Gabapentin

Non-pharmacological approaches including therapeutic exercise, massage, electrolyte correction, and metabolic optimization should be considered before committing a patient to gabapentin. Gabapentin is the standard pharmaceutical treatment for neuropathy but performs only marginally better than placebo in clinical outcomes and produces side effects. Gabapentin does not treat the underlying cause of neuropathy — it only masks the pain signal. Gabapentin does nothing to address the underlying causes of neuropathy—vascular damage, insulin resistance, B1 depletion, or mitochondrial dysfunction—and functions only as a pain signal dampener. Tolerance and dose escalation are the defining clinical pattern with gabapentin, with patients commonly reaching 800–900 mg three times daily over months to years. Gabapentin-induced sedation impairs balance and reaction time, creating a major fall risk especially in the elderly. Chronic gabapentin sedation leads to metabolic deterioration by reducing activity levels, which compounds insulin resistance in a self-reinforcing negative cycle.