Is gabapentin indicated for adhesive capsulitis (frozen shoulder)?

Gabapentin is NOT indicated for frozen shoulder (adhesive capsulitis)

Gabapentin is specifically indicated for neuropathic pain conditions, not musculoskeletal inflammatory conditions like adhesive capsulitis. Frozen shoulder should be treated with corticosteroid injections, physical therapy, and NSAIDs—not gabapentin.

Why Gabapentin is Inappropriate for Frozen Shoulder

Mechanism Mismatch

• Gabapentin works by binding to calcium channel α2δ subunits to reduce neurotransmitter release in hyperexcited neurons, making it effective for neuropathic pain (burning, shooting, electric-like sensations) 1
• Adhesive capsulitis is a fibrotic and inflammatory condition of the glenohumeral joint capsule, not a neuropathic pain syndrome 2, 3
• The pain in frozen shoulder arises from capsular inflammation and mechanical restriction, which does not respond to medications targeting neuropathic pathways 4, 5

Evidence-Based Indications for Gabapentin

Gabapentin is recommended as first-line therapy only for:

• Diabetic peripheral neuropathy 1
• Postherpetic neuralgia 1
• HIV-associated neuropathic pain 6
• Cancer-related neuropathic pain 1

Appropriate Treatment for Frozen Shoulder

First-line management should combine:

• Intra-articular corticosteroid injections combined with physical therapy provide greater improvement than either alone 1, 3, 5
• Physical therapy with stretching and range-of-motion exercises is essential 1, 4, 3
• NSAIDs or short-term oral corticosteroids for pain control 3, 5

Second-line options if minimal improvement after 6-12 weeks:

• Manipulation under anesthesia 3, 5
• Arthroscopic capsular release 7, 3

Common Clinical Pitfall

Do not prescribe gabapentin for musculoskeletal pain without clear neuropathic features. The American College of Physicians specifically recommends reserving gabapentin for pain with neuropathic characteristics (burning, shooting, electric-like quality), not as first-line for musculoskeletal conditions 8. Using gabapentin inappropriately exposes patients to unnecessary side effects (somnolence, dizziness, mental clouding, peripheral edema) without therapeutic benefit 1, 6.