Gabapentin (Neurontin) For Nerve Pain Review – How Does It Compare?
Nerve pain is a very common condition that millions of Americans suffer from. Modern medication is available for nerve pain but is generally only effective for a few hours. As a result, people feel frustrated at the lowering of their quality of life and the constant pain they have to live with. However, a new type of medication, Gabapentin, seems to be providing relief for many.
What Is Gabapentin?
Gabapentin was actually developed to combat seizures in epileptic patients, acting as an anticonvulsant. However, since it affects the nerves, specifically those that cause some types of pain, it was realized that it could be used to treat nerve pain caused by herpes zoster, or shingles, in particular.
Who Created It?
The drug, usually prescribed as Neurontin, was developed by Parke-Davis, a subsidiary of Pfizer. Generic gabapentin is manufactured by Greenstone, also a Pfizer subsidiary. Since 2004, the FDA has also approved Teva, a firm in Israel, to produce a generic form of Neurontin. When the drug was first developed, it became one of Pfizer’s bestsellers, but the company quickly came to face litigations for how it was marketed, specifically due to claims that Parke-Davis marketed it for non-approved uses, an example of which is migraine.
In December 1993, the FDA approved the drug as an anticonvulsant for adults only. In 2000, this was extended to children. It received approval for the treatment of neuropathic pain caused by shingles in 2004. Neurontin is listed as a drug for neuropathic pain by Kaiser Insurance as well.
How Effective Is Gabatin for Nerve Pain – Does It Really Work?
There have been a number of studies into the effectiveness of taking Gabapentin for nerve pain. One study showed moderate quality evidence to suggest that taking 1200 mg of oral gabapentin each day can benefit people who suffer from neuropathic pain not just as a result of shingles, but also as a result of diabetes.
By January 2017, there had been around 37 studies that meet scientific requirements into the effectiveness of the drug on neuropathic pain, albeit only in adults. Those 37 studies had a total of 5,914 participants who were all treated with gabapentin, other drugs, or a placebo. The studies lasted anywhere from four to 12 weeks. Almost all of them demonstrated that people who suffered from neuropathic pain noticed a positive improvement in their condition when taking gabapentin, with the greatest positive outcomes found in people with diabetic neuropathy and neuropathy caused by shingles.
Some of the specific results include:
- That 30% of people suffering from neuropathic pain after shingles saw a 50% or more reduction, compared to just 20% of those who took a placebo.
- That 50% of people suffering from neuropathic pain after shingles who took gabapentin saw their pain reduced by a third, compared to just 30% of those who took a placebo.
- That 40% of people suffering from diabetic neuropathy saw a 50% reduction in their pain after taking gabapentin, compared to just 20% of those who took a placebo.
- That 50% of people suffering from diabetic neuropathy who took gabapentin saw their pain reduced by a third, compared to 40% of those who took a placebo.
None of the studies suggested that gabapentin could benefit people who suffered from nerve pain for reasons other than diabetes or shingles.
How Does It Work?
The studies clearly show that gabapentin works in certain patients. However, it is impossible to tell which patients will benefit and which ones will not. This is why the official recommendation is now to try the medication for a short period of time to determine whether the condition improves or not. The drug works on the central nervous system, essentially stabilizing the brain’s electrical activity.
In so doing, it affects the signals sent from the nerves to the brain. It is not quite understood how it does this, however, although it seems that there is an increase in GABA (neurotransmitter) production after taking the drug, while at the same time there is a reduction in glutamate release.
Dosage for Nerve Damage and Pain
Gabapentin is a prescription-only drug and must be taken as prescribed. Prescriptions depend on the brand and the condition treated. Specifically:
- Horizant should be taken in the evening, around 5pm, with food.
- Gralise should be taken with food.
- Neurontin can be taken with or without food.
Adults being prescribed the drug for postherpetic neuralgia (neuropathy following shingles) should:
- Take 300mg orally on the first day, then two times on the second day, and three times on the third day.
- Never exceed 1800mg per day.
