Is gabapentin (Gabapentin) effective in treating lumbar radiculopathy?

From the Guidelines

Gabapentin is associated with small, short-term benefits in patients with radiculopathy, but its effectiveness for lumbar radiculopathy is limited and not consistently demonstrated compared to placebo. The use of gabapentin for lumbar radiculopathy is based on studies that show small, short-term benefits, as noted in the guidelines from the American College of Physicians and the American Pain Society 1. If prescribed, gabapentin is typically started at 300mg once daily, gradually increased to 300mg three times daily, and potentially up to 1800-3600mg daily divided into three doses, depending on response and tolerability. Common side effects include dizziness, drowsiness, and peripheral edema.

Key Considerations

• Gabapentin works by binding to calcium channels in the nervous system, modulating neurotransmitter release and reducing neuronal excitability.
• For lumbar radiculopathy, a multimodal approach is generally more effective, including physical therapy, anti-inflammatory medications, and addressing underlying causes.
• Patients should be aware that improvement may take several weeks, and regular follow-up is important to assess effectiveness and manage side effects.
• If no benefit is observed after 4-6 weeks of adequate dosing, discontinuation should be considered.

Alternative Approaches

• Nonpharmacologic therapies such as spinal manipulation, intensive interdisciplinary rehabilitation, exercise therapy, acupuncture, massage therapy, yoga, cognitive-behavioral therapy, or progressive relaxation may be considered for patients who do not improve with self-care options 1.
• Herbal therapies like devil's claw, willow bark, and capsicum seem to be safe options for acute exacerbations of chronic low back pain, but benefits range from small to moderate 1.

Important Notes

• Systemic corticosteroids are not recommended for treatment of low back pain with or without sciatica due to lack of efficacy compared to placebo 1.
• Extended courses of medications should generally be reserved for patients clearly showing continued benefits from therapy without major adverse events 1.

From the Research

Efficacy of Gabapentin in Lumbar Radiculopathy

• Gabapentin has been studied as a potential treatment for lumbar radiculopathy, with some studies suggesting its efficacy in reducing pain and improving quality of life 2, 3.
• A study published in 2009 found that gabapentin significantly reduced pain and restricted mobility in patients with discogenic lumbosacral radiculopathy, with a clinically significant effect found in 59% of patients with early onset of treatment and 51% of patients with later onset 2.
• Another study published in 2009 found that gabapentin monotherapy improved quality of life, functional disability, and psychological mood in patients with chronic radiculopathy, with significant improvements in pain intensity, quality of life, and functional disability scores 3.
• However, a multicenter randomized double-blind comparative efficacy study published in 2015 found that epidural steroid injections may provide greater benefit than gabapentin for some outcome measures, although the differences were modest and transient for most people 4.
• Case reports have also suggested the potential efficacy of gabapentin in treating sciatica, with two patients experiencing significant pain relief after treatment with gabapentin 5.
• Additionally, a prospective, randomized, double-blind, placebo-controlled, crossover clinical trial published in 2004 found that gabapentin was effective in reducing the intensity and frequency of neuropathic pain in patients with spinal cord injury, and improved quality of life 6.

Key Findings

• Gabapentin may be effective in reducing pain and improving quality of life in patients with lumbar radiculopathy 2, 3.
• The efficacy of gabapentin may be greater when used early in the course of treatment 2.
• Gabapentin may be a useful treatment option for patients with chronic radiculopathy who have not responded to other treatments 3.
• Further research is needed to fully understand the efficacy and safety of gabapentin in the treatment of lumbar radiculopathy 4, 5.