
The dose of pregabalin for back pain, specifically neuropathic pain associated with spinal cord injury, is 150 to 600 mg/day. The recommended starting dose is 75 mg two times a day (150 mg/day), and the dose may be increased to 150 mg two times a day (300 mg/day) within 1 week based on efficacy and tolerability 2.
From the Research
Pregabalin for Back Pain
- Pregabalin is used to treat chronic low back pain, but its efficacy and safety are still being studied 3.
- A systematic review found that pregabalin was slightly less efficacious than other treatments, such as amitriptyline and celecoxib, for chronic low back pain without radiculopathy or neuropathy 3.
- Another study compared the therapeutic effects of pregabalin and gabapentin after transforaminal epidural nerve block in lumbar radiculopathy, and found that both medications can be equally used to reduce pain in these patients 4.
Dosage and Administration
- The optimal dosage of pregabalin for back pain is not specified in the provided studies, but a study on fibromyalgia found that twice daily and once nightly dosing of 300-mg daily doses of pregabalin were both effective in reducing pain 5.
- The study on fibromyalgia also found that once nightly dosing was associated with fewer treatment-emergent adverse events than twice daily dosing 5.
Comparison with Other Treatments
- A study found that duloxetine, a medication used to treat chronic low back pain, had better compliance and lower opioid use compared to standard of care treatments, which included pregabalin 6.
- Another study found that pregabalin was less efficacious than duloxetine, acceptance and commitment therapy, and other treatments for chronic low back pain 7.