Should You Take Gabapentin for Back Pain? Experts Discuss

Back pain can have a huge effect on your day-to-day life. So it’s not surprising that many people are open to trying different treatment options. Recently, many prescribers have reached for gabapentin to treat back pain and a range of off-label uses. 

Gabapentin was originally developed as an anti-seizure medication. But healthcare professionals don’t just prescribe it for back pain. It’s also used for nerve pain, postsurgical pain, and occasionally anxiety.

Let’s take a closer look at what the research says about gabapentin for back pain, how to take it, and when to consider further care. 

What is gabapentin?

Researchers discovered the medication gabapentin (Neurontin) in the 1970s. It was originally used to treat seizures. Since the FDA approved it in the 1990s, healthcare teams have used it to treat many different conditions. Currently, it has FDA approval to treat partial seizures and postherpetic neuralgia (PHN) — nerve pain related to shingles. 

Another version — gabapentin enacarbil (Horizant) — is approved to treat restless leg syndrome and PHN. Gralise is an extended-release version only approved for PHN. Medical professionals often use gabapentin to treat a variety of other conditions, including:

• Nerve pain

• Back pain

• Fibromyalgia

• Tremors

• Depression

• Anxiety

• Headaches

• Diabetic neuropathy

• Post-traumatic stress disorder (PTSD)

Should you take gabapentin for back pain?

Healthcare professionals often recommend gabapentin as a treatment for nerve pain. In recent years, they’ve prescribed it to treat back pain. Studies show that it can make a difference in nerve pain due to shingles or diabetes. 

But the evidence shows that it doesn’t work that well to ease back pain, particularly chronic low back pain. For chronic low back pain, physical therapy and nonsteroidal anti-inflammatory drugs (NSAIDs) tend to work better.

Gabapentin for sciatica 

The cause of sciatica back pain is compression of the sciatic nerve. This type of back pain typically starts in the lower back and travels down the back of one or both legs. Exercise, physical therapy, and NSAIDs work well to treat this kind of back pain. Recent research suggests that although gabapentin isn’t typically effective for regular back pain, it may work for back and leg pain that comes from the nerves. If you’re considering gabapentin to treat sciatica, talk to a healthcare professional. It may be an option for you.

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Gabapentin for spinal stenosis

Spinal stenosis is the narrowing of the space between the bones of your back (vertebrae) and the spinal cord. This can happen as the spine collapses with age or from spine arthritis. As the space narrows, the bones or discs in the spine can compress the spinal cord and cause pain and nerve symptoms. 

Healthcare professionals sometimes prescribe gabapentin as an off-label use for spinal stenosis. But there’s not much evidence that it provides long-term pain relief. A recent clinical practice guideline didn’t recommend gabapentin for spinal stenosis treatment.

Severe spinal stenosis often needs surgery. Before considering surgery, your medical team may recommend exercises or lifestyle changes, either alone or together with medication. 

Gabapentin for other types of nerve pain

Gabapentin can also treat nerve pain from PHN, which is the most common complication of shingles. It’s also used off-label to treat diabetes-related nerve pain. 

If you have nerve pain from other causes — like back injury, nerve injury, or after surgery — it still may help. But there seems to be evidence that gabapentin is less effective in these cases. 

The best thing to do is talk to your healthcare team about your pain to figure out if gabapentin may be worth a try for you. 

How much gabapentin should you take for back pain?

A typical gabapentin dosage is anywhere from 300 mg to 900 mg, 3 times a day. Some clinical studies have used dosages up to 1,200 mg, 3 times a day. There are a few different gabapentin products. So dosing can vary depending on which one you’re taking. For example, Gralise is only taken once a day. 

Your prescriber will recommend an appropriate dosage depending on: 

• The type of pain you have

• The other medications you take

• How well your body handles the side effects

They’ll typically recommend a lower dosage and gradually adjust it to find a dosage that works well for your pain, while minimizing side effects. 

Gabapentin side effects

Like any medication, gabapentin has side effects. Common, mild side effects include:

• Fatigue 

• Drowsiness

• Dizziness or difficulty walking

• Nausea, vomiting, or diarrhea

• Fever and dry mouth

• Tremor

• Blurry vision

• Forgetfulness

More serious side effects are less common. But they can include:

• Allergic reactions, like anaphylaxis or angioedema

• Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome

• Skin rashes (like Stevens-Johnson syndrome)

• Rhabdomyolysis, a potentially life-threatening condition that can cause muscle pain and kidney failure

• Suicidal thoughts and behaviors

How long does it take for gabapentin to work?

Gabapentin takes days — and up to weeks — to work. You may notice some effects in the first week of taking the medication. But it can take several weeks to see a major difference in PHN or diabetes-related nerve pain. 

It’s important to take gabapentin as your prescriber instructs. Don’t skip doses or take it only “as needed,” because it won’t work that way. 

And if you decide to stop the medication, you need to slowly reduce the dose over about 1 week. Don’t try to do this on your own: Be sure to talk with a healthcare professional.

Other treatments for back pain

Depending on the cause of your back pain, there may be better treatment options. Many types of back pain can be treated with:

• Exercise

• Physical therapy

• Heat application

• Massage 

If these treatments alone aren’t enough, other medications that may work include:

• NSAIDs, like ibuprofen (Motrin)

• Acetaminophen (Tylenol)

• Serotonin and norepinephrine reuptake inhibitors (SNRIs), a type of antidepressant medication, like venlafaxine (Effexor) — especially if the person also has depression or if the pain is nerve related

If you’ve tried different types of medications and still have pain that limits your daily activities, talk to a healthcare professional. It may be time to see a pain specialist to explore your other treatment options.

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Written by:

Kelly Elterman, MD

Kelly Elterman, MD, is a board-certified anesthesiologist by the American Board of Anesthesiologyand has been practicing clinically since she finished her residency training in 2013. Along with her training, she has over 10 years experience in anesthesiology.

Edited by:

Karla Robinson, MD

Karla Robinson, MD, is a medical editor for GoodRx. She is a licensed, board-certified family physician with almost 20 years of experience in health through varied clinical, administrative, and educational roles.

Reviewed by:

Itza Rivera, MD

Dr. Rivera is a board-certified physical medicine and rehabilitation specialist. She completed her medical degree and residency training at the University of Puerto Rico School of Medicine, and her neuromuscular disorders subspecialty training at Northwestern University.

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