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Thread: Tai, et al. (2002). Gabapentin in the treatment of neuropathic pain after spinal cord injury: a prospective, randomized, double-blind, crossover trial.

  1. #1

    Tai, et al. (2002). Gabapentin in the treatment of neuropathic pain after spinal cord injury: a prospective, randomized, double-blind, crossover trial.

    • Tai Q, Kirshblum S, Chen B, Millis S, Johnston M and DeLisa JA (2002). Gabapentin in the treatment of neuropathic pain after spinal cord injury: a prospective, randomized, double-blind, crossover trial. J Spinal Cord Med 25:100-5. Summary: BACKGROUND: Neuropathic pain is a common complaint after traumatic spinal cord injury (SCI). Gabapentin, a synthetic structural analogue of GABA, has been shown to have beneficial effects in the treatment of neuropathic pain in other diagnostic groups; however, no standardized clinical trial has been performed to evaluate its efficacy after SCI. DESIGN: A 10-week, prospective, randomized, double-blind, crossover, and placebo-controlled clinical trial. OBJECTIVE: To determine the efficacy of gabapentin in the treatment of SCI-related neuropathic pain. METHODS: Seven subjects with neuropathic pain, who were more than 30 days post-SCI, completed the study. Two groups received a 4-week course of gabapentin and placebo in a randomized crossover design with a 2-week washout period. The Neuropathic Pain Scale was used to record daily pain levels. Data were analyzed using the Wilcoxon signed rank test. RESULTS: Gabapentin has some beneficial effects on certain types of neuropathic pain. There was a significant decrease of "unpleasant feeling" and a trend toward a decrease in both the "pain intensity" and "burning sensation" at the fourth week of gabapentin treatment compared with those on the placebo. No significant difference was found among other pain descriptors during the gabapentin and placebo treatment, although this may have been limited by the small sample size and low maximum dosage of gabapentin. CONCLUSIONS: Gabapentin reduces certain types of neuropathic pain in the SCI population. Future studies with larger sample sizes, higher dosages, and quicker titration will help further determine the efficacy of gabapentin in the treatment of SCI-related neuropathic pain. UMDNJ-New Jersey Medical School, Newark, USA.

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    I have to say that Gabapentin was the only drug that saved me from that burning pain on my butt.I am 3 1/2 yrs post SCI and am still on Neurotin. I am affraid to stop taking it. In rehab, They started me on 800mg tid. On my on I am now down to 400mg tid. The burning is no longer there. I have winged off of Tizanidine. I have met so many para's that have never taken gaba. and I have let them try it and they are amased at how well it workes. They had never heard of it. Of course, it was not popular when they were hurt. They can't afford it and when they are out they have to deel with the pain. It helps other neurological prob. as well. It has gotten popular. I'm not sure if I can get off of it but would like to try. Don't have a MD monitering my meds.

    Mary Sibley

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    Mary Sibley, I likewise have heard descriptions similar to yours. It doesn't work for everybody but for some, it really does help when no other medication seems to. Wise.

  4. #4
    Junior Member gorgeguy's Avatar
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    I suffer from Central Pain Syndrome caused by a Spinal Cord Injury suffered in 1997. I am in constant unremitting pain (burn) in my hands, feet, arms and legs. Typically the burn is low, 2-4 points on the pain scale in the morning, increasing to 7-9 points at night. I have found that Neurontin (Gabapentin) is somewhat effective (1-2 points decrease), and more effective when taken in combination with Topamax (Topiramate), (2-3 points decrease).

    I take 800mg of Neurontin 4 times daily and 100mg of Topamax 3 times daily. Unfortunately until recently my Neurologist and I haven't the opportunity to determine an optimal dose.

    To: Mary Sibley,
    As far as going off Neurontin goes, it should be done gradually. I suppose it might depend on the dose, I am not an MD, but I have done it Cold Turkey and it really hurt. My experience was that the pain returned as great, or greater anyway so there is no point other than financial for going off.

    PS: Both drugs I mentioned are available from their manufacturers for free to patients who meet financial guidelines and have no prescription drug insurance.

    Love,Peace & Joy
    Gorgeguy

  5. #5
    Gorgeguy, thanks for your comment. Wise.

  6. #6
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    Hi George,

    You need to talk to your Doctor/Pharmacy. Going cold turkey off of antiseizure medication can cause seizures. They generally taper off that type of medication. You always should call your doctor and find out how he wants you to handle going off antiseizure medication. You need to be aware of what type of medication you are taking. Neurontin and Topamax are both antiseizure medications.

    Please take care.... Pearl

  7. #7
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    I didn't know if I had another comment that may or may not be of value to this forum. I am a spinal disorders patient.

    Dr. Young, I have a collasped disc L5-S1 with neuropathy and windup pain, muscle cramps that don't seem to stop. Nerve root contact bilaterally L5-S1 and an interposed nerve root. I did want to mention that my primary put me on Mirapex for the severe muscle spasms in my legs and that has helped but not completely stopped all the firings to my brain/feet/legs/ankles L5-S1. But enough so I can drive again. I have to be really careful how much I take because of a fatigue factor/falling asleep, sleep apnea. So I take it at bedtime and do not drive after I have taken it. 1 hour before bed. I still take . 25 Topamax morn and eve. .50 mirapex bedtime along with other meds.
    Even when I was taking more topamax it was not stopping the severe cramps over the ankles that I can always feel an undercurrent. It is irritating.....

