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Gabapentin reduces neuropathic pain by < 1 point on a 0-10 point scale and benefits about 15% of carefully selected patients (NNT=6-8). A similar proportion of people suffer harm (NNH=8). A test of benefit/harm can be made after 1-2 days at a low dose (100-900 mg/day). Benefit is unlikely to increase with higher doses or longer treatment. Gabapentin is FDA approved for pain management of a limited number of neuropathic pain conditions; Gabapentin is widely used off-label for various chronic pain conditions and for the treatment of acute pain, making it now one of the most commonly described analgesic drugs The purpose of this report is to review the clinical evidence on the efficacy, safety and guidelines for use of gabapentin in adults with neuropathic pain, and to examine evidence on the misuse or abuse of gabapentin and other drugs for neuropathic pain. For short-term treatment of painful diabetic neuropathy and postherpetic neuralgia, gabapentin may be as effective as tricyclic antidepressants, serotonin-norepinephrine reuptake inhibitors, or pregabalin (based on indirect evidence). There is evidence to show that gabapentin is effective in neuropathic pain. There is limited evidence to show that gabapentin is ineffective in acute pain. Twenty-four systematic reviews or meta-analyses and one RCT met the inclusion criteria and provided data on efficacy and safety of gabapentin in patients with neuropathic pain. This Rapid Response Report, however, focused on four reports which provided either direct or indirect comparisons between gabapentin and active agents. Critical appraisal of included RCTs indicated that gabapentinoids are effective in reducing neuropathic pain in adults. The Neuropathic Pain Special Interest Group (NeuPSIG) has recommended antiepileptic drugs to manage neuropathic pain [1]. Scheduled gabapentin doses should be avoided in the post-operative period unless otherwise indicated for neuropathic pain Initial gabapentin doses for post-operative neuropathic pain should be limited to 300 mg per 24 hours Wean gabapentin over at least 2 weeks if receiving high doses (≥ 900 mg per 24 hours) for at least 4 weeks Gabapentin, an anticonvulsant widely used for the treatment of various neuropathic pain syndromes, has recently been investigated as an analgesic agent in the perioperative setting. Although it is not an analgesic itself, early experience suggests this medication can improve analgesia and reduce opioid requirements ( 13 ). N.B. Indication = peripheral neuropathic pain: 1–4 patches to the painful area for 30–60 min every 3 months: WEAK: Moderate–high N.B. Potential safety concerns over sensation with long–term use: Moderate–high: Lidocaine plasters N.B. Indication = peripheral neuropathic pain: 1–3 5% plasters to region of pain one per day for up to 12 Neuropathic pain: Pregabalin/gabapentin vs. placebo: Qaseem A, Wilt TJ, McLean RM, et al. Noninvasive treatments for acute, subacute, and chronic low back pain: a clinical practice guideline Gabapentinoid drugs—specifically gabapentin (Neurontin) and pregabalin (Lyrica)—are increasingly being prescribed for pain because physicians and patients seek alternatives to opioids in the The two new reviews which replace this piece of work can be found on The Cochrane Library as: 'Single‐dose oral gabapentin for established acute postoperative pain' and 'Gabapentin for 'Gabapentin for chronic neuropathic pain in adults'. The remaining gaps from the original review will be updated as soon as possible. The Neuropathic Pain Special Interest Group (NeuPSIG) has recommended antiepileptic drugs to manage neuropathic pain [].Accordingly, the United States (US) Food and Drug Administration (FDA) has permitted gabapentin treatment for postherpetic neuralgia, while pregabalin is approved for postherpetic neuralgia, neuropathic pain associated with diabetes or spinal cord injury, and fibromyalgia []. for all neuropathic pain (except trigeminal neuralgia) a choice of amitriptyline, duloxetine, gabapentin or pregabalin should be offered as initial treatment for neuropathic pain (except trigeminal neuralgia) (1) from previous guidance there is some advice about titration. for amitriptyline The established therapeutic dosing for gabapentin in neuropathic pain is 1800-3600 mg/day in 3 divided doses in patients with normal renal function. Gabapentin and the related, more potent compound pregabalin have been shown to be beneficial in the treatment of neuropathic pain as well as postoperative pain following spinal surgery and hysterectomy. Gabapentin 250 mg is statistically superior to placebo in the treatment of established acute postoperative pain, but the NNT of 11 for at least 50% pain relief over 6 hours with gabapentin 250 mg is of limited clinical value and inferior to commonly used analgesics. Tramadol is considered second-line treatment in most guidelines [3,8,9,13] but firstline in acute neuropathic pain, cancer-related neuropathic pain, and intermittent exacerbations of neuropathic pain. Tramadol has multiple mechanisms of action but primarily acts as a weak μ-opioid agonist and inhibitor of serotonin and norepinephrine reuptake. Neuropathic pain, which occurs as a result of damage to neural tissue, includes phantom limb pain, compression neuropathies, peripheral neuropathies (e.g. due to Diabetic complications, chronic excessive alcohol intake, HIV infection, chemotherapy, idiopathic neuropathy), trauma, central pain (e.g. pain following stroke, spinal cord injury, and syringomyelia), and postherpetic neuralgia
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