Whilst pregabalin (PGB) and gabapentin (GBP) are both used to treat neuropathic 
pain, their relative role in sciatica is unclear. Our aim was to extensively 
review the roles of PGB and GBP in treating sciatica. The efficacy, side effects 
(SE) profile and cost of PGB and GBP in neuropathic pain states were reviewed 
with special reference to sciatica. Eleven articles matched the criteria: seven 
systematic reviews, one retrospective cross-sectional study, one 
placebo-controlled-crossover study, one randomized placebo-controlled 
double-blind study and one case report. GBP and PGB appeared to demonstrate 
comparable efficacy and SE. However, the amount and quality of evidence was low, 
and only indirect comparisons were available. Importantly, no direct 
"head-to-head" study existed. Globally, costs varied widely (by up to 31 times) 
and unpredictably (PGB cheaper than GBP, or vice versa). Formulary regulator 
rulings were globally disparate; however, many exclusively favoured the more 
expensive drug (whether GBP or PGB). No studies assessed PGB-GBP interchange. 
Weak evidence suggests that efficacy and SE with GBP and PGB are probably 
similar; however, firm conclusions are precluded. Despite weak data, and having 
cited minor titration, but definite cost, advantages, UK National Institute for 
Health and Clinical Excellence favoured PGB over GBP. Given that no evidence 
supports unhindered PGB-GBP interchange, neither drug should probably be 
favoured. Prospective "head-to-head" studies are urgently required to provide 
robust evidence-based knowledge for choice of GBP or PGB in sciatica.