From the Guidelines
Gabapentin is the most appropriate medication to treat tingling in legs from back problems, with a recommended dose of 300-1200 mg three times daily. This recommendation is based on the study by 1, which found that gabapentin is associated with small, short-term benefits in patients with radiculopathy.
When considering treatment options, it's essential to weigh the potential benefits and risks of each medication. Some key points to consider include:
- The use of benzodiazepines, such as for short-term pain relief, is not recommended due to the risks of abuse, addiction, and tolerance, as noted in the study by 1.
- Herbal therapies, like devil's claw, willow bark, and capsicum, may be safe options for acute exacerbations of chronic low back pain, but their benefits are generally small to moderate.
- Systemic corticosteroids are not recommended for treating low back pain with or without sciatica, as they have not been shown to be more effective than placebo, according to the study by 1.
In terms of treatment approach, it's crucial to consider a comprehensive plan that includes:
- Nonpharmacologic therapy with proven benefits, such as spinal manipulation for acute low back pain or intensive interdisciplinary rehabilitation for chronic or subacute low back pain, as recommended by 1.
- Physical therapy to address the underlying back condition and improve overall function.
- Regular monitoring to assess the effectiveness of treatment and adjust the plan as needed.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Medication Options for Tingling in Legs from Back
- The treatment of spine-related pain, including tingling in legs, often involves the use of various medications, as discussed in 2.
- Nonsteroidal anti-inflammatories (NSAIDs) and acetaminophen are commonly used for arthritic and myofascial-based pain, while gabapentinoids or duloxetine may be used for neuropathic and radicular pain 2.
- Gabapentin and pregabalin have shown mixed evidence for neuropathic pain, but may be beneficial for some patients, as seen in 2 and 3.
- Serotonin-norepinephrine reuptake inhibitors (SNRIs) have good evidence for neuropathic pain and a more favorable safety profile than tricyclic antidepressants (TCAs) 2.
- Tramadol may be used in older patients, but its use is often limited due to the risk of cognitive and opioid side effects 2.
Safety and Efficacy Considerations
- When using medications for spine-related pain, it is essential to consider the potential risks and benefits, particularly in older adults with reduced liver and renal function, comorbid medical problems, and polypharmacy 2.
- The use of opioids is typically avoided in the treatment of spine-related pain in older adults due to their morbidity and mortality risk, and are reserved for refractory severe pain 2.
- Pregabalin and gabapentin have demonstrated a favorable safety profile in the treatment of pruritus, with common adverse effects including dizziness, somnolence, and nausea 3.