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Thread: Gabapentien

  1. #1

    Gabapentien

    I have tried gabapentien for about a year at 800 mg per day with no benefit. I have stopped and just suffer all day and night. Should I try it again at a higher dose. I am on lamotrigine and it is supposed to help. The doctors in my town have a policy against opiates and will not give me any. I wish I could move to where there are more doctors so I could find one willing to help. There is only one clinic in town. I have been to a pain specialist and she is against opiates as well. Has anyone got success stories from other meds. I just seem to be able to make it with this disease and am tired of living this way. I am married and have three children so I will stick around for them but I feel like I am going to have a heart attack or get cancer due to my poor health. I am able to walk but it sucks. I feel like I am 90 years old at he age of 54. I find it very difficult to concentrate because of the pain and don't seem to be getting better at this. I am rambling but it helps to vent on here when nobody else wants to hear you complain. I haven't slept properly in about ten years and find I am just stuck in a rut that I cannot break free from this constant BS. I also have terrible rinigng in my ears that is difficult to ignore on top of the pain. THe days seem to be twice as long as they should be when you are just exhausted all the time. Any words of wisdom are appreciated.

  2. #2
    Vent away. This is the place.

    800mg gabapentin once per day? That isn't enough. I would say try it again.

    You usually take gabapentin split up in doses every 6 or 8 hours (3 or 4 times per day) - not once a day. 300mg three times a day is usually the lowest starting dose.... so a total of 900mg a day. You weren't even taking that, so I would say that gabapentin has not failed you.... your doctors have failed you by not knowing enough about how to increase your medicines appropriately. Your doctors should have increased the gabapentin over time until you got relief of pain, or until the side effects from the gabapentin were increased so that you couldn't tolerate going any higher.

    For example, my Dad (incomplete para - lots of pain) currently takes 800mg of gabapentin FOUR TIMES A DAY for a total of 3200mg of gabapentin a day. He also takes tramadol 50mg twice a day and more when he is having worse pain. Tramadol is related to the morphine family of medicine, but is not as tightly regulated - some of your docs may be able to prescribe this more easily. Cymbalta is also a medicine that can help nerve pain and help your mood - he is on that too. But when the pain is bad, sometimes the simple things help the most..... icepack to the painful area, get off the painful area (butt for him), stretching, and sleep. He used to always take more pain meds at night to make sure he would sleep well, but right now his pain is fine at night and this isn't a problem.

    Combinations of pain medicines (ex. opiate + neuropathic pain medicine) often help the best for this brutal pain. My Dad also used to take a popular nerve pain medicine every night (amitriptyline). It helped his pain and it helped him sleep. He stopped that several years ago.

    Lamotrigne is a good anti-seizure medicine. Is that why you are on that? It does help pain sometimes, but is not a typical neuro pain medicine.

    My Dad also has ringing in his ears and when he is tired it is TERRIBLE. I bet your ringing is bad because you aren't able to sleep well.

    Anyway, don't give up hope. There are options. Find one, thoughtful doctor willing to work with you. Try one thing at a time, and keep increasing the doses and give it time (a few weeks) before giving up. Sleep is key. Exercise/stretching is key (but not overdoing it), and if you mood is low.... treating that is key. When your mood is low, your pain will feel worse. No doubt.

  3. #3
    Thanks for the input. I know if I don't sleep well I struggle more. I am on amitriptyline already but will try the gabapentin again. Some days are better when I have more energy but some days I don't even want to do anything. My mood seems to be low all the time.

  4. #4
    You are absolutely right that pain is also worse when you are tired. That's another reason why many people have more pain late in the day.

    How much amitrip are you taking? Do you take it at night? Maybe increasing the dose if you take it at night will help you sleep, and will carryover and help your pain. That is the first thing to increase, before adding anything new. Keep increasing it (under your doctor's supervision) until you have side effects that aren't tolerable (dry mouth/fatigue/constipation). Only then, add a second medication if you need more pain control.

    So for example, if you are taking amitriptyline 25mg now, talk to your doc about trying 50mg at night. If that helps some, but not enough, then try 75mg etc.... Give each increase in dose a couple weeks at least. If you find that when you increase the dose you are even more tired the next day (even if your sleep is improved), then you may have to back down to the next lower dose and add a second medicine. Does that make sense?

    It is totally understandable that your mood is low. Nothing is worse than uncontrolled pain. And then you get in a horrible vicious cycle downward. Your mood drops because of your pain, and this makes the pain worse, which then makes you more down, so the pain gets worse.... awful.

    For that reason, talk with your doctor about trying medicine for mood that also helps your pain. For example, cymbalta or effexor both help pain and mood. Both of those have cheap generic versions. If your primary care doctor isn't familiar with them, the pain doctor will be.

    But you need to talk about these things with your doc and be careful about changing all medications slowly, watching for side effects and giving them time to see if they help. You also want to make sure you never abruptly stop these medicines, and realize that they all interact with each other so you need to only change one thing at a time.

  5. #5
    I had to come off opiates because I had become hyper-sensitive to them. To replace them as a source of pain relief, I was put on Suboxen. It helped some, but instead of causing drowsiness in me, it caused insomnia in me. I'm also taking 60 mg Cymbalta once a day. Hopefully it might make you drowsy so you can sleep while maybe getting some pain relief. Good luck.
    DaDutchman
    C5/C6 since 2007 due to car accident

  6. #6
    What other meds have been tried? Lamotrigine is an antiseizure drug, but I have not seen it use much for neuropathic pain. Have you been tried on Lyrica (pregabalin) or Tegregol (carbamazepine)? Medical marijuana? Tell us a little more about your pain too...it is at level of injury or below level of injury?

    (KLD)

  7. #7
    Thanks for the input. I crushed my C-7 in a diving accident in 1987 and was paralyzed from nipple line down for 24hours. Recovered from accident but it took me a year to learn to walk and run again. Had no pain from injury.
    In 2006 I started having weird sensations at nipple line. Kept going to the doctors with no relief or diagnosis. It got worse over time until my c-7 was removed and my spine was fused. By the time it was repaired I had terrible pain in a band across my chest and under my arms. My bowels are also affected by the injury and I have diarrhea every third day since the injury flared up again. When I get out of bed my pain is lower but by the time I walk a few steps I catch on fire. If I lay down the pain will subside a bit as long as I am still for a few hours. This disease has caused me to be sent to the psych ward twice because I just fought with the pain for several days.
    I still fight with the pain ,but can have s sort of normal day. For the first say 5 years post surgery I would over heat if I got to warm and my skin would turn red above the injury sight by 2 pm everyday.
    I have tried lyrica with no help and I have tried marijuana{not medical} a bit with no change. The lamotrigine is supposed to help with pain relief and am slowly ramping up the dose over 3 months to see if it will help. A large part of my life for the since 2009 on has been trying to deal with this disease. I do more now and just live with it but it still just sucks the life out of me everyday.

  8. #8
    So it does sound like you have a plan - increasing the lamotrigine slowly over time. If you are still taking the amitryp, you could still increase some of that at night. Don't think about gabapentin until you figure out if lamotrigine helps.

    But you should get your depression well treated. Don't neglect that. If you were admitted a couple times in the past, I hope this means you have a Psychiatrist following you. I realize, it can be hard to find a good one.... Sometimes it takes a village.

  9. #9
    Yes I guess I have a bit of a plan. It is just old. For the first 3 years after the fusion I thought it would get better and it has a little. I will try the lamotrigine and see if it does anything. I don't have a psychiatrist that is helping. I guess I could make an with the one that treated me the 2 times I was in the psych ward. He put me on risperdone and it seems to help me a bit. Thanks for the help it is good just to discuss this some times and try and put your life into some kind of perspective that is normal.

  10. #10
    Yes, make that appointment with the psychiatrist that knows you. There are lots of options these days. Once your mood is better, it will help the pain be more tolerable. And some of the mood medicines will decrease the pain too. win-win.

    Hang in there. Let us know if the lamotrigne helps.

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