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Thread: Gabapentin (Neurontin)

  1. #1

    Gabapentin (Neurontin)

    It has been fascinating to watch here those who respond to gabapentin and those who do not. Also the dosing seems to vary greatly. This month's Pain and also Neurosignals has work by Suzuki at Univ. College in London which identifies a circuit going from spine to the parabrachial area back down to spine in a loop, which shows gapapentin inhibiting the area in the brain stem markedly which involves 5 hydroxytryptamine 3 receptors. This latter area is part of the serotonin effect on pain (aka autonomic aspect of pain) that you see written about. The inhibition of activity in the 5HT3 area by gabapentin (neurontin) occurs whether or NOT there is neuropathic pain. I just cannot understand why some of us, me included, do NOT respond to gabapentin. We ought to, if this set of articles is all there is to it, so that means there is more to it. We have long known that the periaqueductal gray (PAG) is involved in pain suppression. Suzuki is talking about the parabrachial area as the top of this newly identified loop which goes back down to the 5HT3 area, (making it a spino-bulbo-spinal tract) which if inhibited by gabapentin, decreases signal in the area generally. Suzuki did NOT test this in humans. He just showed that the AREA was inhibited in lab animals.

    Some have said that this particular area is more associated with posterior column pain, which is mostly the muscle and lightning pains, but not all agree that serotonin is only directly involved with posterior column pain. I wonder if any here with the skin burning (which would be from the FRONT of the cord) find gabapentin to be remarkably effective. When I say effective, I refer to actual pain relief, NOT to ease of the mind and nerves.

    I also note another change in the literature. Traditionally, pains are divided into spontaneous and evoked pains. Now, the spontaneous has been divided into "ongoing" and "paroxysmal" pain. The "paroxysmal" would be the lightning or electric shooting pains (which I feel most in legs but elsewhere rarely including the face, esp. after TENS). I don't know whether creating a new category of pain, namely the spontaneous paroxysmal is beneficial or not. Maybe it helps us to keep track of which type of injury leads to it if we keep calling it posterior column pain, lemniscal pain, or whatever people like to call it.

    Watching the positive comments, I went all out with gabapentin only to find that the side effects were sure enough (swelling drowsiness, sort of hallucinating almost and sick to stomach) but the pain benefits just didn't develop. This seems to indicate that my injury which is in the front of the cord just isn't meant to respond to gabapentin. Is there anyone here who can comment on this? Does anyone with really severe skin burning to light touch get a good response from gabapentin, or is it just the muscle pains, and lightning (ongoing paroxysmal) pains which decrease for you??? Also, did you have to drive on through the side effects to get to the pain response level?

    P.S. The area mentioned above has connections to the "affective" part of the brain, ie. the mood/emotional part, so is your pain relief actually lessened pain or are you merely experienced lessened emotional "suffering"? In other words, do you feel better but the pain is still there or is the pain gone? I do a lot of things to keep my autonomic system quiet from an environmental aspect, (music, distraction, avoiding controversy/stress) so I wonder if I have already done for my autonomics what neurontin would do for me if I were out letting myself get worked up.
    Last edited by dejerine; 10-13-2005 at 04:48 AM.

  2. #2
    Senior Member mike's Avatar
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    Initially I took Neurontin and then switch to Gabapentin. I noted no significant differences between the two. Perhaps that is due to neither of these drugs providing me with much relief. I have severe burning and alloydnia from my pelvic area down to my feet. I find it difficult to understand how people respond differently to these two drugs if the chemical formulation is the same. Has any lab actually taken each of these capsules and analyzed them to see if there are any differences? If in fact Neurontin's formulation is different and as a result more effective with some individuals, it is difficult to understand why pharmaceutical companies don't exactly copy the formulation since the patent has expired in places like Canada.
    mike

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    Mike. - Isn’t Gabapentin the stuff inside the drug and Nurontin the brand name?

  4. #4
    That is correct Leif. However, some people respond differently to the generic form.

  5. #5
    Senior Member mike's Avatar
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    Leif, in my comment I was referring to Gabapentin as the gereric and Neurontin as the brand name. Both should be the same drug, buy as pointed out, each is seemingly is different in it's effectiveness with some people.
    mike

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    Mike, I understand now. I’m not too familiar with the generic type, I’m using the original stuff from Pfiser. But the information here is interesting. Thanks

  7. #7
    Senior Member Kaprikorn1's Avatar
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    Dejerine...my neuro pain is 95% the burning type. It occurs on my feet (all surfaces) up to about 4" above the ankle joint. I take Neurontin 600 QID and it relieves it remarkably. If I am late with a dose (4.5-5 hrs max between doses) my feet let me know. I only have the "lightening bolt" pains in back and shoulder areas for a second maybe 4-8 times a day. I seem to remember this frequency to be about the same as before Neurontin (4 yrs ago). Once in a while if I am late on dose or over-exert or miss eating, I get a numbness in tongue, feel faint, get hand tremors and a feeling of disconnection comes over me. Eating, taking the Neurontin and laying down gets these symptoms to pass in about 10-15 minutes. I always take Neurontin with food or even a liquid meal replacement to avoid stomach upset/nausea which can happen with it on an empty stomach.


    I'm L1, walk, neurogenic B/B, 4 yrs post.

    Hope this helps in your research.

    Kap
    accept no substitutes

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