Pregabalin or Gabapentin

Hi Gabapentin does have some crazy side effects.  It can change your petsonality so where you won’t like yourself.  Your mood changes are awful.  If you are not in tune towards your body, you might not see it, but if you have family, they will sure see it sooner rather than later.  I knew something was wrong  2 wks in.  Called Dr., saw Dr. Said, “I don’t like myself, snapping at everyone and want to rip someones head off.”  They knew.  Got off that drug, never to have it enter my body again.  To top it off, darn drug never helped the nerve and leg pain.

Pregablin (Lyrica) didn’t work either.  Both those drugs are used as either primary or secondary drugs for Epilepsy. I wish you luck.  I started using pure CBD oil.  Time will,tell.  Look up Medterra .com.  Also going to try acupuncture.

wish you good luck in your quest for pain relief.

Dee

My GP has now put me on Pregabalin 50mg 3 times a day.

How long does it take to work, if it does, I'm not over confident?

Thanks

Oh boy, what a thread to tackle in one post LOL... Here goes. I am an American retired pain management doc.  I have a limited understanding of how NHS works, with the private on the side stuff.  I do keep current on the latest techniques as I am a chronic pain patient myself, with a horrible spine and now CRPS ( sympathetic dystrophy, a form of neuropathy after injury or surgery) in my right ankle.  I own two spinal cord stimulators, one for my low back, thigh cramps and ankle, the other for my neck. Phew, there are my credentials for commenting here.  LOL, I have also been on EVERY pain drug ever prescribed for any ache ever known.

As to the OP, both drugs have very strong side effects and both drugs can work really well for certain types of pain.  Gabapentin seems to be the preferred drug for nerve pain, while pregabalin is more for fibromyalgia type of pain, but it is really what works for you and what side effects you can tolerate.  Personally, I can not do any of the anti-depressants and I do well with gabapentin, other than it makes me fat.  It really does help with the pain a lot.  And I do mean A LOT.

Radio frequency Ablation of a peripheral nerve is usually not a great idea, as in most studies the outcomes are just not good.  The nerve tries to grow back and often forms a painful tangle called a neuroma that is more painful than what you had before. You can also get syndromes like you do when you amputate a limb, the pain continues even though you have de-nervated the area.  Your brain is filling in the pain for you.  RFA should be considered just for small sensory nerves near the spinal cord, ganglions, things like that.  When you use RFA on a long peripheral nerve it is hard to really take out the entire nerve and so the pieces that are left will try to regenerate, but now they are discombobulated and they re-assemble wrong.  So, I was taught to only RFA something you know you can completely obliterate.

I am always against surgery, it is a last resort, and these new minimally invasive surgeries are the way to go.  Just make sure you aren't your doctor's first minimally invasive patient.  I have watched that, doctors learning how to do laparoscopic gallbladders and such, that took 8-10 hours because they were learning, and that really wasn't good for those patients.  Before embarking on any surgery, I think it is important to figure out where the point of entrapment is- has anyone even told you this?  The specialist who said nothing can be done so live with it, my question would be why can nothing be done, where is the nerve entrapped?  Nerves travel from the spinal cord out through the holes provided by the vertebral bones at their specific level and then they course along the back of our body along a corset of muscle and fiber to eventually branch out and exit to their final destination.  They can be compressed at many points, as they leave the spinal cord by a protruding disc, in the hole of the vertebral bone by encroaching arthritis, along their path by too tight fibrous connections, by super tight muscles constricting around them or by something else along their path that constricts and constrains them.  A classic example of a trapped nerve is carpal tunnel syndrome- that's a nerve in your wrist that over time and because of overuse, arthritis, etc, the hole that the nerve goes through gets so narrow the nerve no longer fits.  As a result, the person gets pain, pins and needles, just like you are.  Figuring out where your tunnel is really would be the best thing for you.  But you might not have a "tunnel", it could really be chronic muscle spasm trapping the nerve.  The muscles of the back are exceedingly strong, as are the pelvic muscles.  As I found out for myself, I thought I had interstitial cystitis with constant burning in my bladder, nope, I had constant pelvic floor muscle spasms.  I had to go through 6 months of agonizing pelvic floor physiotherapy to calm the whole area down before the fire in my lower abdomen went out.  It turns out to be a common thing that happens to chronic pain patients.  I would highly recommend seeing a trained massage therapist who can do deep tissue massage, which is not pleasant, but someone who can really dig their hands in and knows all the tissue planes of your back to see if they can "un trap" your nerve.  

