Why Patients with Numbness Taking Pregabalin or Gabapentin Must Tell Their Physiotherapist

Whether it's numbness in your fingertips, hands, feet, or anywhere else — if you're on this class of medication, telling your physiotherapist matters more than you'd think.

Patients with nerve-related numbness — tingling fingertips, numb hands or feet, burning pain along a nerve — are often prescribed pregabalin or gabapentin to manage symptoms. Many don't realize how important this information is for the physiotherapist treating them.

Always tell your physiotherapist. These medications affect the accuracy of your assessment, your safety during exercise, and how your progress is interpreted — without this information, your physiotherapist may assess and plan your treatment incorrectly.

Both belong to a drug class called gabapentinoids, originally developed for epilepsy but now widely used to treat neuropathic pain — numbness or radiating pain from a herniated disc, diabetic nerve damage, or chronic nerve compression causing numb fingertips.[2]

These medications work by reducing the sensitivity of nerves that transmit pain and numbness signals — which brings relief, but also dampens sensation more broadly.

Numbness in the fingers or feet doesn't always come from nerve compression. Vitamin B12 (cobalamin) deficiency is also a common cause of numbness and burning nerve pain, and in some cases the symptoms closely resemble what pregabalin or gabapentin is being used to treat — hard to tell apart without a blood test.

Groups particularly worth screening include older adults, long-term vegetarians/vegans, and — very commonly — diabetic patients on long-term metformin, since metformin reduces B12 absorption over time. This can make diabetic neuropathy symptoms worse than they should be, because an underlying B12 deficiency is compounding the picture.

A systematic review found that vitamin B12 supplementation clearly improves neurological symptoms only in cases of confirmed deficiency — oral supplementation works as well as injections — but in older adults with low B12 levels and no clear symptoms, supplementation didn't significantly improve neurological outcomes.[3]

So if you have numbness and are taking pregabalin or gabapentin, also tell your physiotherapist whether you've had your B12 levels checked, and whether you're taking a B12 supplement. If your symptoms improve during physiotherapy, your physiotherapist needs to know this so they can account for the B12 correction as a possible contributing factor — not attribute all the improvement to physiotherapy alone.

1. It affects the accuracy of sensory testing

Testing how much sensation has returned is a key part of assessing nerve recovery. If your nerves are chemically less sensitive from medication, the test results may not reflect what's actually going on, skewing the picture of severity or recovery progress.

2. It increases fall risk during balance or gait training

A recent meta-analysis found that this drug class is significantly associated with an increased risk of falls — largely driven by dizziness, drowsiness, and impaired balance (ataxia), commonly seen with pregabalin in particular.[1] If your physiotherapist doesn't know you're taking it, they may not take the extra precautions a balance-challenging exercise requires.

3. It can mask warning signs of overexertion

Dulled sensation from the medication may prevent you from noticing you're pushing a joint or muscle too hard during an exercise — raising the risk of an unnoticed re-injury.

4. It helps distinguish improvement from physiotherapy vs. from the medication

If your physiotherapist doesn't know you're on a medication controlling your numbness, they may misread genuine drug-driven relief as a sign the treatment plan is working — leading to a plan that isn't actually addressing the underlying issue.

5. It helps schedule sessions more safely

These medications tend to cause the most drowsiness or dizziness within 1–2 hours after taking a dose. Your physiotherapist can help schedule sessions around that window for both safety and better training quality.

• The medication name (pregabalin/Lyrica or gabapentin/Neurontin) and dose

• How often you take it, and when you last took it before your session

• Any side effects you notice — drowsiness, dizziness, unsteady walking

• How long you've been on it (just started, or long-term)

• Whether you've had your vitamin B12 levels checked, and whether you're taking a B12 supplement