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Key takeaways
Gabapentin is an anti-seizure medication that is sometimes used to treat nerve pain.
It may be effective for back pain caused by nerve issues, but it likely won’t help with muscle or joint pain.
Older adults and those with kidney disease, respiratory issues, or a history of substance abuse should not take gabapentin because of the danger of serious side effects.
Back pain is one of the most common health complaints among U.S. adults, but not all back pain is the same. Because the causes vary widely, from muscle strain to irritated nerves, the treatments do, too. One medication that often comes up is gabapentin, also sold under the brand names Neurontin or Gralise.
Originally developed to treat seizures in people with epilepsy, gabapentin is now also prescribed for nerve-related pain and used off-label for conditions like anxiety, restless leg syndrome, and alcohol withdrawal symptoms. But when it comes to back pain, its effectiveness depends on what is driving the discomfort.
For pain linked to nerve issues, such as sciatica, gabapentin may offer relief. Here is what to know about when it may help, when it likely will not, and the key safety considerations experts want you to keep in mind.
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How gabapentin works for pain
Gabapentin works by quieting an overexcited central nervous system, says spine surgeon Gbolahan Okubadejo, MD, head of The Institute for Comprehensive Spine Care in the New York City area. “Gabapentin binds to certain calcium channels in nerve cells, which reduces the release of neurotransmitters that send pain signals,” he explains. This is a different mechanism than the one that medications like nonsteroidal anti-inflammatory drugs (NSAIDs) or opioids used to block pain. “Instead, gabapentin turns down the volume on nerves that are misfiring or firing too frequently, which is why it’s much more effective for neuropathic pain than for something like a sprained ankle or a headache,” Dr. Okubadejo says.
Will gabapentin help with back pain?
Yes, but it depends entirely on the cause. “Gabapentin would only be of benefit for nerve-related back pain,” says Medhat Mikhael, MD, a pain management specialist and medical director of the Spine Health Center at MemorialCare Orange Coast Medical Center in Fountain Valley, California. One review published in Pain Practice confirmed that both gabapentin and pregabalin (a gabapentinoid medication) may be effective short-term and long-term treatments for people with lumbar radiculopathy, or pain resulting from a pinched nerve caused by a bulging disc.
Per Drs. Okubadejo and Mikhael, gabapentin may be helpful for pain relief with the following types of back pain
- Lumbar radiculopathy
- Spinal stenosis
- Sciatica (nerve pain radiating down the leg)
- Chronic back pain with a burning, tingling, or shooting quality
- Pain that persists long after an injury has fully healed
On the flip side, gabapentin “would have only minimal to no benefit for mechanical or muscle-related back pain,” Dr. Mikhael says. These types of back pain include:
- Spondylosis of the spine
- Chronic muscle spasms
- Acute muscle strain
- Inflammatory conditions like arthritis
- Fresh injury or trauma
- Mechanical pain caused by posture, weak muscles, or structural issues
NSAIDs, heat, ice, rest, or muscle relaxants are more effective treatments for these types of pain.
Standard dosage for back pain and nerve issues
“The standard approach when prescribing gabapentin is to start at 300 mg once a day and increase every few days until the pain is controlled, typically landing somewhere between 900 mg and 1800 mg daily, split into three doses,” Dr. Okubadejo says.
There are two primary factors that necessitate this gradual increase in dosage.
- Age: “Older adults tend to be much more sensitive to gabapentin’s side effects, dizziness, confusion, and sedation hit harder and faster, so you’d titrate more slowly and aim for a lower final dose,” Dr. Okubadejo explains. Adverse effects can be intense, especially in older adults. For this reason, Dr. Mikhael says that when starting gabapentin, he typically has patients take their single dose at bedtime for a few days before slowly advancing to three times a day.
- Kidney function: “Kidney function matters because gabapentin is cleared almost entirely by the kidneys, so if they’re not working well, the drug builds up in the system, and you can accidentally overdose someone at a dose that would be totally fine in a healthy person,” Dr. Okubadejo says.
