Long-term use of gabapentin for treatment of pain after traumatic spinal cord injury.

[antiquity]

Long-term use of gabapentin for treatment of pain after traumatic spinal cord injury.

Putzke JD, Richards JS, Kezar L, Hicken BL, Ness TJ.

Departments of Physical Medicine and Rehabilitation and Anesthesiology, University of Alabama at Birmingham, Birmingham, Alabama, U.S.A.

OBJECTIVE: To determine the long-term efficacy of gabapentin as a treatment of pain after spinal cord injury. DESIGN: All patients with traumatic-onset spinal cord injury treated with gabapentin were identified and followed up using a longitudinal observational design with two contact points (6 and 36 months after the trial) using a semi-structured interview. The first follow-up interview attempted to capture all 31 patients placed on therapeutic trial. The second follow-up interview attempted to capture those reporting a favorable response (n = 14) to the therapeutic trial at the first follow-up. RESULTS: Of the 27 patients contacted at the first follow-up (87% response rate), 6 (22%) discontinued the trial secondary to intolerable side effects; therefore, the pain analgesic effects of gabapentin in these patients could not be determined. Of the remaining 21 patients, 14 (67%) reported a favorable response (i.e., a 2 or greater point reduction on a 0-10 pain-rating scale). The second follow-up interview captured 11 (79% response rate) of the 14 patients reporting a favorable response at the first interview, and 91% (10 of 11 patients) continued to report that gabapentin was an effective analgesic. There was no evidence to suggest dosing difficulties due to tolerance over the 3-year period. Sedation, dizziness, and forgetfulness were the most common side effects. CONCLUSIONS: Gabapentin may be an effective treatment of pain after spinal cord injury among those able to tolerate initial and long-term side effects.

[alan]

It gave me hallucinations. I had conversations with people who weren't there.

[calico]

I was in a perpetual "fight or flight" mode with my pain. With gabapentin, I was in a foggy-escape mode and could sleep at any time and slept 10 hours/night. I felt like my IQ dropped 20 points (definitely missed) and I had problems recalling words. I also became much klutzier (sp?). There was no change in the pain.

Foggy escapes are better than "fight or flight" and sleeping is better than not sleeping, and alleviation of both those symptoms can help dealing with pain, but there was no real change in the pain itself. I started seeing a new doctor who felt that gabapentin was the latest medical hoola-hoop and that there was a better regimen without so many side-effects. He has come up with a better brew for me.

Gabapentin does seem to help some people but does not help many from the posts I've seen. Nothing to do but try it yourself and see what happens.

[alan]

What's in your new brew?

[calico]

It's a really wierd combination which I don't want to oversell. I always say it doesn't take away the pain. It helps me to function through the pain, and put the pain in the back of my mind to an extent and for a period of time. That's about the best they've been able to do for me.

The brew is:

Wellbutrin SR 150mg AM & PM
Trileptal 150mg 3X/day
Prochlorperazine (Compazine) 5mg AM and 10mg PM
Dexedrine Spansule slow release 15mg AM
Celebrex 100mg AM & PM
Benadryl 25mg PM
Fish oil 1000mg 3X/day
Folic acid 800mcg 3X/day
Calcium + Vit D combo 2X/day

Here's what I think about the different drugs:

Wellbutrin - an anti-depressant that keeps "flight or fight" reaction in check. I'm sure for me that "flight or fight" increases pain.

Trileptal - an anti-siezure drug that helps dampen the burning pain, but doesn't take it away.

Prochlorperazine - Not at all sure and neither is the doctor but he'd used it in pain patients before and saw it help. It has many uses, the last one mentioned in the write-up I saw as being for pain. It's primarily used as an anti-emetic and anti-psychotic. Strange drug. I think it also helps with sleeping.

Dexedrine low dose slow release - Amphetamine, I think. Helps me to concentrate through the pain. I don't get any kind of a buzz off this. Have been on it for about 2 years. I was worried about starting it but no ill effects.

Celebrex - may help with arthritic pain in neck but I doubt it and have been seriously thinking about stopping it.

Benadryl - have used for years for sleep. Definitely helps there.

Fish oil and folic acid - doctors put me on this but I'm not completely sure why. I think, at least in the case of the folic acid, it was to enhance nerve signal transmission.

Calcium + Vit D combo - for osteoporosis and nerve signal transmission. There was an interesting post here from someone who found that their pain was worse when they took calcium and they'd found some scientific support for that. I'm going to discuss it with my doctor. It may be one of those "damned if you do and damned if you don't" situations.

I know you've tried many things, Alan, and there's probably not anything I've noted that would be revolutionary for you. I so wish there were and that something comes that helps all of us.

"Somewhere someone is doing something that will help us someday".

Calico

[QUOTE]Originally posted by alan:

What's in your new brew?[/QUOTE

[alan]

That's some brew, all right!

I've actually tried them all, except for the dexedrine.

[calico]

Alan, I forgot to mention that I'm also trying Ultram (Tramadol?) now. I'm only on 50mgs/day and the max dosage is 400mgs/day. I've heard from a number of people who were helped with nerve pain on 400mgs/day. I'm not getting any benefit from 50mgs/day but the dose is so low it's not surprising. My doc may up the dose, or he may pass given all the meds I'm on. I see him in a few weeks and we'll talk about it.

