People in pain are suffering…not just from the pain but also from the treatments that are being offered. Opioids have developed such a terrible reputation that most physicians are reluctant to prescribe them, even for fairly significant pain. Instead, doctors are prescribing alternative meds, including the anti-seizure drug gabapentin. Are patients being informed about gabapentin risks?
Does Gabapentin Have Anti-Inflammatory Activity?
Q. I had rotator cuff surgery on my shoulder almost a decade ago. Last year I started having pain in that shoulder again. The doctor said I have a lot of inflammation there and prescribed gabapentin.
The pharmacist said this is not commonly used as an anti-inflammatory drug. When I looked it up, I discovered it is an anticonvulsant. Why are doctors prescribing an epilepsy drug for pain?
A. You are correct that gabapentin was originally developed for treating epilepsy. The FDA has also approved its use for treating postherpetic neuralgia. This is persistent severe pain following an outbreak of shingles.
According to a review by the independent analysts at the Cochrane Collaboration, gabapentin can help some people with nerve pain due to diabetes or shingles (Cochrane Library, June 9, 2017). At least half of the people in the studies they reviewed did not get great pain relief from gabapentin, however. The FDA has not approved it as an anti-inflammatory agent.
Doctors might be prescribing this medicine for other types of pain because their other options are limited. They are reluctant to prescribe narcotics because of the opioid crisis. NSAIDs such as celecoxib, diclofenac or naproxen can cause serious side effects. These may include ulcers, kidney damage and stroke or heart attack.
This medicine does come with a range of side effects.
* Unsteadiness, vertigo, dizziness, incoordination
* Depression, mood changes and/or suicidal thoughts
* Upset stomach, heartburn, gas, nausea, diarrhea
* Visual disturbances, blurred vision
* Tremor, shakiness, jerky movements
* Confusion, forgetfulness, anxiety, headaches
* Edema in feet, farms or face
* Dry mouth, gum irritation
* Pain in joints
NEVER stop gabapentin suddenly. Doing so could trigger unpleasant withdrawal symptoms.
Reader describes gabapentin risks:
“I was taking gabapentin for the pain of degenerative disc disease in my neck. It didn’t work at all for the type of pain I’m having. I’ve been withdrawing from it for the past 6 weeks.
“Even though I’m reducing the dose fairly slowly, I’m still having hot flashes followed by freezing cold spells. Other gabapentin risks include nausea, and visual disturbances.
“I can now concentrate enough to read books, something that I haven’t been able to do for about a year. Doctors who prescribe gabapentin for anything other than seizures are not doing their patients any favors.”
Ruth also shared her experience with gabapentin risks:
“I am currently taking gabapentin. It was prescribed by a neurologist for neuropathy. When she mentioned this medication, I told her that I was concerned about weight gain. She ‘looked it up’ on her phone and told me that it doesn’t appear to have that side effect. I also told her that I have suffered from a severe depression and a very serious suicide attempt in the past. This didn’t phase her in the least and off I went, prescription in hand.
“I mentioned this to a pain management doctor I was already seeing and he increased the dose from 100 mg at bed to 300 mg three times a day. It knocks me out, I am rapidly gaining weight and getting depressed again. I was doing better but now I’m not.
“I am going to try and get off the medication but I am afraid of what will happen to me. I was a nurse and knew that somethings about the medication but not the risk of suicidal thoughts. What is going on with the medical profession these days? What ever happened to listening to the person served? This is a tragedy, in my opinion and I hope that I will be alright.”
What is so scary about Ruth’s story is the gabapentin risk of depression and suicidal thoughts.
There is this warning in the official prescribing information:
“Antiepileptic drugs (AEDs), including gabapentin, increase the risk of suicidal thoughts or behavior in patients taking these drugs for any indication. Patients treated with any AED for any indication should be monitored for the emergence or worsening of depression, suicidal thoughts or behavior, and/or any unusual changes in mood or behavior.”
Ruth asked her doctor about weight gain. A systematic review in the Journal of Clinical Endocrinology and Metabolism (Feb. 2015) concluded that gabapentin is associated with weight gain.
Some people do benefit from gabapentin. Many report better control of nerve pain. But patients must be warned about gabapentin risks.
Share your own gabapentin story in the comment section below.