Unfortunately, gabapentin is linked to some significant side effects. One of the most concerning ones is that some people have experienced suicidal thoughts after taking this medication. Additionally, the drug may be prescribed to children, particularly as an anticonvulsant, and they sometimes experience changes in their behavior. For this reason, anyone taking or administering the drug should remain vigilant and alert for changes not just in symptoms, but also in mood. They should also regularly speak to their physician to discuss any changes.
Gabapentin should be taken as prescribed and people should continue to take it even if they feel fine, unless otherwise instructed by their physician.
Studies have shown that 60% of people who take gabapentin will experience side effects. Those who took a placebo only experience side effects in 50% of cases. Some of the most commonly reported side effects included sleepiness, dizziness, problems with walking, and water retention. Around 10% of people experienced each of those. It is uncommon, however, for serious side effects to occur, but it is common to see people discontinue their gabapentin treatment as a direct result of the side effects they experience.
In very rare cases, people have experienced an allergic reaction to gabapentin, which is a medical emergency. Key signs of an allergic reaction include swelling of the throat, tongue, lips, or face; difficulty breathing; and hives. The drug may also cause serious reactions, which can impact any part of the body. As with any adverse allergic reaction, this must be classed as a medical emergency.
Common Side Effects
Some of the most common symptoms experienced by those who have a serious drug reaction include:
- Yellowing of the eyes or skin
- Unusual bruising
- Severe weakness
- Muscle aches
- Flu-like symptoms
- Swollen glands.
- Skin rash
Sometimes, these reactions don’t occur until several weeks after first taking the drug.
As stated, one of the most concerning side effects of this drug is that it can cause changes in behavior and mood, even having suicidal thoughts. This is why those who take gabapentin should be regularly monitored by their physician, and also commit to reporting any changes in behavior or mood, any panic attacks or anxiety, and any difficulty sleeping. Additionally, if people start to feel depressed, physically or mentally hyperactive, restless, aggressive, hostile, agitated, irritable, or impulsive, they should also report this to their physician. Suicidal or self-harming thoughts must immediately be reported.
Rare Side Effects
A number of much rarer but very serious side effects also require immediate medical attention. They include:
- Severe tiredness or weakness
- An increase in the frequency of seizures
- Pain in the upper stomach region
- Difficulties with muscle movement or with balance
- Difficulty breathing, a worsening or new cough accompanied by fever, or chest pain
- Severe numbness or tingling
- Sudden rapid eye movement
- Problems with kidney function, such as swelling (edema) in the ankles or feet, difficulty urinating, painful urination, or significant reduction in or even inability to urinate
Children who take gabapentin are more likely to experience side effects. There are also certain side effects that are more common specifically in younger individuals. As a care giver, it is absolutely vital, therefore, that you properly monitor the child and report any changes. Common side effects in children include:
- Tiredness, drowsiness, dizziness, headaches
- Edema in the feet or hands, leading to quite severe swelling
- Difficulties with the eyes, struggling to focus
- Problems with coordination
- Nausea, vomiting, and fever
If you are looking after a child who takes gabapentin, you must immediately seek medical help if you notice:
- Any marked or unusual changes in the child’s behavior
- Any problem with memory or cognitive function
- The child struggling to concentrate
- The child becoming aggressive, hostile, or restless
- The drug has been around for a long time and has passed the relevant safety standards.
- It is FDA approved for the treatment of some forms of neuropathic pain.
- A significant number of studies, on a significant amount of people, have been conducted to show the drug to be effective in neuropathic pain.
- Gabapentin is approved for neuropathy caused by shingles, and studies have also shown it to be effective in diabetic neuropathy.
- There has been some controversy surrounding the marketing efforts of Pfizer in relation to gabapentin.
- The drug was designed for epilepsy patients, not for neuropathy patients.
- Significant side effects are associated with taking the drug.
If you suffer from neuropathic pain, and particularly if it is caused by shingles or diabetes, you may want to speak to your physician about trying gabapentin as a form of treatment. It has been found to be significantly effective, but only in around half of patients, and it is impossible to tell who it will work on and who it will not. That said, if you suffer from neuropathy, it is likely that you are willing to try anything to improve your quality of life. Do be aware of the potential serious side effects, however, and follow the label’s and your physician’s instructions to the letter.