What to Know Before Using Gabapentin to Treat Your Back Pain

Along with another medication called pregabalin, gabapentin falls under a class of drugs called gabapentinoids (2). These medications are anticonvulsants originally intended to control epileptic seizures (2).

Gabapentinoids can also treat nerve pain caused by diabetes and shingles (2). They work by inhibiting calcium release, which in turn blocks certain pain-inducing neurotransmitters (3).

In addition to being used for treating seizures, gabapentin and pregabalin are often prescribed for many off-label uses not officially endorsed by the Federal Drug Administration (FDA), including back pain, muscle pain from fibromyalgia, anxiety, bipolar disorder, insomnia, migraines, and vertigo (4, 5, 38). Common brand names for gabapentin include Neurontin, Gralise, and Horizant (5).

Gabapentin and pregabalin differ in terms of how they’re regulated. Pregabalin is a controlled substance, regulated by the FDA because of its highly addictive properties, while gabapentin isn’t (5, 6).

Although it has many uses, gabapentin most effectively treats neuropathic (nerve-related) pain (2).‍

Spinal Issues

Research shows that back problems caused by a herniated disk or spinal stenosis are usually treatable with gabapentin (7).

Spinal herniation occurs when a disk between adjacent spinal vertebrae slips out of place and pinches a nerve (8). Spinal stenosis is a degenerative condition typically seen in people over 60 that causes a narrowing of the lower spinal canal (9). Like spinal herniation, stenosis painfully pinches the nerves (9).

Subjects in one study reported a significant improvement in their disk hernia pain after taking gabapentin for three months (7). Another study that examined far lateral lumbar disc herniations, disc pain that extends outwards, found similar results and recommended gabapentin as a first-step medication for hernia pain (10).

Individuals with lumbar spinal stenosis treated with gabapentin have exhibited increased walking distance while wearing steel braces, as well as reduced lumbar spine pain (7). Subsequent research has replicated these findings (11).

Sciatica

Gabapentin can help relieve sciatica, intense pain that runs along the sciatic nerve from the lower back through the hips and buttocks (12). Sciatica affects one side of the body and is usually caused by disk herniation or spinal stenosis (12).

Early research has found that prescribing gabapentin at the onset of sciatica symptoms can help prevent central sensitization of the nerves (13). If it’s not prevented, then central sensitization can result in long-term alterations in the body’s perception of pain, including feeling pain in response to normally painless stimuli (14).

In addition to preventing central sensitization from developing, gabapentin’s primary use in cases of sciatica is in helping to control short-term severe sciatic pain (15). Additional research is needed to better understand the long-term efficacy of gabapentin for sciatica (15).

Gabapentin performs similarly to more interventional treatment methods like steroid injections in cases of sciatica, but avoids some of the adverse effects that these interventions carry like injection site damage (16, 17).

Other Neuropathic Pain

Gabapentin can effectively treat chronic lower back pain caused by diabetes and shingles (18).

High blood sugar levels associated with diabetes can lead to nerve pain called diabetic neuropathy (19). Although this condition usually results in pain in the feet and legs, it can also affect the hips, buttocks, or thighs (19). Cochrane reviews show that gabapentin can effectively reduce this kind of neuropathic pain (18).

In people over 50, shingles commonly cause postherpetic neuropathy, a burning pain that lasts after shingles’ symptoms disappear (20). Studies show that extended-release gabapentin may successfully treat post-shingles pain (18, 21).

Post-surgery Back Pain

‍Current research suggests that gabapentin is safer than opioids for reducing postoperative pain (2).

Gabapentin and opioids both require prescriptions and alter brain function (22). But, gabapentin is significantly less addictive and causes milder withdrawal symptoms than opioids (22).

Gabapentin can provide significant pain relief following spinal disk surgery (23). Subjects who used a combination of gabapentin and epidural steroid injections reported better pain relief than those who relied on injections and non-steroidal anti-inflammatory drugs (NSAIDs) (24).

Arthritis

Studies indicate that gabapentin is largely ineffective for treating back pain caused by chronic conditions like arthritis (25, 26).

Gabapentin is also ineffective for treating non-specific lumbar pain, regardless of if the pain is radicular or non-radicular (27, 28).‍

Fibromyalgia

‍Research shows that discomfort caused by fibromyalgia, a nerve disease that manifests as widespread musculoskeletal pain, can be treated with gabapentin (29, 30).

Gabapentin comes in capsule, tablet, and liquid formulations (31).

When taking gabapentin, try to use the smallest effective dosage, best determined by gradually increasing your dosage until there’s a reduction in pain (33).

Don’t abruptly stop taking the medication as this can cause withdrawal symptoms like anxiety and sleeping issues (32).

