Does the combination of gabapentin and pregabalin have a rationale in the treatment of neuropathic pain? A critical narrative review

Neuropathic pain is a complex condition to manage, and although gabapentin and pregabalin are used as firstline alternatives, their combined use is not supported by clinical guidelines or robust evidence. The aim of this critical narrative review was to examine the pharmacological plausibility, available clinical evidence, and practical implications of this combination. A comprehensive search was conducted in PubMed/ MEDLINE, Embase, Scopus, and Google Scholar, supplemented by grey literature and crossreferenced sources. The search identified only one recent randomized clinical trial with substantial methodological limitations, alongside a very small number of preliminary, lowquality studies. Overall, the available evidence remains scarce, heterogeneous, and methodologically weak. Current data indicate limited pharmacological plausibility, weak clinical signals, and a documented risk of additive toxicity, preventing this combination from being considered an evidencebased strategy and restricting its potential use to highly selected refractory cases under close clinical supervision.