I’m a 3 time board-certified family physician and I have peripheral sensorimotor neuropathy and RSD (aka Complex Regional pain Syndrome). My days, and nights, are, well, entertaining, to say the least.
I’ve been prescribing this stuff for decades. gabapentin, pregabalin, topiramate, duloxetine, nortriptyline, as well as suggesting other treatments like cucurmin, turmeric, valerian root (nothing says “natural herbal medicine” quite like the scent of old gym socks), capsaicin topical and more, or less, depending on the times, medicine being as much art as it is science, I do try and practice evidence-based medicine as much as possible.
pregabalin (Lyrica) made me so “loopy” I couldn’t concentrate; patient to patient I’d forget what I was doing, have to refer to the chart in hand, I was having “word-finding” issues and felt hung over for the most part. This lasted about a month. Did it help modulate any of the pain? barely.
gabapentin, started at 100mg at bedtime for a week, then 200mg then just 300mg a day, seemed to be taking the edge off my pain, the continuous burning in one foot was lessened to where I could really ignore it. I could also ignore other things as well, as I seemed to be losing my glasses, keys, coffee cup, patient charts more often than usual. I found myself one afternoon parked in front of a grocer’s with the sudden realization that I was there, didn’t know how I got there, what it was I wanted to buy - the shopping list on the pasenger seat was an obvious hint, but I didnt recognize the handwriting - this was scarier than anything I’ve ever experienced, including stomping along parts of the Ho Chi Minh trail dodging land mines for MIA/POW recovery missions or riding motorcycles around Europe, California and DC in my youth. I stopped taking that crap that day.
topiramate? just made me a little nauseated. Didn’t even put a dent in the symptoms.
nortriptyline? 10mg a night helped some, very noticeable, but I didn’t have a bowel movement for 3 days, then 5, then 7. I’ve played with it some, every other night dosing for example, but it literally puts my gut at a standstill.
The valerian tea works some, but the smell makes my wife sick.
Turmeric, cucurmin, nada.
I’m going in for some facet blocks in a week, going to get a second opinion from a neurosurgeon soon - first one wanted to cut, but I’ve seen the result of too many laminectory-foraminotomies-fusions and all that and think I may have another year or so before I need to decide if this is worth the trouble or just file for disability. Hard to do when I earn as much as I can, but I can’t afford to make mistakes or dosing errors, or pay any less attention to detail than suppressing/ignoring the pain already does.
I have an ongoing relationship with a physiatrist/pain specialist and go through about 30-60 percocet a month; orthopedics is doing viscosupplementation in my knees after years of cortisone and surgeries; neurology wants me taking the nortriptyline until I “get used to it” (fuck him and the ivory tower he rode in on), rheumatology is looking into some obscure connective tissue disorders, and I’ve asked all of them if the Lyme disease I had in 2000-2001 might have caused some, any, much of this.
The hemming and hawing was deafening.
Meanwhile, trazodone and percocet help me sleep - when the neuropathic pins/needles/railroad spikes don’t wake me.
Good luck.
The Neurontin is what works for me as I have had the EMG test that diagnoses neuropathy. In fact, I just had two more lumbar spine surgeries this year. One was a PLIF of L5-S1 where all old stainless steel was taken out and replaced with titanium plus larger screws where they had come loose. The last was 02/21/2018 an ALIF/ALPC L4-S1. The nuerontin helps the crazy feelings in lower calf/foot. It is not a pain killer like MS Contin or oxy 15’s. I hope to be off all those narcotics soon as I hate the problems they cause with digestion.