Gabapentin – The Good, the Bad, and the Overprescribed
Summary:
Gabapentin is often seen as a “safe” opioid alternative, but in workers’ comp it’s increasingly overprescribed. While effective for neuropathic pain, its benefits in acute pain are limited, side effects hinder recovery, and misuse risk is real. Prodigy data shows gabapentin ranked #2 in Q1 2025 prescriptions—underscoring the urgent need for tighter oversight, appropriate indication checks, and timely deprescribing.
Gabapentin, known by the brand name Neurontin, entered the pharmaceutical market in 1993. Originally FDA-approved as a muscle relaxant, it was soon recognized for broader utility—most notably in seizure management. Over time, its reputation expanded, and gabapentin became a go-to agent for multiple conditions, especially as a perceived alternative to opioids.1,2
So why the concern?
The Case for Gabapentin
Gabapentin exerts its effects through the central nervous system as a depressant. Although the precise mechanism remains unclear, this activity supports its use in a wide range of conditions: chronic pain, neuropathic pain, anxiety, and restless legs syndrome.1
Its appeal is obvious: a non-opioid, initially a non-controlled substance, and often positioned as a “safer” option for pain management—particularly in workers’ compensation claims.1,2
The Clinical Reality
The story is more complex.
Side effects: Dizziness, drowsiness, and cognitive impairment are common—hardly optimal for injured workers trying to recover and return to work.
Evidence base: While efficacy in neuropathic pain is well supported,2,3 evidence for acute pain is far weaker.4
Misuse potential: Despite its non-controlled federal status, at least 14 states reclassified gabapentin as a controlled substance by 2016 due to high rates of misuse and abuse.5
Prodigy Data Spotlight: In the first quarter of 2025, gabapentin ranked #2 among Prodigy’s top ten prescribed medications.6 This underscores the scale of its use—and the need for ongoing clinical vigilance.
Appropriate Prescribing: Where We Go from Here
Gabapentin is often prescribed reflexively, added to pain regimens without strong indication. In workers’ compensation, this “band-aid” approach can drive unnecessary exposure and long-term dependency risks.
Key considerations for adjusters, prescribers, and case managers:
Check the indication: Is the pain neuropathic, or is gabapentin being used indiscriminately for acute pain?
Monitor duration and dose: Long-term, high-dose use warrants timely intervention to prevent dependency.7
Support deprescribing: Tapering may be difficult for some patients, but when clinical benefit is lacking, discontinuation is the safer path.7
Bottom Line
Gabapentin is not the villain of pain management—but it isn’t a hero either. The best outcomes emerge when we apply it with precision: right indication, right duration, right dose. Appropriate oversight reduces side effects, minimizes misuse risk, and helps injured workers recover more effectively.
By Lexy MacArthur
PharmD Candidate (P4)
For questions, e-mail pharmd@prodigyrx.com
Citations
1. Yasaei R, Katta S, Patel P, et al. Gabapentin. [Updated 2024 Feb 21]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK493228/
2. Goodman CW, Brett AS. Gabapentinoids for Pain: Potential Unintended Consequences. Am Fam Physician. 2019 Dec 1;100(11):672-675. PMID: 31790179.
3. Goodman CW, Brett AS. Gabapentin and Pregabalin for Pain – Is Increased Prescribing a Cause for Concern? N Engl J Med. 2017 Aug 3; 377:411-414. DOI: 10.1056/NEJMp1704633
4. Perry T, editor. Therapeutics Letter. Vancouver (BC): Therapeutics Initiative; 1994-. Letter 75, Gabapentin for pain: New evidence from hidden data. 2009 Dec. Available from: https://www.ncbi.nlm.nih.gov/books/NBK598447/
5. Peckham AM, Ananickal MJ, Sclar DA. Gabapentin use, abuse, and the US opioid epidemic: the case for reclassification as a controlled substance and the need for pharmacovigilance. Risk Manag Healthc Policy. 2018 Aug 17;11:109-116. doi: 10.2147/RMHP.S168504. PMID: 30154674; PMCID: PMC6103607.
6. Bunny Trail to the Top 10: Q1 2025 Drug & Therapy Classes — Prodigy Care Services
7. Anderson PA, McLachlan AJ, Shaheed CA, Gnjidic D, Ivers R, Mathieson S. Deprescriping interventions for gabapentinoids in adults: A scoping review. BJCP. 2023 May 23. DOI: 10.1111/bcp.15798