Gabapentin?

Austin discusses gabapentin in episode #99 of the podcast. What research would be recommend reading on it?

Context: My sister had ACDF surgery in mid-January to relieve pressure on her cervical spinal cord following a fall. She is in a lot of pain. Her neurosurgeon said pain was from nerve damage from the compression on her spinal cord. Another doctor prescribed gabapentin, which seems to provide some relief. In addition to pain, her main issue are greatly diminished strength and ability to move her hands, but she has been going to PT and OT and is making good progress. She can now lift 3# with her right hand and 1# with her left. In addition to the gabapentin she is taking Tylenol but no other meds.

Also, a pain management doctor recommended a cervical epidural, but her neurosurgeon said no, it was much too soon to consider an injection in her neck. I’m guessing you would not recommend it even after time, but haven’t seen anything specifically on point.

Sorry to hear about this challenging situation. A more specific question about this drug would be helpful, though.

For general information about the drug, a simple search of gabapentin pharmacology will turn up lots of review articles and other general discussions of the medicine and evidence for/against its use.

Trying to be more specific, does the following sound correct:

It seem her pain is neuropathy for which gabapentin can be effective. It seems somewhat effective in her case (it decreases but does not eliminate pain). She has some swelling and loss of fine motor control, which are possible side effects, but those seem attributable to her injuries rather than the drug. There do not appear to be other drugs that are more effective. PT/OT are key non-drug recommendations and she is doing those regularly.

Overall this is reasonably accurate. Caveats:

I am not sure what you mean by “swelling”; this can occur for a variety of reasons. Gabapentin has a calcium channel-blocking effect, which can cause leg swelling, although it’s not clear which swelling you’re referring to / where it is located.

There are other options for so-called “neuropathic” issues, including pregabalin (related to gabapentin), other antiepileptics, tricyclics or other medications often classified as “antidepressants”, and certain topical options like lidocaine, capsaicin, etc. We do not have strong evidence supporting the superiority of one of these over others, broadly speaking.

By swelling I mean a couple of the fingers on her left hand, the most affected hand, are swollen. Reportedly neither her doctor nor her PT was not concerned

From what I’ve read, antidepressants seem an alternative to the anti-epileptics rather than something to take in addition. This paper prefers SNRIs to tricyclics: Antidepressants Are Effective in Decreasing Neuropathic Pain After SCI: A Meta-Analysis - PMC

Lidocaine has helped but only a little.

She’s against opiods and doesn’t want to try an epidural. She’s tried edible marijuana, which has either had no effect or made her drowsy, depending on dosage.

Other than possibly trying anti-depressants or anti-epileptics, it sounds as if she’s out of medical options and that PT/OT and time are her best hopes. Fortunately, she’s optimistic that things will get better with time and feels lucky to be alive (her hospital admission notes are certainly scary).

Thank you.

I’ve been recommending trying pregabalin and SNRI antidepressants for months, as well as cognitive behavior therapy, and have provided links to research to show her doctors in case they are not familiar. So far as I can tell, my sister has been ignoring this advice, despite being in what she describes as dire pain and willing to try anything. Also, her PT said to suspend treatment until her pain issues improve (which may not be the best advice).

Today she tells me a friend of a friend was given Lyrica, a nerve medication, and it was working well for pain. She intends to discuss this with her doctor ASAP.

I looked up Lyrica. It’s pregabalin.

Seems as if social anecdotes trump published research. Sigh. I wonder if there’s anything useful I can do.