March 24, 2023

This question is from one of our podcast listeners who listened to our episode on Cervical Radiculopathy, which you can watch here –

Hello this is dr grant cooper from princeton spine and joint center i wanted to respond to a question that i received the other day the question came in response to a podcast that i had done with dr mailer a while ago the podcast was on cervical radiculopathy basically pinched nerves in the neck and the the podcast went on for uh oh i think it’s about an hour

And a half and we really got into the weeds on things and the the person that wrote in asked you know they said that they really enjoyed the podcast thank you um i appreciate that but why hadn’t we talked about gabapentin why hadn’t gabapentin or neurontin gabapentin being the generic of neurontin galapentin is a medication that’s often used to treat nerve pain

And you know honestly i hadn’t even thought about the fact that we hadn’t talked about that in the in the podcast and that’s a really good question first what is gabapentin it’s a nerve membrane stabilizing drug originally it’s been used as an anti-epileptic some people use it it’s no longer used as a first-line anti-epileptic but sometimes it is used to treat

To treat seizures seizure disorders in conjunction with other medications it’s also used sometimes to help treat depression and it’s used in our space more for pain and specifically for for nerve pain it’s really a pain medication for nerves is the way that that it gets used in the orthopedic and musculoskeletal spaces um now the reason you know that that we

Didn’t touch on that and and when i thought about the question about gabapentin i realized we hadn’t talked about a lot of pain medications um the reason being is that the way that our our practice is is really structured the way that i tend to think about these things even when i write books or or articles is about fixing the underlying problem right and i’m sure

That’s how how people like to think of it as well which is you know someone comes in and they have a pinched nerve in their neck or a penis nerve in their lower back and uh the way we like to go about it is to find out you know where is the the inflammation where’s the pain coming from which you know usually means finding where the inflammation is coming from and

Then talking about how can we make the inflammation go away and then talking about once the inflammation is away how do we use exercises and ergonomics and biomechanics to make sure that the inflammation doesn’t return and that’s the way that we really uh effectively treat um and you know cure these kinds of these kinds of issues so where’s the role for something

Like gabapentin well gabapentin um and other pain medications aren’t going to cure a problem right the gabapentin if you take it for nerve pain might help the nerve pain but when you stop taking the gabapentin you haven’t changed any underlying issue right that the pain is going to come back now that doesn’t mean that there’s no role for gabapentin actually i do

Prescribe gabapentin in in my practice sometimes and i have colleagues that prescribe it a lot more and and some less um but basically i think that uh well a couple of things sometimes life just isn’t as easy as we would like to to think it is and sometimes pain is harder to get to get better and the treatment course becomes more protracted right the exercises

Take longer uh we try injections maybe they don’t work the person is not a surgical candidate or doesn’t want surgery um and and and then what do you do and i think there certainly the the idea of using gabapentin uh becomes much more attractive basically gabapentin goes people take it from anywhere from 100 milligrams all the way up to 3 200 and more milligrams

Sometimes in in my practice and my colleagues that i talked to about this we tend to use anywhere from three to six hundred milligrams or or less a good rule of thumb with gabapentin is that you don’t want to go up or down any on any given day by more than 300 milligrams because you have to remember you can use gabapentin to treat epilepsy to treat seizures and

So it makes me uncomfortable to have someone on a high dosage and then stop it like that you worry about withdrawals you worry about seizures so you want to always taper if you’re on a high dose or if you’re on even a medium dose you want to taper and certainly not go down by more than 300 milligrams in any given day um you want to talk to your doctor about the

Best way to come off of it but it also underscores that this is a you know it’s a serious medication um and uh and so you you wanna you wanna realize that if you’re gonna use it usually you’re gonna stay on it for a little while the way that i like to prescribe it is to to give it to people at night because one of the major side effects of gabapentin is it can

Make you sleepy and i find a lot of people will feel tired and sometimes feel a little bit loopy on the gabapentin and so taking it at night time can sometimes be a really nice way to help people to fall asleep if they’re having trouble sleeping because of the pain one thing you have to be careful of especially in older people is that then if they get up in the

Middle of the night and they go to the bathroom or otherwise get out of bed you worry about fall risks so you have to you have to think about that as well um but that’s that those are the kinds of spaces that gabapentin can can fill the other side effects uh it can it can affect the mood you know it is used sometimes to to help treat depression not as a first or

Even second line treatment usually but but it’s it’s one of the armamentarium of things that people might be be taking um so it affects mood for better or or sometimes worse so you have to be aware of that um and sometimes it affects the memory especially in older people but in anyone it can it can kind of i’ve had people tell me that they have trouble remembering

Their words when they’re taking gabapentin those are the main side effects there are others and obviously the higher the dosage that you that you get on with the gabapentin uh the more likely you are to have to have side effects from it uh but i do think that if you’re looking for that if you’re if you’re having pain and it’s especially if it’s limiting you from

Doing your exercises or if it’s just really seriously impacting your quality of life while you’re hopefully also going about getting the underlying problem better if you’re going to be taking a pain medication and it’s and if that medicine is not going to be tylenol which is probably one of the safest things that people can take as long as they take the recommended

Dosage then gabapentin can be can can be a a good choice when when uh when you also look at the other medications that you’re taking and make sure there’s no contraindications etc something to always be talking about with your doctor obviously uh to make sure that it’s safe and appropriate for you but um with that said and when you’re thinking about also the last

Thing is if you’re taking it during the day it can also make you dizzy so you also want to be thinking about things like like balance um but within those kinds of confines i think gabapentin can be can be a worthwhile medication to consider for for nerve pain um there’s also gabapentin is the the trade name is neurontin the generic is gabapentin there’s a newer

Medication lyrica or pregabalin which you can also take basically for essentially the same indications when it comes to nerve pain a lot of people report fewer side effects on lyrica but i’ve had other people who report more side effects on lyrica so like with any medication uh you have to see how it’s going to respond with you and like with any medication you

Want to start on a lower dosage before you try going to a a higher dosage and work in close consultation with your doctor but lyrica would be another another another option um to take for a nerve pain medication lyrica with older people i would say from my own experience prescribing i’ve noticed a lot more uh issues with cognition with lyrica and it’s and it’s

Made me more reticent uh to use it with some of my older patients that’s just my personal prescribing uh experience um and it’s just something something else to consider and a lot of times you won’t know how you’re going to how you’re going to react to these medicines both as in terms of how it’s going to perhaps help you and also in terms of the possible side

Effects but lyrica is another is another nerve pain medication that one could consider in the same vein as a gabapentin thank you for your question i really appreciate it it was a really good point i think we’ll we’ll talk about more about other medications in uh future videos i think it’s a really good point and something that gets gets overlooked sometimes

Um as we really as we focus on trying to only fix fix fix but sometimes you also have to say look quality of life while you’re going about getting things better is is super um important to uh uh to consider and to address obviously uh that that’s that’s ultimately what all of this is really about and uh we don’t wanna ignore how people are feeling while they’re

Going through the process and so we want to use all the things that we can safely use when they’re appropriate okay thank you very much again thanks for the question uh if you enjoyed this video answer please click like and subscribe and if you have any questions that you would like for me to answer in future videos please send them in you can send me questions

Or comments to my email at dr cooper or feel free to leave a comment in the comment section or question in the comment section thank you very much

Transcribed from video
Does Gabapentin (Neurontin) Work for Nerve Pain? By Princeton Spine \u0026 Joint Center