Management of Chronic Low Back Pain

Introduction to Gabapentinoids

Gabapentinoids are specifically effective only for radicular/sciatic pain, not for chronic axial low back pain, as stated by the American College of Physicians 1, 2, 3
The American College of Physicians recommends against using gabapentinoids for chronic low back pain without radiculopathy due to the lack of benefit and significant risk of adverse effects 1, 2, 3

Antidepressants, such as amitriptyline, have demonstrated moderate efficacy for chronic low back pain, according to the American College of Physicians, with higher-quality evidence 2, 4
Duloxetine has shown modest improvement in pain intensity and function compared to placebo, as recommended by the American College of Physicians 4
Nonsteroidal anti-inflammatory drugs (NSAIDs) are recommended as first-line treatment for short-term pain relief, according to the American College of Physicians 4

The American College of Physicians recommends adjusting the dose of gabapentin in patients with moderate renal impairment (eGFR 37-50 mL/min) to avoid accumulation and toxicity 1, 2, 3

The American College of Physicians recommends re-evaluating the nature of the pain to determine if there is a radicular component, and if so, gabapentin may be considered with strict renal adjustment 2, 4
For chronic axial low back pain without radiculopathy, the American College of Physicians recommends stopping pregabalin and switching to an antidepressant or duloxetine 4