Is gabapentin an anti-inflammatory?

In this article:

• Is gabapentin an anti-inflammatory?
• Conditions treated
• Gabapentin vs. NSAIDs
• The bottom line

In this article

• Is gabapentin an anti-inflammatory?
• Conditions treated
• Gabapentin vs. NSAIDs
• The bottom line

Gabapentin, also known as brand-name Neurontin, is a multi-faceted medication. As an anticonvulsant, healthcare providers prescribe it to manage epilepsy and postherpetic neuralgia. However, it’s shown some effectiveness in treating a variety of off-label conditions, like mood disorders, sleep disorders, alcohol addiction, allodynia, diabetic neuropathy, and other types of nerve pain. 

But what about inflammatory conditions? While inflammation isn’t its target, research suggests that it could help with certain inflammatory conditions. Here are all the important details. 

Is gabapentin an anti-inflammatory?

Gabapentin is an anticonvulsant, not an anti-inflammatory. “Gabapentin works by adjusting calcium channels in the nervous system, which helps reduce the transmission of pain signals,” says Dr. Po-Chang Hsu, MD, MS, a healthcare provider, writer, and consultant at Alpas Wellness. “While it may alleviate symptoms where inflammation leads to nerve pain, it does not directly target or reduce inflammation like traditional anti-inflammatory medications such as nonsteroidal anti-inflammatory drugs (NSAIDs).”

Although gabapentin doesn’t have direct anti-inflammatory effects, some studies have shown that it may help treat certain inflammatory conditions. For example, a 2020 study showed that it can affect bowel inflammation by managing mast cell signaling—an event that triggers allergic reactions. Separate studies on rabbits concluded that gabapentin can affect ocular inflammation because it restricts the production of certain inflammatory cytokines—chemical messengers and mediators—that can cause inflammation. Another study indicates gabapentin may suppress inflammatory responses triggered by substance P—a protein linked to pain and inflammation—in certain cell types.

Aside from partial seizures, gabapentin is most often prescribed for nerve pain or neuropathic pain, often caused by nerve damage or malfunction. Sometimes, nervous system inflammation can cause or compound this nerve pain. Gabapentin treats it by changing how calcium channels throughout the nervous system release neurotransmitters. It may also increase gamma-aminobutyric acid (GABA) concentrations, a neurotransmitter that can calm overexcited neurons.

Which inflammatory conditions can be treated with gabapentin?

“Gabapentin may be useful for inflammatory conditions where nerve involvement leads to pain,” says Dr. Rizwan Bashir, MD, neurologist at AICA Orthopedics. “For example, conditions like fibromyalgia, certain types of arthritis, and chronic lower back pain with a neuropathic component can sometimes be managed with gabapentin as part of a broader treatment plan. It’s often prescribed in cases where traditional anti-inflammatories aren’t fully effective for managing nerve pain associated with inflammation.”

Here’s how it may help specific inflammatory conditions.

Osteoarthritis

Osteoarthritis (OA) is a chronic degenerative condition that causes the deterioration of cartilage around the joints. It can also cause inflammation of the joint lining. There have been a few different studies concerning gabapentin’s effectiveness as a knee OA treatment. In one from Clinical Rheumatology, a combination of gabapentin and duloxetine was more effective than acetaminophen and duloxetine. A separate study from 2022 concluded that pregabalin (similar to gabapentin) is a safe and effective treatment for OA, but researchers said proving its efficacy would require a larger sample size.

Colitis

Colitis is an intestinal disease which causes inflammation of the colon. It can sometimes be chronic, but other times, it’s not. Either way, it can cause a range of gastrointestinal symptoms, including fever, fatigue, anemia, and dehydration. In a 2021 study, researchers reported that gabapentin helped reduce colon inflammation in animals.

Allergic asthma

Allergic asthma is a condition in which the immune system overreacts to certain inhaled allergens, causing airway inflammation and closure. A 2018 study showed that gabapentin lowered certain immune responses linked to asthma inflammation in mice.

Fibromyalgia

While fibromyalgia isn’t an inflammatory condition, there’s some evidence of systemic inflammation and neuroinflammation in fibromyalgia patients, who may experience chronic pain. Either way, a study from 2016 demonstrated gabapentin’s analgesic effects associated with the condition.

Gabapentin vs. NSAIDs

In the ongoing fight against inflammatory conditions, NSAIDs like ibuprofen and naproxen are often first-line treatments for inflammatory pain. At the same time, gabapentin is better suited for pain with a nerve component, especially for long-term issues. So, to evaluate the effectiveness of gabapentin’s anti-inflammatory properties, it’s helpful to see how these two stack up.

According to Dr. Hsu, “gabapentin and NSAIDs serve different functions. NSAIDs, such as ibuprofen and aspirin, reduce inflammation by inhibiting the COX enzymes that produce inflammatory chemicals (prostaglandins). Gabapentin, on the other hand, is designed to address nerve pain by reducing the excitability of neurons but does not affect inflammatory pathways.”

Those differences in how they work make them each better suited for different conditions. “NSAIDs work by directly reducing inflammation and are typically first-line treatments for acute inflammatory pain,” Dr. Bashir says. “Gabapentin, on the other hand, does not address the inflammatory process but can be beneficial for chronic pain that has a neuropathic element.”

Both gabapentin and NSAIDs are options for managing pain after surgery. Gabapentin may work better for certain procedures. For example, a 2014 study showed that gabapentin relieved persistent pain better than naproxen for people who had spine surgery. Another study found gabapentin effective in reducing pain in dental procedures, like root canals.

In some cases, healthcare providers may prescribe gabapentin and NSAIDs together. They don’t have known interactions and can be effective for pain after surgery. This combination has been used to help lower the need for opioids, which carry risks of addiction. 

Comparing side effects

 It is important to understand the side effects of gabapentin and NSAIDs, which can help in choosing the best option for pain relief. 

The most common side effects of ibuprofen are gastrointestinal issues like heartburn, stomach pain, diarrhea, constipation, and nausea. Other possible side effects include:

• Fluid retention
• Liver problems
• Ringing in the ears
• Rash
• Itching
• Headache
• Dizziness
• Cough
• Decreased appetite

Gabapentin’s most common side effects are drowsiness, dizziness, ataxia (balance issues), nausea, vomiting, fever, and fatigue. But it may also cause:

• Sleepiness
• Swelling of the extremities
• Uncontrolled eye movements
• Tremors
• Weakness
• Diarrhea
• Dry mouth
• Infection
• Sore throat
• Cough
• Constipation
• Nausea
• Vomiting
• Blurred or double vision
• Weight gain
• Slurred speech
• Memory problems
• Depression
• Upset stomach

While NSAIDs are not linked to dependence, gabapentin has been linked or may pose a low risk of abuse and dependency, so it’s essential to weigh these side effects and discuss them with a healthcare provider to determine the safest choice based on individual needs and health history. Although it’s not federally classified as a controlled substance, there is still some risk, which can lead to withdrawal symptoms like anxiety, nausea, trouble sleeping, pain, and sweating if stopped suddenly. NSAIDs, on the other hand, do not carry a risk of addiction, so they might be a safer option for some people.

The bottom line

Gabapentin might not be classified as an anti-inflammatory drug, but it might still be useful in treating certain inflammatory conditions, such as osteoarthritis, colitis, and neuropathic pain. Deciding whether gabapentin or NSAIDs—or another medication—is best depends on your specific condition, medical history, and other medications. Only a healthcare provider familiar with your overall health can make the right recommendation, so consult your healthcare provider to see if gabapentin might be helpful for you.