Is gabapentin (Neurontin) effective for treating tendinosis?

Gabapentin for Tendinosis

Gabapentin is not recommended for the treatment of tendinosis as there is no evidence supporting its efficacy for this specific condition. While gabapentin has established effectiveness for neuropathic pain conditions, tendinosis represents a different pathophysiology that does not typically respond to this medication.

Understanding Tendinosis vs. Neuropathic Pain

Tendinosis is characterized by:

• Degenerative changes in tendon tissue without inflammation
• Disorganized collagen fibers
• Increased ground substance
• Neovascularization
• Absence of inflammatory cells

Unlike neuropathic pain conditions where gabapentin has proven efficacy, tendinosis involves structural tissue damage rather than nerve dysfunction.

Evidence for Gabapentin Use

Gabapentin has been extensively studied and is recommended for:

• Diabetic peripheral neuropathy 1
• Postherpetic neuralgia 1, 2
• Other neuropathic pain conditions 3

The American Academy of Neurology and American Diabetes Association recommend gabapentin as a first-line treatment for neuropathic pain 1. However, none of the guidelines or research evidence supports its use for tendinosis or other musculoskeletal conditions without a neuropathic component.

Appropriate Treatment Options for Tendinosis

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

1. First-line treatments:

   • Relative rest and activity modification
   • Physical therapy with eccentric strengthening exercises
   • NSAIDs for short-term pain relief

2. Second-line treatments:

   • Extracorporeal shock wave therapy
   • Platelet-rich plasma injections
   • Corticosteroid injections (limited use)

Potential Pitfalls of Using Gabapentin for Tendinosis

Using gabapentin for tendinosis presents several concerns:

• Unnecessary exposure to side effects including dizziness (19%), somnolence (14%), peripheral edema (7%), and gait disturbance (9%) 2
• Delayed implementation of appropriate treatments
• Risk of medication dependence with long-term use
• Lack of therapeutic benefit for the underlying pathology

When Gabapentin Might Be Considered

The only scenario where gabapentin might be considered in a patient with tendinosis is if:

1. There is a concurrent neuropathic pain component clearly identified
2. Standard tendinosis treatments have failed
3. Pain is significantly impacting quality of life

In such cases, the treatment would be targeting the neuropathic component, not the tendinosis itself.

Conclusion

Based on current evidence, gabapentin should not be used for treating tendinosis. Treatment should instead focus on addressing the underlying tendon pathology through appropriate physical therapy, activity modification, and evidence-based interventions specific to tendinosis.