Gabapentin vs. Amitriptyline: A Comprehensive Look at Nerve Pain Treatment Options

Neuropathic pain, also known as nerve pain, can be debilitating. It’s often described as a burning, shooting, or stabbing sensation and can be triggered by various conditions, including diabetes, shingles, or injuries. Fortunately, there are several treatment options available, including medications like gabapentin and amitriptyline. This post will delve into these two medications, comparing their uses, efficacy, side effects, and more.

Understanding Neuropathic Pain

Before we dive into the specifics of gabapentin and amitriptyline, it’s crucial to understand what neuropathic pain is. This type of pain results from damage to or dysfunction of the nervous system. It can be associated with a range of conditions, from diabetes and multiple sclerosis to nerve injuries and infections like shingles.

Neuropathic pain can be challenging to manage because it doesn’t respond as well to conventional pain medications, such as nonsteroidal anti-inflammatory drugs (NSAIDs). This is where medications like gabapentin and amitriptyline come in. They work by interacting with the nervous system to reduce pain signals.

Gabapentin for Nerve Pain

Gabapentin is an anticonvulsant medication, originally developed to treat epilepsy. However, it’s also been found to be effective in managing neuropathic pain. It works by calming down the overactive nerve signals that cause nerve pain.

How Effective is Gabapentin?

Numerous studies have shown that gabapentin can be effective in treating nerve pain. For example, a systematic review published in the Cochrane Database of Systematic Reviews found that gabapentin provided significant pain relief for people with postherpetic neuralgia (nerve pain following shingles) and painful diabetic neuropathy.

Gabapentin Side Effects

Like all medications, gabapentin can have side effects. The most common ones include dizziness, fatigue, weight gain, and swelling in the hands and feet. In some cases, gabapentin can also cause more serious side effects, such as changes in mood or behavior, difficulty breathing, or severe weakness. It’s important to discuss these potential side effects with your healthcare provider before starting gabapentin.

Amitriptyline for Nerve Pain

Amitriptyline is a tricyclic antidepressant medication that is often used off-label to treat neuropathic pain. It works by increasing the levels of certain chemicals in the brain that help improve mood and reduce pain perception.

How Effective is Amitriptyline?

Amitriptyline has been shown to be effective in managing various types of neuropathic pain. A Cochrane review found that amitriptyline was one of the most effective medications for neuropathic pain, providing significant pain relief for many people.

Amitriptyline Side Effects

Common side effects of amitriptyline include dry mouth, constipation, blurred vision, and drowsiness. Some people may also experience changes in appetite, weight gain, or difficulty urinating. In rare cases, amitriptyline can cause more serious side effects, such as irregular heartbeat, mental/mood changes, or severe abdominal pain. As with gabapentin, it’s critical to discuss potential side effects with your healthcare provider before starting amitriptyline.

Comparing Gabapentin and Amitriptyline

Here’s a comparative table of Gabapentin and Amitriptyline:

Class of DrugAnticonvulsantTricyclic antidepressant
Primary UseOriginally developed for epilepsyOriginally developed for depression
Off-label UseNeuropathic painNeuropathic pain
EfficacyEffective in managing neuropathic painMay provide greater pain relief for some
Common Side EffectsDizziness, fatigue, weight gainDry mouth, constipation, blurred vision, drowsiness
Serious Side EffectsMood changes, difficulty breathingIrregular heartbeat, mental/mood changes
Risk of WithdrawalYesYes
InteractionsCan interact with other medicationsCan interact with other medications
Lifestyle ConsiderationsMay cause drowsiness and dizzinessMay cause drowsiness and dizziness

Both gabapentin and amitriptyline have been shown to be effective in managing neuropathic pain, but they work in different ways and have different side effect profiles. So, which one is better? The answer may depend on the individual and the specific type of nerve pain they’re experiencing.

In terms of efficacy, both medications have been shown to be effective, but some studies suggest that amitriptyline may provide more significant pain relief for some people. However, gabapentin is often better tolerated, with fewer side effects than amitriptyline.

In terms of side effects, gabapentin tends to cause fewer anticholinergic side effects (like dry mouth and constipation) than amitriptyline. However, it can cause dizziness and fatigue, which some people may find bothersome.

Ultimately, the decision between gabapentin and amitriptyline will depend on the individual’s specific symptoms, overall health, the potential for side effects, and personal preference. It’s essential to have a thorough discussion with your healthcare provider about the benefits and risks of each medication to determine the best treatment option for you.

Important Considerations

While both gabapentin and amitriptyline can be effective in managing neuropathic pain, they are not without risks. Both medications can cause drowsiness and dizziness, which can be dangerous if you’re driving or operating heavy machinery. They can also interact with other medications, so it’s important to discuss all current medications and supplements with yourhealthcare provider before starting either treatment.

Additionally, both medications can cause withdrawal symptoms if stopped abruptly. Therefore, it’s critical never to stop taking these medications without first consulting your healthcare provider.

Moreover, while gabapentin and amitriptyline can help manage neuropathic pain, they do not cure the underlying condition causing the pain. As such, it’s essential to work with your healthcare provider to manage the underlying condition and explore other treatment options, such as physical therapy, lifestyle changes, or other medications, as appropriate.

The Role of Lifestyle Management

While medications like gabapentin and amitriptyline can play an essential part in managing nerve pain, lifestyle factors can also significantly impact pain levels. Regular physical activity, for example, can help reduce pain and improve overall health. However, it’s crucial to speak with your healthcare provider before starting a new exercise program.

Similarly, a balanced diet can also play a role in managing nerve pain. Some studies suggest that certain dietary factors, such as high sugar intake, can worsen neuropathic pain, while a diet rich in fruits, vegetables, whole grains, lean proteins, and healthy fats can help manage pain and promote overall health.

Additionally, stress management techniques such as mindfulness, meditation, and yoga can be valuable tools in managing nerve pain. These practices can help reduce stress levels, which can, in turn, help manage pain.


Neuropathic pain can be a challenging condition to manage, but medications like gabapentin and amitriptyline can provide significant relief for many people. Both drugs have been shown to be effective in managing nerve pain, although they work in different ways and have different side effect profiles.

While these medications can play a critical role in managing neuropathic pain, it’s also important to consider lifestyle factors and other treatment options. Regular physical activity, a balanced diet, stress management techniques, and other treatments can all play a role in managing nerve pain.

Ultimately, the decision between gabapentin and amitriptyline should be made in consultation with your healthcare provider, taking into account your specific symptoms, overall health, and personal preferences. With the right treatment plan, it’s possible to manage neuropathic pain effectively and improve quality of life.

Remember, this blog post is not intended to replace professional medical advice. Always consult with your healthcare provider before starting any new medication or treatment plan.

There are various forms of drugs available, such as tablets or liquids, and each may have a separate patient information leaflet (PIL) for different doses. It is important to refer to the PIL for the specific form and dose of the drug that you have been prescribed.

You can search for further information and PILs on websites such as: