Health Organization for Pudendal Education

I’m not one to take any type of medication if I don’t have to, I’m just wondering what the long term affects on our bodies are i.e. liver, brain, etc.? My neurologist has me on Gabapentin right now, I’ve worked my way up to 1200mg per day, and he wants me at 1800mg, this stuff makes me loopy and it’s hard to concentrate at work. Up to this point it has only seemed to help with the hot flashes down both legs and in my arm, I still have burning pain in my buttocks and pelvis area. Just not sure the benefits out weigh what this medication might be doing to my body? He also wanted to put me on opiates, which I don’t want to take, thoughts?

Paul,
I found that Lyrica has less side effects than gabapentin. Opiates have really helped me. Anything that gets you thru the day without unacceptable side effects is fine. Long term opiate use has zero effect on you body. Pain on the other hand sensitizes the nerve and causes your condition to deteriorate faster. They are of course addictive but so is Lyrica and gabapentin. You can always wean off anything gradually if you get better. Meanwhile. you have to do whatever works for you.

Best Wishes,

Don

Paulsa,

You will know when you need opiates. Trust me. I have held off using them for years but cannot wait any longer. I'll be asking Dr. Gordon for a prescription when I see him on Friday and it will be none too soon.

As for the Gabapentin, I have found that if you increase the dose very very slowly, the discombobulation effects (is this a word?) are less. I recently went up from 900 to 1200 to 1500 mg/daily, taking two weeks between each increase. My brain is of course not working up to its usual brilliance but I sheem to be funxshinning jesh fine.

Paul, I've read that you really need to get up to at least 1800 mg of neurontin to see improvement in pain levels but I was one of those people who just couldn't tolerate the drug so I understand your frustration with it. My understanding is that it's pretty benign as far as long-term damage to body organs.

My thoughts on opioids is to consider them a temporary necessity to prevent CNS sensitization while you are searching for a more permanent solution. With opiates, according to the literature, toxicity is not a major concern but efficacy of longterm use might be because you can develop a tolerance. Constipation is a major concern but there are many ways to avoid constipation. You can find many articles on the subject by going to google scholar and typing in" long term opioid use toxicity" Here is an interesting article abstract:

Pain
Volume 25, Issue 2, May 1986, Pages 171-186
doi:10.1016/0304-3959(86)90091-6
Copyright © 1986 Published by Elsevier Science B.V. Cited By in Scopus (293)

Research report
Chronic use of opioid analgesics in non-malignant pain: Report of 38 cases

Russell K. Portenoy and Kathleen M. Foley
Pain Service, Department of Neurology, Memorial Sloan-Kettering Cancer Center, and Department of Neurology, Cornell University Medical College, New York, NY 10021, U.S.A.
Received 10 June 1985; accepted 28 October 1985. ; Available online 24 March 2003.
Abstract
Thirty-eight patients maintained on opioid analgesics for non-malignant pain were retrospectively evaluated to determine the indications, course, safety and efficacy of this therapy. Oxycodone was used by 12 patients, methadone by 7, and levorphanol by 5; others were treated with propoxyphene, meperidine, codeine, pentazocine, or some combination of these drugs. Nineteen patients were treated for four or more years at the time of evaluation, while 6 were maintained for more than 7 years. Two-thirds required less than 20 morphine equivalent mg/day and only 4 took more than 40 mg/day. Patients occasionally required escalation of dose and/or hospitalization for exacerbation of pain; doses usually returned to a stable baseline afterward. Twenty-four patients described partial but acceptable or fully adequate relief of pain, while 14 reported inadequate relief. No patient underwent a surgical procedure for pain management while receiving therapy. Few substantial gains in employment or social function could be attributed to the institution of opioid therapy. No toxicity was reported and management became a problem in only 2 patients, both with a history of prior drug abuse. A critical review of patient characteristics, including data from the 16 Personality Factor Questionnaire in 24 patients, the Minnesota Multiphasic Personality Inventory in 23, and detailed psychiatric evaluation in 6, failed to disclose psychological or social variables capable of explaining the success of long-term management. We conclude that opioid maintenance therapy can be a safe, salutary and more humane alternative to the options of surgery or no treatment in those patients with intractable non-malignant pain and no history of drug abuse.

For a great article on central sensitization go to this link:

http://www.medscape.org/viewarticle/481798

Here is a portion of the article:

Brain Plasticity and Central Sensitization

Central sensitization describes changes that occur in the brain in response to repeated nerve stimulation. Following repeated stimulation, levels of neurotransmitters and brain electrical signals change as neurons develop a "memory' for responding to those signals. Frequent stimulation results in a stronger brain memory, so that the brain will respond more rapidly and effectively when experiencing the same stimulation in the future. The resulting changes in brain wiring and response are referred to as nerve plasticity (describing the ability of the brain to change easily) or central sensitization. Thus, the brain is activated or sensitized by previous or repeated stimuli to become more excitable.

The changes of central sensitization occur after repeated experiences with pain. Research in animals shows that repeated exposure to a painful stimulus will change the animal's pain threshold and result in a stronger pain response. Researchers believe that these changes may explain the persistent pain that can occur even after successful back surgery. Although a herniated disc may be removed from a pinched nerve, pain may continue as a memory of the nerve compression. Newborns undergoing circumcision without anesthesia will respond more profoundly to future painful stimuli, such as routine injections, vaccinations, and other painful procedures. These children have not only a greater hemodynamic response (tachycardia and tachypnea), but increased crying as well.

This neural memory of pain has been studied extensively. In a review of his earlier studies, Woolf[1] noted that the enhanced reflex excitability after peripheral tissue damage does not depend on continuing peripheral input; rather, hours after a peripheral injury, spinal dorsal horn neuron receptive fields continued to expand. Investigators have also documented the importance of the spinal NMDA receptor to the induction and maintenance of central sensitization.[2]

Implications for Pain Management

Once central sensitization is established, larger doses of analgesics are required to suppress it. Preemptive analgesia, or treatment before pain progresses, may reduce the impact of all these stimuli on the CNS........

Great info, Violet. Always grateful for your insight and assistance. Keep up the good work!

My daughter is in her last year in Pharmacy and has told me that neurontin can cause Jaundice but it is rare. (less than 0.1% )She is willing to join our forum next year when she is fully qualified to answer questions about drugs.

Catherine

Can you stop taking Gabapentin cold turkey or do you have to slowly decrease your dose? I think I may want to try Lyrica, the more I up my dose of Gabapentin the more I find I can't concentrate and feel very loopy/tired.

Paul,
You are supposed to decrease gradually over a week to avoid seizures. I must say that I stopped fairly quickly as I was so fed up with it. I did not experience any problems but you should be careful.