One concern with Ultram is it can cause siezures when used in conjuntion with an anti-depressant. But in addition to the anti-depressant, I'm on an anti-siezure drug so I guess there may be some off-setting protection there. I talked to a pharmacist about it and he wasn't worried unless I took more than the 400mg/day max dose.

The dexedrine really does help me concentrate through the pain, so if you find the pain is getting you down to the point where you can't think about anything else, consider talking to your doc about a low-dose slow release. Like I said, no buzz for me and no bad side-effects.

Calico


Originally posted by alan:

That's some brew, all right!

I've actually tried them all, except for the dexedrine.

[TD]

I have been taking 400 mg/day for nearly 5 years. I have found that it only takes the edge off the (central)pain. The MDs have tried everything else with no results so I just try and put it out of my mind. I take it in combination with gabapentin (1200 mg/day).

I am so thankful for those occasions when I suddenly realize "Hey!! I don't hurt right now." It can come at any time whether I am just sitting at the computer, lying in bed, or up in the standing frame.

"And so it begins."

[alan]

Ultram's on my list of "been there, took that."

Concentration is a major problem - it's been a long time since I've been able to concentrate on anything but pain. With so many areas so intensely affected, it overwhelms my brain. I'm actually amazed I haven't gone nuts already.

[bruce]

I'm currently taking 1800 to 2400 mg of gabapentin a day and experience no noticible side effects and certainly nothing like what some of you have described here. I have recently ramped up my dose from 900 mg as I am experiencing more neuropathic pain, especially after intense exercise. I'm C6 incomplete.

[Brittany]

I have been on gabapentin for nerve damage to my spinal cord for about ten years, since I was thirteen, and I have had a myriad of side effects. I completely agree with the whole lack of intelligence, and some of the other side effects as well. One of the many side effects that sticks out in my mind is severe memory loss, and I have essentially no short-term memory at all now. I spend the majority of my time writing out lists so I can remember things. I am now officially over the reccomended dosage and the side effects have been getting worse but apparently none of the several doctors I have seen since this whole thing started know of anything that gabapentin can be replaced with. Also because it doesn't always work I take another drug to counteract the pain as well (which I currently can't remember the name of). I was wondering if anyone can possibly recommend something that has worked for them. It is centralized pain to the right lower half of my body so far, that can't be fixed so if anyone has any suggestions let me know. Thanks.

[quadvet]

Some swear by Lyrica, been discussed here, use the search engine top of the page. Welcome to CareCure.

[GL]

quadvet thx for reminding me of oooh yes the Lyrica lol

Tons of posts about it from arndog me n others lmao I dont know what to make of Lyrica yet imop it made me gain weight

[quadvet]

No prob, GL, keep up the good work. :)

[GL]

quadvet can I ask you a question ? what do you think of this
Gabapentin stuff ?


Does it have the side effects like Lyrica with weight gain etc ???

Definitely something has to be changed by my dr soon
I cant stand Lyrica
Thx

[quadvet]

10+ years on it. Wish I could stand to take a break from it, see if it's really doin anything. Don't remember it having any effect on my pain, but pain skyrockets when I try to stop.

Seems to affect people differently, same with Lyrica.

[GL]

quadvet thx for the insight 10 yrs is quite a long time

Side effects all vary from person to person with these meds

[smokymtn memories]

I've been taking Gabapentin for several years now. Weight gain had been my biggest problem, but I've managed to loose about thirty pounds in the last few months. I'm not sure how long I've been gradually loosing weight, but I think it started with finding a pain pill that finally helps. And, a cardiologist that prescribed a diuretic that actually worked. I see him again in March and we still need to work a little at getting rid of the swelling.

For severe, chronic central pain......neuropathy......there just isn't a simple, easy answer. It seems to take more than one drug, and seems like it's different for different people.

[Pargetting]

So glad I found these posts. I'm a psychologist by profession and of course knew all sorts of terrible reasons why people forget words so I was getting very worried. My Gabapentin was increased after my spinal cord was squashed by someone dropping my head when I was unconscious during an operation, so I'm told since I wasn't conscious. I'm not sure if it has helped or whether time has played a part. I'm on Amitriptyline at a dose that is used for neuro pain to see if it helps with neuro pain in my feet -but it hasn't so far, all it has done is made me want to eat [sigh]. I'm on 20mg MST [morphine] as well as tramadol [plus the ones mentioned above]. I'd do anything if I could lose the pain in my feet because everytime it happens my head, neck and face get hot and perspire about nine times a day. I'd rather have my worst pain back [at least from a distance, where I've probably forgotten how bad it was] than have this happen.
I did lose it after the operation to remove three discs from my neck, to stop me being paralysed for ever [woke paralysed from the neck down after the first operation where something happened] and for a while after the operation where my new surgeon had to re-do the first operation, yes, the operation where I was paralysed [sigh]
It's been a long journey so far but I am a lot better. Losing words did worry me though.
Thanks to you all