From the Guidelines
Gabapentin 100mg taken three times daily is a reasonable starting dose for treating numbness and pain, particularly neuropathic pain, as supported by recent guidelines and studies 1. This medication works by affecting calcium channels in the nervous system, which helps reduce abnormal nerve signals that cause pain and numbness. The three-times-daily dosing schedule helps maintain consistent blood levels of the medication throughout the day. Be aware that this is typically a starting dose, and your doctor may gradually increase it based on your response and tolerance. Some key points to consider when taking gabapentin include:
- Common side effects include dizziness, drowsiness, and fatigue, which often improve after the first few weeks 1.
- Take gabapentin with or without food, but consistent timing helps maintain effectiveness.
- Don't stop taking it abruptly as this can cause withdrawal symptoms; always follow your doctor's guidance for any dosage changes.
- It may take several weeks to experience the full benefits, so continue taking it as prescribed even if improvement isn't immediate.
- Contact your doctor if you experience severe side effects or if your symptoms don't improve after several weeks of treatment. Recent studies suggest that gabapentinoids, including gabapentin, are effective in treating neuropathic pain, with a recommended starting dose of 100-300 mg nightly or 100-300 mg three times a day, with gradual increases as needed and tolerated 1. It's essential to follow your doctor's guidance and monitoring to ensure the best possible outcome and minimize potential side effects. Additionally, other treatment options, such as pregabalin, duloxetine, and topical capsaicin, may be considered based on individual patient needs and responses 1.
From the Research
Gabapentin for Numbness and Pain
- Gabapentin is commonly used to treat neuropathic pain (pain due to nerve damage) 2
- The typical dose of gabapentin for neuropathic pain is 1200 mg or more daily, with study durations typically ranging from four to 12 weeks 2
- For postherpetic neuralgia, more participants (32%) had substantial benefit (at least 50% pain relief or PGIC very much improved) with gabapentin at 1200 mg daily or greater than with placebo (17%) 2
- For painful diabetic neuropathy, more participants (38%) had substantial benefit (at least 50% pain relief or PGIC very much improved) with gabapentin at 1200 mg daily or greater than with placebo (21%) 2
Mechanism of Action
- Gabapentinoids, which target the voltage-dependent calcium channels α2δ-1 subunit, inhibit calcium currents, thus decreasing the excitatory transmitter release and spinal sensitization 3
- Gabapentinoids also activate the descending noradrenergic pain inhibitory system coupled to spinal α2 adrenoceptors 3
Treatment Outcomes
- A stepped approach employing tricyclic antidepressants (TCAs) and gabapentin resulted in 54.8% of all treated patients reporting improvements of ≥ 50% in pain intensity scores 4
- Patients who did not respond to TCAs may be a distinct subgroup and this needs further investigation 4
- Gabapentin, at a lower dose than previously reported, is a good alternative in TCA-resistant patients 4
Side Effects
- Adverse event withdrawals were more common with gabapentin (11%) than with placebo (8.2%) 2
- Serious adverse events were no more common with gabapentin (3.2%) than with placebo (2.8%) 2
- Atypical side effects of gabapentin include myoclonus, ataxia, pediatric aggression, respiratory depression, pneumonia, pregnancy complications, sleep interference, encephalopathy, peripheral edema, suicidal ideation, dyskinesia, anorgasmia, and myopathy 5