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Thread: Alternative to Neurontin for Neuropathic Pain treatment?

  1. #1
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    Alternative to Neurontin for Neuropathic Pain treatment?

    Hi all. I've had an incomplete T7/8 spinal cord injury for over 7 years now and have neuropathic pain (burning in calves and toes, which spreads up to abdominal area sometimes). I'm currently taking neurontin at 4200 mg/day and don't want to go higher because of fatigue side effects. I have too many things to do to be hanging in bed!

    Does anyone know of another drug regimen that would be effective, so that I could at least take a break from neurontin? My dose of neurontin has been slowly creeping up over the years to give the same level of pain relief and I hope that taking a break from it might break this tolerance. Is that realistic?

    I like neurontin because, other than fatigue, I have no known side effects and I'd like to get back to it, but at a lower dose.

  2. #2
    Have you checked the Pain forum? There are quite a few discussions there.

    _____________
    Tough times don't last - tough people do.

  3. #3
    I just gave the following answer to a question for another member via email. If all the following fail, there is a clinical trial going on, assessing methadone (an oral opioid) that is being conducted by NIH for neuropathic pain http://carecure.org/forum/showthread.php?t=39743


    At 7:20 PM +0200 8/23/02, Alberto wrote:
    my doctor has give me of antidepressant drugs but not had no useful result.
    I want to try one goader electrical worker butÂ*Â*he hasÂ*dissuaded me to use him.
    I don't make other therapy.
    I succeed to localize the point of the burning but my doctor says that it is only a feeling why my lesion is total.


    --
    Alberto,

    Usually, low-dose amitryptaline (antidepressant elavil) is the first drug to try. If that does not work, you should try neurontin (gabapentin) which often is effective initially and then requires progressively higher doses until you get to 2-3 grams per day. If these two treatments don't work, you can start combinations of drugs, such as neurontin and clonidine, with or without low-dose (20 mg per day) amitryptaline.

    Sometimes intrathecal baclofen helps reduce the pain although this generally is held off until the above treatments do not work. Some people use intrathecal morphine. I understand that spinal cord stimulation also helps some people with neuropathic pain. Both of these, however, require a team with considerable expertise in the techniques to optimize them.

    If all of the above fail to have much effect on your pain, there are a number of surgical procedures that people carry out. However, I would not recommend any lesions of your spinal cord or spinal roots until you have tried some of the newer experimental drugs that may be helpful.

    Several groups recently have reported the glutamate receptor blockers such as dextromethorphan and agmantine. There is a clinical trial on SNX-111 (a calcium channel blocker) but I don't think that the trial has yielded positive results. Several groups have been trying transplants of cells, including adrenal chromaffin cells. Washington University is considering doing embryonic stem cell transplants. Finally, there have been reports that 4-aminopyridine helps reduce burning type pain, The last one is in clinical trial right now.

  4. #4
    Senior Member alan's Avatar
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    Methadone, like any opiate, will constipate you and cause urinary retention. It's also a bear to taper off of due to its long half-life. If you can tolerate it, it's supposed to bbe the best opiate for neuropathic pain. It's also inexpensive.

  5. #5
    Senior Member Joe B's Avatar
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    Dr. Young, I am curious why hospitals and the NIH spend money on clinical trials that have essentially already been tried. Johns Hopkins did a trial in 1996 comparing methadone/ placebo / and behavior mods on neuropathic pain. I was in it. The mods help a little, I got placebo durng the trial and they gave me a trialon methadone when I finished. I couldn't get an effective dose because it caused constipation in me immediately and wasn't giving any relief.

    I have seen trials by other hospitals and universities that were similar except some compared methadone and Elavil. The results are almost always the same, methadone seems to help the nonneuropathic symptoms, causes many side effects but in general is not efffective on central pain.

    I would think methadone would be well understood. Is this an efficient way for NIH to spend money

    Joe B
    C6-7
    1988

  6. #6
    Wise,

    I read you reply a few days ago and for some reason it didn't hit me until today (probably something to do with sleep deprivation) that I should mention a couple of other possibilities.

    A handful of central pain patients I've heard from have mentioned a fair degree of success with Duragesic (fentanyl) patches or lidocaine patches. When these patches work for people they might not claim total relief, but they often say that they make a dramatic and welcome difference.

    David Berg

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    I was just given an Rx for lidocaine patches by one of my spinal docs, and when I tried them they gave a fair amount of local relief to my right calf and much of my foot (I used 2 patches for 12 hours, one on my calf and one on the top of my foot). They seem pretty effective for local neuropathic pain and to calm break-through pain in my leg & foot. I'm not sure that they'd be a good replacement for neurontin, in that the neurontin calms my central nervous system, leading a lower overall pain level. I thank all who replied to my questions and will take your input into my next appt. with my doc. I'm in line for a clinical trial for fampridine (4-aminopyridine) that will begin in the next month, too, so I wonder if I should just hang on and hope that I get the good stuff and not the little sugar pills.

    Such an adventure......

  8. #8
    Senior Member alan's Avatar
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    I tried the lidoderm patches on my back. No joy. At least they didn't make me sick as a dog like the Duragesic (fentanyl) patch did.

    There are other substitutes for neurontin. Trileptal, Keppra, Lamictal, Zonegran, Gabitril, and more, but all have various side effects (only one I haven't tried is Keppra.) www.neuroland.com has a section on pain medications, and you can look up possible side effects and warnings at www.rxlist.com.

    David, if you have any new ideas for me and the rest of us to discuss with our docs, please post them. I'm about ready to find a railroad crossing and wait for the 5:15 (and not to hop on a boxcar and ride the rails.)

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