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Is gabapentin good for sciatica?

Gabapentin may be prescribed off-label for sciatica, but may not be the most effective treatment option
By | Dec. 5, 2024
Three Rx bottles and the middle has a question mark on it: Is gabapentin good for sciatica?

Key takeaways

  • Gabapentin is a prescription anticonvulsant medication that’s FDA-approved to treat nerve pain caused by shingles and certain types of seizures. It’s also used off-label for various conditions, such as nerve pain and sciatica.

  • Sciatica is a condition characterized by nerve pain, weakness, numbness, or tingling along the sciatic nerve. It usually starts with pain in the lower back that extends down the leg to the calf or foot.

  • Early evidence showed gabapentin may provide relief for chronic sciatica. However, more recent studies concluded the drug was not effective at reducing pain or disability caused by low back pain or sciatica.

  • Ultimately, gabapentin isn’t recommended for the treatment of sciatica due to its lack of effectiveness and increased risk of adverse effects. Fortunately, there are alternative painkillers available.

In this article:

The sciatic nerve is the largest nerve in the body. It helps control the muscles in the back of the knee and lower leg. Sciatica—or lumbosacral radiculopathy—is a very common condition characterized by nerve pain, weakness, numbness, or tingling along the sciatic nerve. It usually starts with pain in the lower back that extends down the leg to the calf or foot. Treatment includes a combination of physical therapy, at-home remedies, and medication. So, can Neurontin (gabapentin) help?

Gabapentin is a prescription medication that’s FDA-approved for partial seizures in people with epilepsy and postherpetic neuralgia—a type of nerve pain caused by shingles. Healthcare providers also prescribe gabapentin off-label for neuropathy, fibromyalgia, restless leg syndrome (RLS), and other medical conditions. Although it’s one of the preferred treatments for neuropathic pain, gabapentin has mixed evidence supporting its use for sciatica. 

In this article, we’ll discuss whether gabapentin is good for sciatica. 

Does gabapentin help sciatica?

Sciatica treatment consists of home remedies and medications. Drugs used to relieve sciatic pain include oral nonsteroidal anti-inflammatory drugs (NSAIDs), prescription pain medications, muscle relaxants, corticosteroids, and anticonvulsants, such as gabapentin or Lyrica (pregabalin). 

As an anticonvulsant, gabapentin blocks the release of excitatory neurotransmitters (chemicals) in the nervous system. This helps calm nerve signals to relieve nerve pain. For this reason, gabapentin may have utility in the relief of sciatica. However, the evidence supporting its use is mixed. A 2012 study found gabapentin was beneficial for chronic sciatica, but only in the short term. But, a 2018 clinical trial found anticonvulsants, including gabapentin, were not effective at reducing pain or disability caused by low back pain or sciatica. Researchers also found gabapentin had a higher risk of side effects when compared to placebo (sugar pill). 

Ultimately, American Family Physician doesn’t recommend gabapentin for the treatment of sciatica due to its lack of effectiveness and increased risk of adverse effects. 

How fast does gabapentin work for sciatica?

The immediate-release version of gabapentin starts to work within two to three hours of taking a dose. However, it may take a few weeks to notice the full effects. Certain factors, such as age, kidney health, and the dosage prescribed, may affect how quickly the drug works in the body. 

Gabapentin dosage for sciatica

A clinician will prescribe a dosage of gabapentin based on the intensity of your back and leg pain and your kidney function. In most cases, your healthcare provider will prescribe a low starting dose and increase the dosage slowly until your sciatica pain is well managed. Gabapentin is usually taken in divided doses, up to three times per day. In studies, gabapentin dosages of 900 mg to 3,600 mg per day were used to treat sciatica. 

Gabapentin alternatives for sciatica

While there is some evidence that gabapentin may be effective for sciatica, gabapentin isn’t recommended for use due to its risk of side effects. Fortunately, there are alternatives available. 

According to the American Academy of Orthopaedic Surgeons, sciatica usually heals with time and rest. However, nonsurgical and surgical treatment is available. Nonsurgical treatment helps with sciatica pain management. These include:

  • Applying gentle heat or cold where your pain is
  • Remaining active, as motion helps improve inflammation
  • Stretching exercises 
  • Going on short walks
  • Going to physical therapy

Certain medications, such as nonsteroidal anti-inflammatory drugs (NSAIDs), may also help with pain relief. Examples of NSAIDs include Advil (ibuprofen), Aleve (naproxen), and Mobic (meloxicam). Muscle relaxants, such as Zanaflex (tizanidine), may also help. Alternatively, doctors may suggest spinal injections with corticosteroids. Overall, nonsurgical treatments are used short-term for sciatica; in most cases, your pain will improve after a few weeks. 

If your pain is disabling after three or more months of nonsurgical treatment, you may need surgery. Surgeries aim to correct the underlying cause of sciatica. As part of the surgery, the surgeon may remove your herniated disk or bone spurs that are compressing your sciatic nerve. 

If you find that your pain is severe or uncontrolled with over-the-counter (OTC) analgesics, consult a healthcare provider. They can help determine if you need prescription medication or surgical treatment for your pain.

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