Developed initially as an anti-convulsant, gabapentin has found a crucial role in managing various types of neuropathic pain. In this post, I’ll explain how this drug works to block pain signals temporarily.
The Science Behind Gabapentin
To understand how gabapentin blocks pain, we must delve into our nervous system’s intricate workings. Gabapentin’s effectiveness lies in its interaction with specific calcium channels in our nerve cells.
Calcium Channel Interaction
Gabapentin binds to the α2δ subunit of voltage-gated calcium channels, which play a crucial role in the transmission of pain signals throughout the body. By attaching to these subunits, gabapentin reduces calcium influx into nerve cells. This might seem like a small change, but it has significant implications for pain perception.
Neurotransmitter Modulation
The reduced calcium influx leads to a decrease in the release of excitatory neurotransmitters. These neurotransmitters amplify and transmit pain signals from one nerve to another. By limiting their release, gabapentin effectively “turns down the volume” of the pain signals being sent through our nervous system.
How This Translates to Pain Relief
The modulation of calcium channels and neurotransmitter release doesn’t eliminate the source of pain. Instead, it alters how intensely we perceive these pain signals. Think of it as adjusting the sensitivity of your body’s pain alarm system. The pain stimulus might still be present, but your brain receives a muted version of the signal, reducing the pain sensation.
Effectiveness in Neuropathic Pain
It’s worth noting that gabapentin’s pain-blocking effects are most pronounced in cases of neuropathic pain – pain caused by nerve damage or dysfunction. This is why many patients are prescribed this medication who are suffering with back pain.
When a disc bulges or herniates, it often causes stenosis, occluding the intervertebral foramen, which is colloquially known as a pinched nerve. In this scenario, neuropathic pain starts in the spine and radiates down into the legs.
With back pain, the nerves are in an excited state, which can send exaggerated pain signals. The medication gabapentin helps normalize this overactive signaling, providing temporary relief to patients who may have found little success with other pain management strategies.
Potential Side Effects and Considerations
While gabapentin can be highly effective in providing short-term pain relief, I’ve had many patients complain of weight gain as a direct result of taking this drug. They often report that increased weight gain is negatively impacting their health and making their spine pain worse. I always tell my patients to report this to the prescribing physician and keep track of adverse reactions.
What other options are there?
Patients who are dealing with spine pain often find relief from a non-pharmacological approach, such as non-surgical spinal decompression. This treatment has a nationwide success rate of 88-92% for discogenic spine pain. Often, chronic pain is multifactorial, meaning there is no one-size-fits-all solution. However, this treatment is proving to be a viable option for patients who don’t want drugs, injections, or surgeries.
