Skip to content
Umbrella Aged Care
← Pain in older people

Nerve pain and the gabapentinoids

GPs & clinicians Aged care staff 6 min read

By Dr Josh Hatch, FRACGP

Nerve pain, or neuropathic pain, arises from the nerves themselves rather than from joints or muscles. Pregabalin and gabapentin, the gabapentinoids, are among the medicines recommended first for it, but the benefit is modest 31, and in sciatica the one large trial found none 32.

Numbers in the text link to the 5 sources listed at the foot of this page.

What the trials show

Gabapentinoids for neuropathic pain

Supported by trial evidence

They help a minority of people with nerve pain: about one extra person in nine gains meaningful relief.

The evidence

A 2025 meta-analysis of 313 randomised trials for the Neuropathic Pain Special Interest Group found a number needed to treat of 8.9 (95% CI 7.4 to 11.1) for the gabapentinoids, with one extra person withdrawing because of adverse events for every 26 treated. Tricyclic antidepressants (number needed to treat 4.6) and serotonin and noradrenaline reuptake inhibitors (7.4) were also recommended first-line. Capsaicin and lidocaine plasters received weak, second-line recommendations, and opioids a weak, third-line recommendation 31.

In practice

The medicines section explains anticholinergic burden, which is relevant when a tricyclic antidepressant is considered for an older person.

Pregabalin for sciatica

Not supported

In an Australian trial, pregabalin did not reduce sciatica leg pain and caused more side effects, mainly dizziness.

The evidence

In 209 people with sciatica, leg pain at eight weeks was no better with pregabalin than with placebo (adjusted difference 0.5 on a 10-point scale, 95% CI −0.2 to 1.2), and no better at one year. There were 227 adverse events with pregabalin against 124 with placebo, and dizziness was more common 32.

In practice

The trial was funded by the NHMRC 32. The Australian low back pain standard advises avoiding anticonvulsants for back pain because their risks often outweigh potential benefits 14.

Gabapentinoids with opioids

In Ontario, among people taking opioids, also taking gabapentin was associated with a higher risk of opioid-related death (adjusted odds ratio 1.49, 95% CI 1.18 to 1.88). This was an observational study of people on public drug coverage, and unmeasured differences between groups may explain part of the association 33.

The combination is common in Australian aged care. In 12 South Australian nursing homes, 62% of residents prescribed a gabapentinoid were also prescribed an opioid, and the authors called for attention to the central nervous system-active polypharmacy that results 5.

Questions for a review

  • What is it treating, and is the pain neuropathic?

  • Has it helped, judged against a goal set when it was started?

  • Is the resident also taking an opioid or a sedative?

  • Has there been dizziness, unsteadiness, drowsiness or new confusion since it started?

Related pages on this site

Sources cited on this page

  1. 5 Dowd LA, Pitkälä KH, Jadczak AD, et al. Analgesic and adjuvant co-prescribing in Australian and Finnish residential care homes. Australas J Ageing. 2025;44(3):e70062. (Cross-sectional secondary analysis.) View source
  2. 14 Australian Commission on Safety and Quality in Health Care. Low Back Pain Clinical Care Standard. Sydney: ACSQHC; September 2022. (Scope: people aged 16 and over in primary care and emergency departments.) View source
  3. 31 Soliman N, Moisset X, Ferraro MC, et al. Pharmacotherapy and non-invasive neuromodulation for neuropathic pain: a systematic review and meta-analysis. Lancet Neurol. 2025;24(5):413–28. (313 randomised trials; NeuPSIG recommendations.) View source
  4. 32 Mathieson S, Maher CG, McLachlan AJ, et al. Trial of pregabalin for acute and chronic sciatica. N Engl J Med. 2017;376(12):1111–20. (PRECISE trial; funded by the NHMRC.) View source
  5. 33 Gomes T, Juurlink DN, Antoniou T, Mamdani MM, Paterson JM, van den Brink W. Gabapentin, opioids, and the risk of opioid-related death: a population-based nested case–control study. PLoS Med. 2017;14(10):e1002396. (Observational; Ontario, Canada.) View source

See every source cited across the pain section →

Written by Dr Josh Hatch, FRACGP. General information only, reflecting his reading of the published evidence as at November 2026. It is not individual medical advice, does not create a doctor–patient relationship, and must not be used to start, stop or change any treatment. It gives no doses, and it does not recommend any procedure, clinic or practitioner. Evidence and Australian regulatory and PBS arrangements change — always confirm current advice with the treating GP, pharmacist or specialist.

This is general education, not a clinical protocol. The doctors who practise with Umbrella Aged Care are independent general practitioners, and each makes their own clinical decisions with the resident and family. Your GP’s advice for an individual may differ from what is written here. If it does, please ask them to talk it through with you.

Enquire about care