Can Gabapentin Cause Neck Pain?
Gabapentin does not directly cause neck pain as an adverse effect; neck pain is not listed among the documented side effects in FDA labeling or clinical guidelines. 1
Known Adverse Effects of Gabapentin
The FDA-approved labeling for gabapentin documents a comprehensive list of adverse reactions from controlled trials, and neck pain is notably absent 1:
- Most common adverse effects include dizziness (17-28%), somnolence (19-21%), peripheral edema (8%), ataxia (13%), fatigue (11%), and nausea 1
- Musculoskeletal effects documented include back pain (2%), peripheral edema (2-8%), and weight gain, but not neck pain 1
- Rare serious effects include movement disorders, rhabdomyolysis, and elevated creatine kinase 1
Gabapentin's Role in Musculoskeletal Pain
Importantly, gabapentin is not effective for general musculoskeletal pain and should not be used for such conditions 2, 3:
- The American College of Physicians specifically recommends against using gabapentinoids for chronic low back pain without radiculopathy due to lack of benefit and significant risk of adverse effects 3
- Gabapentin is effective only for neuropathic pain with radicular features (nerve root compression), not axial musculoskeletal pain 2, 3
- For musculoskeletal conditions like neck pain, skeletal muscle relaxants (cyclobenzaprine, tizanidine) have demonstrated efficacy, not gabapentin 2, 4
Clinical Interpretation
If a patient on gabapentin develops neck pain, consider these possibilities:
- Coincidental musculoskeletal issue: The neck pain is likely unrelated to gabapentin and represents a separate musculoskeletal condition 2
- Indirect effects: Gabapentin-induced ataxia (13% incidence), dizziness (17-28%), or abnormal gait (2%) could theoretically lead to falls or postural changes that secondarily cause neck strain 1
- Misattribution: Patients may incorrectly associate temporal proximity with causation
Common Pitfalls to Avoid
- Do not use gabapentin to treat neck pain unless there is clear cervical radiculopathy with nerve root involvement 3
- Do not confuse gabapentin's neuropathic pain indication with general musculoskeletal pain management 2, 3
- Monitor for actual gabapentin toxicity symptoms: myokymia, myoclonus, tremor, and gait instability rather than neck pain 5