One-year follow-up for the therapeutic efficacy of pregabalin in patients with leg symptoms caused by lumbar spinal stenosis

Abstract

BackgroundPregabalin is a well-accepted treatment option for patients with neuropathic pain. However, the therapeutic efficacy of pregabalin for reducing the incidence of spinal surgery to treat leg symptoms in patients with lumbar spinal stenosis remains unknown. The purpose of this study was to analyze the therapeutic efficacy of pregabalin for reducing the incidence of spinal surgery for leg symptoms in patients with lumbar spinal stenosis during the first year of treatment.MethodsConsecutive patients diagnosed with lumbar spinal stenosis at our hospital from January to June 2009 were treated with nonsteroidal anti-inflammatory drug monotherapy and formed the control group (n = 47; 22 males, 25 females). Patients diagnosed with lumbar spinal stenosis at our hospital between August 2010 and October 2011 were treated with a nonsteroidal anti-inflammatory drug and pregabalin combination therapy and formed the pregabalin group (n = 49; 27 males, 22 females). The proportions of patients who underwent spinal surgery during the first year of treatment were assessed and compared between the two groups using the Mann-Whitney U test. In addition, the periods in which patients decided to undergo spinal surgery were compared using the Kaplan-Meier method.ResultsSix patients (12.2 %) in the pregabalin group and 22 patients (46.8 %) in the control group underwent spinal surgery during the first year of treatment (P = 0.0035). The period in which patients decided to undergo spinal surgery was significantly delayed in the pregabalin group compared with the control group in those for whom spinal surgery was necessary (P = 0.0128).ConclusionsNonsteroidal anti-inflammatory drug and pregabalin combination therapy may result in a lower incidence of spinal surgery during the first year of treatment or a delayed period before undergoing spinal surgery if necessary compared with nonsteroidal anti-inflammatory drug monotherapy in patients with leg symptoms caused by lumbar spinal stenosis.

Pregabalin for Refractory Radicular Leg Pain due to Lumbar Spinal Stenosis: A Preliminary Prospective Study

“…Taken together, the effects of PGB on neuropathic leg pain in the LSS patients in the current study were similar to those observed in a previous study including 96 LSS patients [ 1 ], thus confirming the analgesic effects of PGB in LSS patients with neuropathic leg pain. Total of 82.4% of the patients showed improved pain, which indicates clinical efficacy of PGB.…”

“…Therefore, the patients included in the present study were considered to have moderate-to-severe leg pain with a mean VAS score of 72, which significantly improved after PGB treatment for 6 weeks. There are multiple pathological mechanisms underlying leg pain in LSS patients; central canal stenosis may compress the cauda equina, whereas lateral recess stenosis and foraminal stenosis may compress the nerve roots while sparing the spine, resulting in inflammation, ischemia, malnutrition, nerve degeneration, nerve injury, and mechanoreceptive compression [ 1 ]. This implies the involvement of both NocP and NeP.…”

“…Patients with lumbar spinal stenosis (LSS) often experience chronic and refractory pain, and this condition is the most common reason for spinal surgery in patients older than 65 years [ 1 ]. The major pathologies underlying pain in LSS patients are neurological damage to the cauda equina and spinal nerve compression by the degenerative and bulged intervertebral disc, degenerative facet joint, and hypertrophic bone and/or ligamentum flavum.…”

Transforming Growth Factor-β Induces Interleukin-6 Secretion from Human Ligamentum Flavum–Derived Cells through Partial Activation of p38 and p44/42 Mitogen-Activated Protein Kinases

“…Although inflammatory responses, including those related to interleukin-6 (IL-6), are known to be important pain mediators in sciatic symptoms [ 4 ], and specific features, such as LF hypertrophy, are common in patients with LSS, the precise relationship between LF hypertrophy and pain in these patients remains unclear. Standard treatments for LSS primarily focus on pain reduction through nonsteroidal anti-inflammatory drugs, gabapentinoids, and certain opioids [ 5 ]. Surgical interventions, such as decompression, are considered when conservative approaches fail.…”

p38 Mitogen-Activated Protein Kinase Is Involved in Interleukin-6 Secretion from Human Ligamentum Flavum–Derived Cells Stimulated by Tumor Necrosis Factor-α

“…However, the mechanisms responsible for ligamentum flavum hypertrophy in this context are not known. Therefore, standard treatments for LSS include drugs such as nonsteroidal anti-inflammatories, gabapentinoids, and certain opioids, which only reduce the pain without addressing the root of the problem [ 9 , 10 ]. When these medicines do not work well for patients, surgical interventions such as decompression are considered [ 11 ].…”