Is Gabapentin an Effective Treatment for Arthritis?

Neurontin (gabapentin), generally prescribed for the treatment of nerve pain, is sometimes used to relieve severe pain caused by knee osteoarthritis (OA) Osteoarthritis, also known. as wear-and-tear arthritis, can often become so severe that joint replacement surgery is needed. Using gabapentin with other arthritis treatments may help delay such procedures.

While potentially useful for treating severe knee OA, there is no strong evidence that gabapentin can provide relief from autoimmune forms of arthritis, such as rheumatoid arthritis and psoriatic arthritis.

The article describes how gabapentin is commonly used and how it may be prescribed to treat knee arthritis pain. It also explains how gabapentin is taken and possible side effects of treatment.

Common Uses for Gabapentin

Gabapentin, sold under the brand name Neurontin, belongs to a class of drugs called anticonvulsants. Gabapentin has two approved uses: the treatment of partial seizures in people with epilepsy and the treatment of neuropathic (nerve-related) pain.

An extended-release form of gabapentin, sold under the brand name Horizont, is licensed for the treatment of restless legs syndrome (RLS), a condition that causes the strong urge to move.

When used for nerve pain, gabapentin may be recommended if you have:

• Cancer pain
• Diabetic neuropathy
• Fibromyalgia
• Multiple sclerosis
• Post-herpetic neuralgia (caused by shingles)
• Severe carpal tunnel syndrome
• Severe peripheral neuropathy (caused by certain autoimmune diseases like lupus, chemotherapy, untreated HIV, alcoholism, stroke, spinal cord injuries, and others)

Gabapentin is also sometimes used off-label (meaning for uses other than what it is licensed for) to prevent migraines, although the evidence supporting such use is inconclusive.

Benefits of Gabapentin for Arthritis

Gabapentin is used off-label for the treatment of severe knee osteoarthritis and typically when all other treatment options have failed to provide adequate relief.

The rationale behind its use is based on the types of pain that OA causes, namely nociceptive pain (pain caused by damage to tissues) and nociplastic pain (pain caused by altered sensory perception). Fibromyalgia is the main example of nociplastic pain, the condition of which is responsive to drugs like gabapentin.

Even so, the evidence remains mixed as to how effective the drug is when applied to OA pain.

What the Research Says

A 2019 study published in Clinical Rheumatology reported that 300 milligrams (mg) of gabapentin, when combined with Cymbalta (duloxetine), reduced knee OA pain more effectively than Cymbalta combined with Tylenol (acetaminophen).

The three-month study, which involved 150 adults with moderate to severe OA, concluded that gabapentin was an effective add-on treatment to Cymbalta, an antidepressant commonly used for the treatment of nerve pain. When used in this way, pain relief was felt within two to four weeks and leveled off thereafter.

The findings were supported by a 2022 review of studies in BMC Rheumatology which concluded that gabapentin appears to be safe and effective for relieving knee OA pain but warned that the small sample size (304 participants, including 150 from the abovelisted study) limited certainty of the findings.

Other studies are less supportive of treatment. A 2023 analysis from Brigham and Women’s Hospital in Boston. which evaluated the cost efficacy of gabapentin in treating OA, reported that gabapentin was only "modesty effective" and that the benefits of treatment largely outweighed the high rate of side effects.

Gabapentin Side Effects

As with all medications, gabapentin can cause side effects, some of them significant. According to the manufacturers, the most common side effects (by order of frequency) are:

• Sleepiness
• Dizziness
• Clumsiness and poor muscle control
• Fatigue
• Uncontrolled eye movements
• Tremors
• Double vision
• Changes in the alignment of your eyes ("lazy eye")
• Increased weight
• Upset stomach
• Dry mouth
• Constipation
• Swelling of legs and feet

Some side effects will subside as your body adapts to treatment. Others may develop later due to long-term exposure to the drug.

Nervous system side effects like sleepiness, dizziness, fatigue, uncontrolled eye movement, and loss of muscle control affect 8% or more of users. Other side effects are far less common, affecting only 2% to 4% of users.

The risk of side effects is largely dose-dependent, meaning that larger doses or prolonged exposure increases their risk. Given that gabapentin is often prescribed on an ongoing basis, it is important to discuss the benefits and risks with your healthcare provider before starting treatment.

Gabapentin Interactions 

Gabapentin has few drug interactions. Interactions can cause the concentration of gabapentin or the accompanying drug to rise or fall. Increases in concentration increase the risk of side effects, while decreases in concentration decrease the effectiveness of the drug.

The two main interactions reported by the manufacturer are:

• Opioid drugs: Taking gabapentin with opioid painkillers reduces the concentration of the accompanying opioid. It can also increase the risk of drowsiness and cause respiratory depression (abnormally slowed breathing).
• Antacids: Taking gabapentin with aluminum or magnesium antacids like Tums or Maalox reduces the concentration of gabapentin in the blood.

Do not drink alcohol with gabapentin as it can also increase the risk of drowsiness, sleepiness, and loss of coordination.

Gabapentin Dosage

Gabapentin is taken by mouth and is available either as a capsule (100 mg, 300 mg, and 400 mg) or a tablet (600 mg and 800 mg). Gabapentin can be taken with or without food.

When used for pain, gabapentin is prescribed at a lower "loading dose" and gradually increased to the optimal "therapeutic dose." This helps ease you into treatment with minimal side effects.

This is typically done as follows:

• Day 1: Take one 300-mg capsule in the evening
• Day 2: Take one 300-mg capsule in the morning and one 300-mg capsule in the evening (600 mg total)
• Day 3: Take one 300-mg capsule in the morning, one 300-mg capsule around lunchtime, and one 300-mg capsule in the evening (900 mg total)

The dose can be increased if needed up to 1,800 mg per day (600 mg three times a day) to achieve the desired effect.

Other Arthritis Treatment Options

The treatment for osteoarthritis arthritis focuses on relieving pain, swelling, and stiffness while improving joint function. You will likely need to take different medicines or a combination of treatments before you find the solution that works best for you.

Among the options:

• Nonsteroidal anti-inflammatory drugs (NSAIDs) relieve joint pain and inflammation. Options include Advil (ibuprofen), Aleve (naproxen), Mobic (meloxicam), and Relafen (nabumetone).
• Topical pain relievers, including ointments and gels containing capsaicin or menthol, can temporarily block nerve pain signals and ease acute joint pain.
• Corticosteroids like prednisone can quickly reduce inflammation and pain while slowing down joint damage. These medicines are available as oral pills or joint injections.
• Intraarticular hyaluronic acid involves the injection of a synthetic lubricating fluid called Hyaluronan into a joint space to help the joint move smoother.
• Physical therapy can help improve the range of motion of a joint and strengthen the muscles surrounding the joint.

Summary

Gabapentin is an anticonvulsant drug approved for the treatment of partial seizures and neuropathic pain. It is sometimes used off-label to treat severe knee osteoarthritis (OA), although the evidence supporting this use is mixed.

Gabapentin is available as a capsule or tablet and is taken three times daily by mouth with or without food. Side effects include sleepiness, loss of coordination, fatigue, uncontrolled muscle movements, nausea, constipation, and swelling of the legs and ankles.

If intended for the treatment of OA, speak with your healthcare provider about the benefits and risks of gabapentin to make an informed choice.