IF OVER-THE-COUNTER OPTIONS FALL SHORT, THIS NERVE PAIN MEDICATION MAY OFFER RELIEF DURING OR AFTER AN OUTBREAK
Gabapentin is a prescription anticonvulsant used to manage epilepsy, certain types of nerve pain, and restless legs syndrome. It is also available under the brand name Neurontin.
Although gabapentin is not generally used to treat the early symptoms of shingles, it may be helpful when shingles causes severe nerve-related pain. It is also commonly prescribed for nerve pain that continues after the shingles rash has cleared, a condition known as postherpetic neuralgia.
Here’s what to know about using gabapentin for shingles-related nerve pain.
Key Takeaways
- Gabapentin is an anticonvulsant medication that can also be used to manage nerve pain, including pain associated with shingles.
- It can be an effective treatment for postherpetic neuralgia (PHN), the persistent nerve pain that may remain after shingles damages the nerves.
- Gabapentin may cause side effects such as drowsiness and dizziness. Your healthcare provider can help determine the appropriate dose based on your individual needs.
How Does Gabapentin Work for Shingles Pain?
Shingles develops when the varicella-zoster virus, the same virus responsible for chickenpox, becomes active again after remaining dormant in the body. The reactivation can affect the nerves and lead to inflammation, burning, tingling, and significant pain.
Gabapentin was originally developed to help control seizures in people with epilepsy, but it is also used for certain forms of neuropathic pain, including the nerve-related discomfort associated with shingles. It works by attaching to specific proteins on nerve cells, helping reduce the excessive nerve signalling that contributes to pain.
Gabapentin is more commonly prescribed when nerve pain continues after the shingles rash has healed, although some research suggests it may also provide relief during an active shingles outbreak. One small study involving adults over age 60 found greater pain relief among participants who took gabapentin during a shingles outbreak compared with those who received a placebo.
Is Gabapentin Effective for Postherpetic Neuralgia (PHN)?
Shingles pain generally occurs in two stages: acute pain during the outbreak and, for some people, persistent pain after the rash disappears.
When pain continues after the rash has healed, it is known as postherpetic neuralgia (PHN). About 10% to 18% of people who develop shingles experience PHN. This condition results from nerve damage caused by the infection and can persist for months.
PHN is often described as burning, shooting, tingling, or electric-shock-like pain. Some people may also experience itching, numbness, or increased sensitivity to touch or changes in temperature.
Because gabapentin reduces abnormal nerve signalling, it can help manage both shingles-related nerve pain and PHN. There is particularly strong evidence supporting its use after shingles, and it is considered a frontline treatment for PHN.
A long-acting formulation of gabapentin, Gralise, was approved for PHN in 2011. Research has found that it can reduce average daily pain compared with placebo. Studies of the standard immediate-release form have also shown reductions in PHN symptoms and improvements in sleep.
Gabapentin Dosage for Shingles
The appropriate gabapentin dose varies from person to person. One commonly described starting regimen is 300 mg once daily, with the dose potentially increased to 600 mg three times daily, for a maximum of 1,800 mg per day.
However, gabapentin dosing should be individualized. People who are older or who have reduced kidney function may require lower doses because the medication is eliminated through the kidneys. Impaired kidney function can increase the risk of side effects.
What to Expect and How to Manage Side Effects
Many people tolerate gabapentin without major problems, but possible side effects include:
- Dizziness
- Drowsiness
- Weakness
- Diarrhea
- Dry mouth
- Swelling of the arms or legs
- Tremors or other uncontrolled movements
Drowsiness, dizziness, and low energy are among the more commonly reported problems. Older adults may be particularly susceptible to dizziness.
A rare but serious reaction called DRESS syndrome (Drug Reaction with Eosinophilia and Systemic Symptoms) can also occur. This is a medical emergency. Possible symptoms include fever, rash, facial swelling, and abnormal kidney or liver test results.
If gabapentin causes significant sleepiness or dizziness, work with your healthcare provider to determine whether adjusting the dose or timing can provide pain relief while minimizing these effects. Avoid driving if the medication makes you drowsy.
Tell your healthcare provider about any medical conditions, medications, or supplements you use before starting gabapentin. People with impaired kidney function may need a lower dose. Gabapentin should also not be combined with opioid or narcotic pain medications without medical guidance because the combination can increase the risk of respiratory depression, including dangerously slow or shallow breathing.
Combining Gabapentin With Other Treatments
Gabapentin may be used alongside other treatments to improve pain control during or after shingles.
- During an active shingles outbreak: Some evidence suggests that combining gabapentin with the antiviral medication valacyclovir may help reduce short-term pain and potentially lower the risk of developing PHN.
- During and after the outbreak: Topical pain-relieving treatments such as lidocaine or capsaicin creams and patches may provide additional relief.
- For PHN: Certain tricyclic antidepressants, including amitriptyline and nortriptyline, may be used to manage persistent nerve pain. These medications may work alongside gabapentin, particularly for people who cannot tolerate higher gabapentin doses.
When Gabapentin May Not Be the Best Option
Although gabapentin can be helpful for shingles-related nerve pain and PHN, it isn’t appropriate for everyone. An alternative treatment may be preferable if someone experiences severe side effects or has medical conditions or takes medications that increase the risks associated with gabapentin.
It is also important to remember that gabapentin does not completely eliminate pain for everyone. If pain continues despite treatment—or if side effects are interfering with daily activities—talk with your healthcare provider about other options.
The Bottom Line
Gabapentin can help manage nerve pain during shingles and persistent nerve pain after the rash has healed. It is particularly well established as a treatment for postherpetic neuralgia and may be combined with other therapies when additional pain control is needed.
Because gabapentin can cause drowsiness, dizziness, and other side effects, finding the appropriate dose is important. Work with your healthcare provider to determine whether it is suitable for you, especially if you have kidney problems or take other medications.
Source: SingleCare