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Gabapentin Not as Effective as Previously Thought

Of the 1 in 14 adults who live with chronic neuropathy, few see benefit from active intervention

A PPM Brief

A clinical synopsis published in JAMA1 earlier this year revealed that the gabapentin only reduced chronic neuropathic pain by at least 50% in fewer than 20% of patients. Subjects who experienced improvements from active treatment of the medication ranged from 30% to 48% versus 11% to 30% who took placebo. 

The authors evaluated data from 37 randomized clinical trials, involving more than 5,900 patients, to provide an updated review on the use of gabapentin for neuropathic pain. Among patients with postherpetic neuralgia (PHN), substantial pain reduction (at least 50%) was achieved in 32% with gabapentin versus 17% with placebo; moderate pain reduction (at least 25%) was achieved in 46% with gabapentin versus 25% with placebo. Subjects with painful diabetic neuropathy (PDN) reported substantial relief (38%) compared to 21% for placebo, and moderate benefit (52%) versus 37% placebo. For patients with mixed neuropathic pain, spinal cord injury, cancer-related neuropathic pain, phantom pain, radicular leg pain, nerve injury pain, or neuropathies related to HIV, there were no differences demonstrated between gabapentin and placebo.1

Normal oral gabapentin prescriptions taken at 1200 to 3600 mg a day for 4 to 12 weeks by patients with moderate or severe neuropathic pain from PHN or PDN, therefore, was associated with pain reduction of at least 50% in 14% to 17% more patients than placebo.1

In a meta-analysis of the trials, gabapentin was associated with modestly, but significantly, higher rates of withdrawal due to adverse events (11% versus 8% for placebo) and with slightly, but also significantly, lower rates of withdrawal due to lack of efficacy (2% vs. 3% for placebo). Reported adverse-event rates were significantly higher with gabapentin (63%) than with placebo (49%), but rates of serious adverse events were not (3% with both). In particular, gabapentin was associated with more somnolence or drowsiness, dizziness, peripheral edema and gait disturbance or ataxia, compared with placebo.1

“The authors concluded that gabapentin is associated with reduction in acute pain associated with postherpetic neuralgia and peripheral diabetic neuropathy (the latter indicated is not approved by the FDA), and that there is limed evidence to support the use of gabapentin for other types of neuropathic pain and pain disorders,” said JD Wallach in a related JAMA commentary.2

Last updated on: March 22, 2018
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Gabapentin Dosing for Neuropathic Pain
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