HTH

Lynn

Thanks for your detailed reply I had decompression surgery, a copy of my specialists report below which may explain better to someone like your yourself:

His lumbar MEI scan shows scattered aging changes throughout his lumbar spine. He does have evidence of a 

degenerative scoliosis with the apex in the mid lumbar area convex to the right and there is a fractional curve 

below with the concavity facing the right side. The degree of scoliosis is not marked but is sufficient to produce 

foraminal-narrowing at both the L4/5 and L5/31 levels on the right side. However the foraminal narrowing at 

1.415 produces IA roblentrapment and he does not seem to have any relevant IA symptoms. He also has a Grade 

1 degenerative spondy/oksthests at the L4/5 level Ind norsurprismthe there is aa-la-Tend recess stenos is 

which clearly would produce the L5 nerve root symptom. At the L5/S1 level he also appears to have a small disc 

protrusion which encroaches to the traversing Si nerve root and he has a mild degree of lateral recess stenosis at 

L5/S1 as well so that it would be difficuk to tell whether the current leg pain is also contrthuted to from the L5/81 leveL

leveL

As he is primarily a claudicant I reassured him that be does not have any serious pathology responsible for the 

symptom and there is always an option for him to persevere with conservative care. In the long run injection 

treatment would have no value and I do not think that a facet injection would produce any positive effect for nerve 

root symptom as it is designed primarily to relieve facet joint pain which in his case does not seem to have had a 

positive effect Assuming that his lower extremity symptom is primarily related to the lateral recess stenosis at the 

1A/5 and L5/S1 level, the main surgical option would be to decompress the lateral recess and being an 

anteroposterior decompression it would be relatively straight forward However, doing so would not be able to 

address the foraminal narrowing and there is a possibility that he can develop subsequent L4 root symptom and if 

that becomes a problem surgical treatment would be rather more difficult as it would involve at least a total 

facetectomy and in situ fusion of the relevant level and the cranial caudal narrowing of the foramen may even be 

best addressed by an interbody fusion, which clearly is an even bigger undertaking.

So what the heck did he do in your surgery then? Take care of that one tiny little protruding disc and call it a day?  LOL like that was going to do anything ?  Hello????  You have a page long report of all that's wrong and needs fixing.   He is definitely thinking like a surgeon though, well, it would be an enormous surgery to go in and fix that opening that is getting too small for the nerve to fit through. There are other ways to optimize things without always going in like a gorilla and operating LOL. You have a lot going on with the scoliosis and arthritis and all of it causing the nerves leaving the spinal cord to have little room to do so.  One thing that epidural steroid injections can do in these situations is calm everything down and reduce any swelling so that the nerves have more room. I would think that one of the biggest parts of your diagnosis is your scoliosis and how it affects your nerves.  Have you done any kind of treatment for it? Any physical therapy?  You do have a significant enough curvature that it is causing narrowing in the foramin, which is the hole in the bony vertebrate that the nerves exit through.  Obviously, it would have been best if they had caught your scoliosis when you were still growing and could have "straightened you out", but there are still things you can do in rehab, physical therapy to strengthen the muscles to pull the opposite way to try to lessen the effects of the curve that might help some of the nerve entrapment.  I didn't know your problem was scoliosis, but you ought to get help from a specialist in that--not only a surgeon who specializes in treating patients with it, but also a rehabilitation specialist.  There is a lot they can do for you, you do NOT have to live with this.  We actually had a girl in our medical school class who had been ashamed and hiding all her life that she had mild scoliosis. The professor called her up in front of the class and asked her to touch her toes, and we could all see the hump on her one side.  She went on to become a successful pediatrician, and also got help for her painful back.  You need to find the right docs and other help. HTH

Lynn

Thanks Lynn for your kind reply - a lot to take in there.

 You asked - Have you done any kind of treatment for it? Any physical therapy? I have been down this route been given 4 exercises to do which do not seem to help and now even this department has said that there is not much they can offer, years ago when I went to physio they would give massage, ultrasonic and various other treatments.

I have now given up the Pregabalin, a week in and I have stomach cramps & diarrhoea, not nice.

Thanks so much for making that report so much clearer to understand/