    I know you are doing great work...forgive me for intruding. I will go back to Massachusetts General Hospital...Thank you. Whenever I see anyone that has questions involving their cervical/SCI, I post this www for them.
    Pearl4949

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    Pearl, thanks for your comment. This was the first time I had heard of Mirapex being used for this purpose. Wise.

    Quote Originally Posted by Pearl4949
    I didn't know if I had another comment that may or may not be of value to this forum. I am a spinal disorders patient.

    Dr. Young, I have a collasped disc L5-S1 with neuropathy and windup pain, muscle cramps that don't seem to stop. Nerve root contact bilaterally L5-S1 and an interposed nerve root. I did want to mention that my primary put me on Mirapex for the severe muscle spasms in my legs and that has helped but not completely stopped all the firings to my brain/feet/legs/ankles L5-S1. But enough so I can drive again. I have to be really careful how much I take because of a fatigue factor/falling asleep, sleep apnea. So I take it at bedtime and do not drive after I have taken it. 1 hour before bed. I still take . 25 Topamax morn and eve. .50 mirapex bedtime along with other meds.
    Even when I was taking more topamax it was not stopping the severe cramps over the ankles that I can always feel an undercurrent. It is irritating.....

    I know you are doing great work...forgive me for intruding. I will go back to Massachusetts General Hospital...Thank you. Whenever I see anyone that has questions involving their cervical/SCI, I post this www for them.

  9. #9
    http://www.journalstar.com/articles/...7970200701.txt

    Study briefs, 9/20: Common drugs appear linked to bouts of ill-timed sleeping
    By The Washington Post

    THE QUESTION Sudden, uncontrollable sleepiness at inappropriate times — dozing off while driving or talking with friends — is not normally associated with Parkinson’s disease, a nervous system disorder characterized by trembling, stiffness, difficulty walking and balance problems. Might the drugs commonly taken to control these symptoms be related to such sleep episodes?

    THIS STUDY analyzed medical data on 929 people with Parkinson’s, 22 percent of whom reported having at least one attack of irresistible sleepiness during the six months before being interviewed for the study. Those who took drugs called dopamine agonists — including pramipexole (Mirapex), ropinirole (Requip) and pergolide (Permax) — were nearly three times more likely to have had sleep attacks at inappropriate times than were people who took other drugs for the disease. For these three drugs, higher doses produced more severe attacks. Compared only with people who took levodopa, a classic Parkinson’s drug, those who took dopamine agonists were twice as likely to have sleep attacks.

    WHO MAY BE AFFECTED BY THESE FINDINGS? People taking medication for Parkinson’s. About a half-million Americans have the disease, which is more common after age 60. No cure has been found for Parkinson’s; rather, treatments focus on making its symptoms more tolerable.

    CAVEATS Some of the data for the study stemmed from people’s recollections of their sleep attacks. The study was funded by a grant from Pharmacia Corp. (since acquired by Pfizer).

    FIND THIS STUDY August issue of Archives of Neurology; abstract available online at www.archneurol.com.

    LEARN MORE ABOUT Parkinson’s disease at www.ninds.nih.gov/disorders and www.michaeljfox.org/parkinsons.
    http://economictimes.indiatimes.com/...ow/1235034.cms
    Parkinson's drugs likely to trigger gambling obsession

    REUTERS[ MONDAY, SEPTEMBER 19, 2005 01:30:57 AM]
    NRI Special Offer!
    NEW YORK: Recent reports suggest that pathologic gambling, a severe addiction to gambling, is a rare complication of using anti-Parkinson’s drugs. Now, new research delves deeper into this association and reveals that the gambling may resolve when the drug is stopped and that the drug pramipexole is often implicated.

    The findings, which appear in the Archives of Neurology, are based on a study of 11 patients with Parkinson’s disease and pathologic gambling who were seen at the Mayo Clinic between ’02 and ’04. Despite having had no previous history of compulsive gambling, one patient had lost more than $200,000 and another in excess of $100,000.

    In addition to assessing these patients, M Leann Dodd and colleagues, from the Rochester, Minnesota-based medical centre, conducted a systematic review of previous case reports linking gambling and Parkinson’s disease. All of the subjects were receiving therapeutic doses of a “dopamine agonist” drug, the mainstay of treatment for Parkinson’s diseases. In all but two cases, the agonist was pramipexole.

    In the medical literature, pramipexole was cited in 10 of 17 case reports describing pathologic gambling in patients with Parkinson’s disease.

    In seven patients, the pathologic gambling began within three months of starting the drug or changing the dose, the report indicates. In the remaining four patients, the period between the start of treatment and the gambling behaviour was longer, but the gambling stopped after the drug was discontinued

    In the packaging insert for Mirapex, the trade name Boehringer Ingelheim Pharmaceuticals markets pramipexole under, pathological gambling is listed as a side effect seen on post-marketing surveillance.
    Last edited by Wise Young; 09-21-2005 at 03:45 AM.

  10. #10
    Dr. Young,

    My son is having neuropathic pain. He was taking Gabapentin (300mg) twice a day. His pain is getting so much worse so his doctor told him he could take two Gabapentin 3X a day. I am worried that is too much for him. He is still in pain but does not seem as severe. He is 20 yrs. old and it is almost 12 weeks post. Thank you....

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