What medications are used to treat pinched nerve symptoms?

From the Guidelines

Gabapentinoids, such as pregabalin, are the most effective medications for treating pinched nerve symptoms, according to the most recent and highest quality study 1. Several medications can effectively treat pinched nerve symptoms.

• Nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen (400-800mg every 6-8 hours) or naproxen (220-500mg twice daily) are typically first-line treatments to reduce inflammation and pain.
• Acetaminophen (Tylenol, 325-650mg every 4-6 hours, not exceeding 3000mg daily) can help manage pain without reducing inflammation.
• For more severe pain, muscle relaxants such as cyclobenzaprine (5-10mg three times daily) or methocarbamol (750mg every 8 hours) may be prescribed for short-term use (1-2 weeks).
• In cases of intense pain, doctors might prescribe corticosteroids like prednisone (typically a 5-7 day tapering course) to reduce inflammation, or gabapentin (starting at 300mg daily, gradually increasing) for nerve pain, as recommended by a systematic review of rehabilitation and exercise recommendations in oncology guidelines 1.
• Topical treatments like lidocaine patches (5%, applied for up to 12 hours daily) or diclofenac gel (apply to affected area 4 times daily) can provide localized relief.
• The use of combination therapies, such as gabapentin and extended-release morphine, or pregabalin and topical 5% lidocaine, may also be effective in treating pinched nerve symptoms, as suggested by a study on recommendations for the pharmacological management of neuropathic pain 1.
• Additionally, a consensus recommendation on diagnosis, assessment, and management of painful diabetic peripheral neuropathy suggests that first-line therapies should include a TCA, the SNRI duloxetine, or the anti-convulsants pregabalin or gabapentin 1. These medications work by either reducing inflammation around the compressed nerve or by interrupting pain signals, but they should be combined with rest, physical therapy, and proper posture to address the underlying cause of nerve compression.

From the FDA Drug Label

The efficacy of the maximum recommended dose of pregabalin for the management of neuropathic pain associated with diabetic peripheral neuropathy was established in three double-blind, placebo-controlled, multicenter studies The efficacy of pregabalin for the management of postherpetic neuralgia was established in three double-blind, placebo-controlled, multicenter studies

Medications for Pinched Nerve Symptoms:

• Pregabalin (PO) is used to treat neuropathic pain associated with diabetic peripheral neuropathy and postherpetic neuralgia, which may be related to pinched nerve symptoms.
• The studies 2 show that pregabalin can statistically significantly improve the endpoint mean pain score and increase the proportion of patients with at least a 50% reduction in pain score from baseline.
• However, the label does not directly mention "pinched nerve" as an indication, so this answer is based on the assumption that pinched nerve symptoms may be related to neuropathic pain.

From the Research

Pinched Nerve Medication

Medications used to treat pinched nerve symptoms include:

• Gabapentin: an anticonvulsant that has been shown to be effective in treating neuropathic pain, including pain caused by pinched nerves 3, 4, 5
• Pregabalin: an anticonvulsant that is similar to gabapentin and has been shown to be effective in treating neuropathic pain, including pain caused by pinched nerves 6, 7
• Tricyclic antidepressants: may be used to treat neuropathic pain, including pain caused by pinched nerves, although their use is limited by unwanted side effects and a risk of cardiovascular mortality 6, 5
• Naproxen: a nonsteroidal anti-inflammatory drug (NSAID) that may be used in combination with gabapentin or pregabalin to produce antihyperalgesia 7

Dosage and Administration

The dosage and administration of these medications may vary depending on the individual and the specific condition being treated. For example:

• Gabapentin: treatment should be started at a dose of 900 mg/d and titrated to 1800 mg/d for greater efficacy, with doses up to 3600 mg/d possible in some patients 5
• Pregabalin: dosing information is not as well established, but it has been shown to be effective at doses of 600 mg/d 6
• Combination therapy: gabapentin or pregabalin may be used in combination with naproxen to produce antihyperalgesia, with a fixed-dose ratio of 50:1 or 10:1 showing synergistic effects 7

Efficacy and Safety

The efficacy and safety of these medications have been established in various studies, including:

• Gabapentin: has been shown to be effective in treating neuropathic pain, including pain caused by pinched nerves, with a number needed to treat (NNT) of 6.7 for substantial pain relief and 4.8 for moderate pain relief 4
• Pregabalin: has been shown to be effective in treating neuropathic pain, including pain caused by pinched nerves, although comparative trials are lacking 6
• Combination therapy: gabapentin or pregabalin in combination with naproxen has been shown to produce antihyperalgesia, although the safety and efficacy of this combination have not been fully established 7