Gabapentin is available in four formulations: capsules, tablets, extended-release tablets, and oral liquid solution. The capsules, tablets, and liquid are taken three times a day, evenly spaced, with or without food, while the extended-release tablets are typically taken once daily with food in the early evening. If you miss a dose, take it as soon as you remember, unless it’s nearly time for your next dose. In that case, just take the next dose instead of doubling up.
Potential side effects
“The most common side effects are dizziness, drowsiness, and coordination problems, which is why gabapentin is usually started at a low dose,” Dr. Okubadejo says. “At higher doses or with long-term use, it can cause memory and concentration issues, sometimes described as feeling foggy or mentally slow.”
Other possible side effects of gabapentin include headache, uncontrollable shaking, blurred vision, anxiety, unwanted eye movements, nausea, vomiting, heartburn, diarrhea, constipation, increased appetite and weight gain, swollen extremities, fever, flu-like symptoms, ear pain, and red, itchy eyes. If you experience a rash, itching, swelling of the face, throat, tongue, lips, or eyes, hoarseness, difficulty swallowing or breathing, or seizures, you should call your healthcare provider immediately.
Gabapentin vs. other back pain treatments
If you visit your healthcare provider complaining of back pain, unless you’ve been diagnosed with a nerve-related ailment, gabapentin likely won’t be their first-line treatment option. Instead, there are a variety of other back pain treatments that could be beneficial. Here are some of the most common, along with when they would be most helpful.
Heat or ice
Heat and ice are most effective in the first few days after an injury. Dr. Okubadejo suggests ice in the first 24-72 hours to reduce swelling, followed by heat to ease muscle stiffness and tightness.
NSAIDs
NSAIDs, such as ibuprofen and naproxen, are best for inflammation-driven pain, muscle strain, and herniated discs, Dr. Okubadejo says. He adds that they would be most helpful during the first few weeks of acute back pain or during a flare-up.
Muscle relaxants
When pain is clearly coming from seized or spasming muscles rather than a mechanical or nerve-related problem, muscle relaxants like cyclobenzaprine may provide relief, Dr. Okubadejo says. However, they should only be used for a week or two.
Massage
Massage is best for muscle tension, chronic stiffness, and as a complement to other treatments once the acute inflammation has settled following an injury, Dr. Okubadejo says.
Physical therapy
Providers will use physical therapy after surgery, a few weeks after an injury, or for chronic, recurring, or posture- or muscle-imbalance-related pain, Dr. Okubadejo says.
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Safety considerations and interactions
There are several safety considerations to keep in mind if you’re taking gabapentin. As mentioned earlier, gabapentin is only eliminated by the kidneys, so people with kidney disease need to be very careful taking it or avoid it altogether. “Gabapentin should also be used with major caution in patients with chronic respiratory disease like COPD,” Dr. Mikhael says. That’s because it can cause sedation and depression of the central nervous system, especially if combined with pain medications or alcohol, which can lead to respiratory depression, he explains.
In addition to folks with the conditions mentioned above, Drs. Okubadejo and Mikhael say that older adults, people with a history of substance abuse, people with heart failure, and people who are pregnant or breastfeeding should not take gabapentin.
“Combining it with opioids, benzodiazepines, or alcohol is genuinely dangerous and has been responsible for a significant number of overdose deaths,” Dr. Okubadejo says. On the flip side, if you’re on a high dose for a long period of time, it’s important to taper down your dose of gabapentin as opposed to stopping cold turkey. “There’s real potential for dependence and withdrawal if stopped abruptly,” Dr. Okubadejo says.
Is gabapentin right for your back pain?
If your back pain is nerve-related, such as a pinched nerve from a bulging disc, sciatica, or spinal stenosis, gabapentin may help. But if you’re struggling with something like lower back pain from sitting in the wrong chair at work, it likely won’t have much effect. Ultimately, it’s important to seek medical advice from your healthcare provider to identify the underlying cause of your back pain and develop the best possible treatment plan.
- Comparing the effectiveness of pregabalin and gabapentin in patients with lumbar radiculopathy: A systematic review and meta-analysis, Pain Practice (2024)
- Gabapentin, National Library of Medicine (2020)
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