Gabapentin has been approved in the United States for the treatment of
epilepsy and
postherpetic neuralgia.
Gabapentin has also demonstrated proven efficacy for the treatment of diabetic
peripheral neuropathy and
trigeminal neuralgia, although these represent
off-label uses of the
drug. However, to our knowledge, no data have been published regarding the efficacy of
gabapentin for treating
sciatica. We describe two patients with
sciatica who were successfully treated with
gabapentin. The first was a 32-year-old man with severe shooting
pain in his left leg that was later diagnosed as
sciatica secondary to a fifth lumbar-first sacral
intervertebral disk herniation. The patient was treated with
acetaminophen, nonsteroidal antiinflammatory drugs (
NSAIDs),
narcotics, and muscle relaxants; he reported only limited
pain relief with any of these agents or combination of agents. He was then prescribed
gabapentin 300 mg once/day; his
pain substantially improved, even after the first dose. The
drug was titrated gradually up to 900 mg 3 times/day with good results. The patient subsequently underwent a
laminectomy and
diskectomy on the advice of his neurosurgeon, who assured him that the result would be immediate
pain relief. After surgery, the patient continued to experience
pain; however, his
pain resolved completely after several weeks of receiving
gabapentin 600 mg 3 times/day. The second patient was a 68-year-old Caucasian woman with
renal insufficiency who experienced severe
burning pain and
numbness of abrupt onset in the posterior right leg; this was diagnosed as
sciatica. The patient had
contraindications for
NSAID therapy and was intolerant of
hydrocodone. Initial
therapy with
propoxyphene and
acetaminophen, self-started by the patient, was ineffective.
Gabapentin 100 mg at bedtime was started and then titrated up to 100 mg twice/day with 200 mg at bedtime. The patient's
pain improved rapidly, and at follow-up approximately 5 weeks later, she was experiencing good
pain control with
gabapentin.
Gabapentin is widely prescribed for management of peripheral
neuropathic pain syndromes. To our knowledge, however, these two case reports are the first to describe
sciatica successfully controlled with
gabapentin. Because
gabapentin has the potential to prevent central sensitization, consideration should be given to prescribing this
therapy early in the course of
sciatica. Further research using randomized, placebo-controlled trials are needed to validate the benefit of
gabapentin in the treatment of
sciatica.