Should You Be Taking Gabapentin for Pain?

But is gabapentin really an effective option for pain relief? The answer depends on the type of pain — along with a few other factors. Here’s what experts say about gabapentin, its recommended uses, potential risks and side effects, and who might want to try it.

• Partial Seizures To help calm overactive brain cells
• Postherpetic Neuralgia (PHN) To ease nerve pain after shingles
• Restless Legs Syndrome (RLS) To reduce uncontrollable leg movements during sleep, with only the Horizant formulation approved for this purpose

So how did gabapentin become commonly used off-label for other types of pain — despite not having FDA approval for those conditions?

• Diabetic neuropathy
• Fibromyalgia
• Irritable bowel syndrome (IBS)

• Postherpetic neuralgia pain (PHN), or nerve pain that happens after a shingles infection occurs, is an FDA-approved use of gabapentin, which is available in capsule, tablet, and oral solution form.

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  It’s considered to be a first-line option for this shingles complication.

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• Restless legs syndrome (RLS), a condition that causes uncontrollable movement and painful sensations in the legs. Current medical guidelines from the American Academy of Sleep Medicine strongly recommend gabapentin as part of RLS treatment.

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• Diabetic neuropathy pain, or pain that occurs as a result of damaged nerves from high blood sugar levels, may benefit from gabapentin.

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  While gabapentin is not FDA-approved for this purpose, it’s still recommended by the diabetes professional medical association, and physicians often utilize it as a first-line treatment in these cases.

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  “There is general consensus of effectiveness for gabapentin when used for painful diabetic neuropathy — though not without caveats,” Growdon says.

While clinicians and patients report that gabapentin may be effective at calming nerve pain for non-FDA-approved conditions like diabetic neuropathy, more scientific evidence is needed before it can be broadly — and officially — recommended. “The off-label use of gabapentin is commonplace for nerve pain conditions; however, specific studies for other pain conditions may be more limited despite its [possible] efficacy,” says Dr. Liao.

• Drowsiness
• Dizziness
• Headache
• Blurry vision
• Coordination difficulties
• Weight gain
• Swollen hands, legs, and feet
• Nausea or vomiting
• Fever
• Memory loss or confusion
• Difficulty speaking
• Double vision or unusual eye movements
• Skin rash or hives
• Swelling of the face, tongue, throat, lips, or eyes
• Difficulty swallowing or breathing
• Seizures
• Abnormal changes in mood or behavior
• Trouble urinating, dark-colored urine, or blood in your urine
• Yellowing of the skin and eyes (jaundice)
• Bluish tint to lips, skin, and nail bed color

“We know that taking three or more centrally nervous system active medications increases the risk of falls in older adults, which can be a major cause of morbidity and even mortality among older adults,” Growdon explains.

• Older adults, as the medication can increase drowsiness and risk of falling
• People with lung or respiratory conditions, as it can lead to serious breathing issues
• People with kidney disease, as it may not clear the body properly, which could lead to toxicity
• People who are pregnant, as while human research is limited,

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   some evidence suggests a potential link to a higher risk of birth impacts, particularly in late pregnancy

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   As with other medications, gabapentin use should be discussed in consultation with your healthcare provider to assess individualized safety during pregnancy.

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Gabapentin may be a pain management treatment option for people with nerve pain-related conditions. “Patients with nerve-related pain conditions are potential candidates for gabapentin; however, evaluation by a medical professional is necessary before it can be prescribed,” Liao says.

But even if you’ve been diagnosed with neuropathic pain, it’s important to ask your healthcare provider about the specific potential risks and possible benefits of gabapentin.

“When discussing chronic pain with a primary care physician, focus on how the pain has changed your ability to do your activities of daily living, sleep, or exercise, and what an effective treatment would look like for you,” MacKenzie says.

In addition, a healthcare provider can advise you about available pain management approaches — including other nerve pain medications, physical therapy, topical treatments, and lifestyle modifications.

“Medication may be one part of this, but mindfulness, physical therapy, acupuncture, and other modalities may be effective ways to control pain without the side effects of medication,” says MacKenzie. “Sometimes, medication does help patients — even when prescribed off-label, like gabapentin. It is important to have a reward-risk discussion with your doctor to see if it is the right fit for you.”

• Gabapentin is a prescription medication that’s FDA-approved to treat partial seizures, postherpetic nerve pain from shingles, and restless leg syndrome (for which only the Horizant formulation is an approved treatment).
• In recent decades, healthcare professionals have prescribed it off-label to treat other types of pain and conditions, such as low back pain, migraine, and more, though more research is needed to confirm its efficacy for these unapproved conditions.
• Despite its off-label uses, research suggests that gabapentin is most effective for nerve-related (neuropathic) pain.
• If you’re experiencing pain, experts recommend consulting with a healthcare provider about which treatment options may be best for you.