In recent years, a lot of people have told me they were prescribed gabapentin (Neurontin) for pain. This was recommended after major surgery as a means to lower the necessity of opioid use. Gabapentin was thought to make opioids more potent and thus the prescribed doses of opioids could be less. The terminology used is that gabapentin “potentiates” opioids.
Most patients who were prescribed gabapentin told me they didn’t feel like it did any good; their pain wasn’t any less. Plus the amount of opioid they were taking was the same. My patient-sample group was largely made up of people over age 65 which may affect the results of my observation.
My skepticism was borne out by a report in JAMA Internal Medicine. An analysis of nearly 120,000 pairs of older (over age 65) adults compared gabapentin users to non-users. While adding gabapentin did reduce opioid doses and control pain, it also had adverse effects that were as bad, if not worse, than the post operative pain. Patients who used gabapentin in the hospital after major surgery had a modestly increased risk of delirium (confusion, over-sedation), new anti-psychotic use, and pneumonia. 12.3% of gabapentin users got goofy after surgery and had to be given drugs to control the bad symptoms they were having. As the hours after surgery went on, the symptoms worsened. The patient was free of pain but was having psychotic symptoms that were of much greater concern. The higher the dose of gabapentin the higher the chance of delirium.
This is a great example of “physician do no harm!” With the best of intentions, physicians were giving older, debilitated patients who had just had a major surgery, a drug which suppresses the nervous system and ultimately caused more problems than benefits. This harm resulted in symptoms that required the prescribing of anti-psychotic drugs, which are not without major risks of adverse effects, themselves. The last paragraph of the reference says, “The authors advised that physicians should not routinely prescribe gabapentin for peri-operative pain management to older patients.” I couldn’t agree more!
References: https://www.jamanetwork.com/journals/jamainternalmedicine/article-abstract/2796501
News From JAMA Network. “Perioperative Gabapentin Linked to Harms for Older Adults” JAMA 2022 November 1;328(17):1677-1678.
Hope you are doing well and you have recovered from your illness!! Question…..Mom and I both take Gabapentin for other reasons than pain. I take it to help with restless legs but I’m not sure why she takes it. She takes 250 mg of Ropinirole for restless legs. Is this a good reason to take Gabapentin or should we consider taking an alternate medication? I take 300 mg at night. What do you take for RL?
Thanks for this blog. I love it!!
Sharon Tolin
Sharon, Thanks for your very kinds words and support. Gabapentin can be used for any neurologic symptoms like neuropathies—burning, tingling, pins and needles, numbness, pain, etc. Restless legs can loosely be considered a neurologic syndrome so it’s appropriate to try gabapentin. It’s a fairly harmless drug adverse effects wise. I take Mirapex (pramipexole) for RLS and have for many years. It works great. I tried Sinemet (carbidopa-levodopa), but it worked only temporarily. If Gabapentin works, stay on it. Neuropathies are treated by trial and error. Try different drugs until you find one that works. Dr. G