From the Guidelines
Gabapentin for low back radicular pain should be initiated at a dose of 100-300 mg at bedtime or 100-300 mg three times daily, with gradual titration as tolerated, up to a maximum dose of 3600 mg/day in three divided doses. The dose can be increased by 100-300 mg every 1-7 days, with careful monitoring of response and tolerability 1. It is essential to start with a low dose and gradually increase to minimize side effects such as dizziness, somnolence, and peripheral edema. Elderly patients or those with renal impairment may require lower doses. Taking gabapentin with food can improve absorption and reduce gastrointestinal side effects. Allow 2-4 weeks at a stable dose to assess effectiveness. Gabapentin's mechanism of action, binding to calcium channels in the nervous system and reducing the release of excitatory neurotransmitters involved in pain signaling, makes it particularly effective for neuropathic pain components of radicular back pain. If side effects become problematic, reducing the dose temporarily before slowly increasing again often helps with tolerance.
Some key points to consider when prescribing gabapentin for low back radicular pain include:
- Gradual titration to minimize side effects
- Careful monitoring of response and tolerability
- Lower doses for elderly patients or those with renal impairment
- Taking with food to improve absorption and reduce gastrointestinal side effects
- Allowing 2-4 weeks at a stable dose to assess effectiveness
- Potential for gabapentin to be effective for neuropathic pain components of radicular back pain, as supported by studies such as those cited in 1 and 1.
From the Research
Dose of Gabapentin for Low Back Radicular Pain
- The dose of gabapentin for low back radicular pain can vary, but a study published in 2009 2 found that patients with chronic radiculopathy were treated with oral gabapentin from a total of 300 mg per day once up to a total of 1800 mg per day divided in 3 doses for an eight-week trial period.
- Another study published in 2010 3 also used oral administration of gabapentin to treat patients with radicular pain caused by lumbar disk hernia or lumbar spinal stenosis, but the specific dose was not mentioned.
- A systematic review published in 2023 4 found that the evidence for the use of gabapentin in chronic low back pain without radiculopathy or neuropathy is limited, but one study found a reduction in pain scale and improved mobility with gabapentin treatment.
- A meta-analysis published in 2017 5 found that gabapentin compared with placebo showed minimal improvement of pain, but the quality of evidence was very low.
- A study published in 2022 6 compared the therapeutic effects of pregabalin and gabapentin after transforaminal epidural nerve block in lumbar radiculopathy and found that both medications can be equally used to reduce pain, but the specific dose of gabapentin was not mentioned.
Key Findings
- Gabapentin may provide benefits in terms of alleviation of pain and overall quality of life in patients with chronic radiculopathy 2.
- Gabapentin can be an option in the conservative management of acute or chronic radicular pain 3.
- The evidence for the use of gabapentin in chronic low back pain without radiculopathy or neuropathy is limited 4.
- Gabapentinoids may have significant risk of adverse effects without any demonstrated benefit in chronic low back pain 5.
- Both pregabalin and gabapentin can be equally used to reduce pain in lumbar radiculopathy patients who underwent transforaminal epidural steroid injection 6.