From the Guidelines
Gabapentin is not recommended as a first-line treatment for carpal tunnel syndrome, and its use should be considered only when other treatments have failed, due to the lack of strong evidence supporting its effectiveness in this condition. The current evidence suggests that surgical interventions, such as open and endoscopic release, are more effective in relieving symptoms and improving functional status compared to non-surgical treatments, including medication like gabapentin 1. When considering gabapentin for carpal tunnel syndrome, it's essential to weigh the potential benefits against the risks of side effects, such as dizziness, drowsiness, and fatigue. Some key points to consider when using gabapentin for carpal tunnel syndrome include:
- Starting with a low dose, typically 300mg once daily, and gradually increasing as needed and tolerated
- Monitoring for side effects and adjusting the dose accordingly
- Considering gabapentin as part of a comprehensive treatment approach that may include other interventions, such as wrist splinting, activity modification, and physical therapy
- Being aware that gabapentin may provide only partial relief for some patients, and that surgical intervention may ultimately be necessary for persistent symptoms. It's crucial to note that the evidence for gabapentin in carpal tunnel syndrome is limited, and more research is needed to fully understand its effectiveness and optimal use in this condition, as the current evidence is based on very low to low quality GRADE evidence 1.
From the Research
Efficacy of Gabapentin for Carpal Tunnel Syndrome
- Gabapentin has been studied as a potential treatment for carpal tunnel syndrome (CTS), with mixed results 2, 3, 4, 5.
- A 2015 study found that gabapentin in low doses (100 mg/day and 300 mg/day) was effective in improving symptoms of CTS, including pain and functional status, with no significant side effects 2.
- Another study from 2009 found that gabapentin was partially effective and safe in treating CTS symptoms, with a median dosage of 1800 mg/day 3.
- However, a 2025 systematic review and meta-analysis found that gabapentinoids probably do not improve CTS symptoms compared to placebo, and may cause adverse effects such as fatigue and dizziness 4.
- A 2011 randomized controlled trial found that gabapentin did not produce a significant reduction in symptom severity compared to placebo over an eight-week period 5.
Postoperative Pain Management
- Gabapentin has also been studied as a potential analgesic for postoperative pain management in patients undergoing carpal tunnel release surgery 6.
- A 2025 systematic review and meta-analysis found that gabapentin was associated with reduced postoperative pain at 6,12, and 24 hours, with comparable rates of adverse events compared to placebo 6.