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gabapentin + tramadol is a combination pharmacological regimen investigated for the conservative management of symptomatic sacral perineurial cysts, also known as Tarlov cysts. This combination therapy utilizes two distinct mechanisms to address chronic neuropathic and nociceptive pain. Gabapentin is a gabapentinoid that binds to the α2δ-1 subunit of voltage-gated calcium channels, leading to a reduction in the release of excitatory neurotransmitters. Tramadol is a centrally acting analgesic that functions as a weak agonist at the μ-opioid receptor and simultaneously inhibits the reuptake of norepinephrine and serotonin, thereby enhancing descending inhibitory pain pathways. The specific use of this combination for Tarlov cysts has been evaluated in clinical trials led by Southwest Hospital in China, comparing its efficacy against surgical interventions like microscopic tamponade.
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