Store gabapentin tablets and capsules at room temperature, and refrigerate liquid preparations (33).

Using gabapentin to treat back pain carries significant risks. Provide your doctor with a detailed list of current medications and pre-existing medical and psychological conditions before taking gabapentin (32).

Drug Interactions

Never take gabapentin with opioids, unless advised to do so by your doctor (32).

Gabapentin carries a high risk of misuse, especially for individuals with a history of substance abuse issues (34). In recent years, gabapentin has come under increased scrutiny over its role in the opioid epidemic as opioid deaths have been linked to gabapentin (34, 35).

Those seeking an “opioid high” may use gabapentin to magnify opioids’ euphoric effects, increasing the risk of respiratory depression, the primary cause of opioid-related overdose death (34, 35).

Most physicians consider gabapentin to be safer than opioids, but some members of the medical community are calling for increased regulation (35). States like Ohio, Michigan, Kentucky, Tennessee, and West Virginia have labeled gabapentin a controlled substance alongside pregabalin (36).

Other less serious drug interactions can occur when taking gabapentin (32). Exercise caution when taking gabapentin concurrently with NSAIDs like Advil, heartburn medications like Mylanta, or antacids (32). Separate doses of antacids and gabapentin by two hours to avoid gastrointestinal discomfort (31).

Other Adverse Effects

Gabapentin can result in dizziness, fatigue, confusion, and sight issues like double vision (37). It can also lead to nausea and vomiting, rapid weight gain, shakiness, and swelling in the hands or feet (33).

Use of gabapentinoids may cause or exacerbate symptoms associated with mood disorders, such as anxiety, panic attacks, and sleeping problems (32). Report any behavioral changes to your doctor (32).

Seek immediate medical attention if you experience an allergic reaction, coordination issues, extreme fatigue, jaundice, difficulty breathing, muscle pain, or uncontrollable eye movement after taking gabapentin (31, 32, 33).

Special Considerations

If you’re pregnant, breastfeeding, or have kidney issues, consult with your doctor before taking gabapentin (31, 32). Use caution when driving or operating a vehicle as gabapentin can cause drowsiness (32). Alcohol can amplify the drowsiness effects (32).

If gabapentin isn’t right for you, muscle relaxants, antidepressants, steroid injections, and surgery are potential alternatives for treating back pain.

Disk Herniation

Muscle relaxants and antidepressants are common non-invasive treatment options for slipped disk pain (38). If these medications aren’t effective, injections and surgery may be worth considering (39).

Clinical trials show that epidural steroid injections are highly effective in reducing slipped disk pain (39). In many cases, pain that’s unresponsive to steroid injections can be successfully treated with a surgical procedure called a discectomy (40).‍

Spinal Stenosis

Pain caused by spinal stenosis can be treated with muscle relaxants, steroid injections, antidepressants (41, 42).

Muscle relaxants are usually the first course of treatment, followed by steroid injections (42, 43, 44). Initial clinical trials reveal that tricyclic antidepressants (TCAs) are highly effective in treating stenosis-induced back pain, but more research is needed to substantiate these results (45).

Fibromyalgia

Studies indicate that antidepressants can successfully reduce fibromyalgia pain (46, 47). TCAs are better than selective serotonin reuptake inhibitors (SSRIs) for treating fibromyalgia, and the serotonin-norepinephrine reuptake inhibitor (SNRI) duloxetine is also effective (46).

Pregabalin can also treat fibromyalgia (48).

Non-specific Lumbar Pain

‍Muscle relaxants like cyclobenzaprine can effectively treat acute non-specific low back back (49, 50). However, these sedatives carry some risk of dependence and may result in adverse side effects, including dizziness, nausea, and vomiting (49, 50).

Gabapentin is an antiepileptic drug originally intended for seizures. It’s most effective for treating neuropathic back pain caused by disk herniation and consequent sciatica, as well as spinal stenosis, diabetic neuropathy, and postherpetic neuralgia. It’s largely ineffective in treating non-specific chronic pain and arthritis, but may relieve fibromyalgia.

Given the risks and adverse events possible with this medication, you should exercise caution when taking gabapentin. Because of its risk of dependence, don't take gabapentin while using opioids. Report any sudden changes in mood or behavior, and signs of an allergic reaction, to your doctor.

Be sure to follow your doctor’s exact directions when taking gabapentin. Don’t increase your dosage amount or frequency unless advised to do so by your doctor. Individuals who are pregnant, breastfeeding, or have kidney issues should consult their doctor before taking gabapentin.

Alternatives to gabapentin include muscle relaxants, antidepressants, steroid injections, and in severe cases, surgery.