Is gabapentin (Neurontin) effective for treating carpal tunnel syndrome?

Gabapentin for Carpal Tunnel Syndrome: Limited Efficacy and Not Recommended

Gabapentin is not recommended as a treatment for carpal tunnel syndrome as current evidence does not support its use, with no clinically significant benefits compared to placebo and potential adverse effects including fatigue and dizziness. 1

Evidence Assessment

Efficacy of Gabapentin in CTS

• The most recent and highest quality evidence from a 2025 systematic review and meta-analysis found that gabapentinoids (including gabapentin) provide no clinically important benefits for carpal tunnel syndrome symptoms compared to placebo 1
• This meta-analysis demonstrated only a 0.08-point improvement on the Boston Carpal Tunnel Syndrome Questionnaire Symptom Severity Scale, which falls far below the minimal clinically important difference of 1.14 points 1
• A 2011 randomized controlled trial specifically examining gabapentin for CTS found no significant reduction in symptom severity compared to placebo over an eight-week period 2

Adverse Effects

• Gabapentinoids likely cause more fatigue (67% increased risk) and may cause more dizziness (96% increased risk) compared to placebo 1
• Other common side effects include somnolence, dry mouth, and constipation 3

Treatment Recommendations for Neuropathic Pain

While gabapentin is considered a third-line agent for certain neuropathic pain conditions 3, its efficacy varies significantly depending on the specific neuropathic condition:

• Effective for: Diabetic peripheral neuropathy, postherpetic neuralgia, and central neuropathic pain 3
• Not effective for: Carpal tunnel syndrome 1, chemotherapy-induced peripheral neuropathy 3, and HIV-associated neuropathy 3

Appropriate Management of Carpal Tunnel Syndrome

Instead of gabapentin, the following evidence-based approaches should be considered:

1. First-line treatments:

   • Wrist splinting
   • Activity modification
   • Ergonomic workplace adjustments
   • Local corticosteroid injections

2. Surgical intervention: Carpal tunnel release for patients with persistent symptoms or those who fail conservative management

Concerning Trends in Clinical Practice

A 2020 study revealed that despite lack of evidence supporting gabapentinoid use for CTS, approximately 6% of patients were prescribed these medications prior to surgery 4. More concerning, 24% of preoperative users continued to fill gabapentinoid prescriptions 3-6 months after carpal tunnel release surgery 4.

Clinical Implications

• Prescribing gabapentin for CTS represents an off-label use without supporting evidence
• Patients prescribed gabapentinoids preoperatively have higher odds of persistent postoperative gabapentinoid use (22% vs. 1%) and persistent postoperative opioid use (18% vs. 9%) 4
• Given the effectiveness of proper CTS treatments and the risks associated with gabapentinoids, these medications should be avoided for CTS management

In conclusion, current evidence does not support using gabapentin for carpal tunnel syndrome. Treatment should focus on established effective interventions including splinting, corticosteroid injections, and surgical release when indicated.