Pregabalin for neuropathic pain

I have a bilateral lumbar disc re-herniation (currently on a waiting list for a revision discectomy) which is causing significant nerve pain and paresthesia. I'm well established on a combination of Tramadol and Naproxen but have also started taking Pregabalin alongside them with the hope that it will help with the neuropathic pain.

I started on 50mg and have worked up to 300mg by now. My GP has given me a free rein to an extent (although has obviously discussed and advised me on this, and is only a phone call away if needed) and allowed me to sensibly work myself up to a therapeutic dose. Unfortunately I have yet to derive any relief at all, in fact it just seems to be getting worse.

I know everyone is different, but has, or does anyone here take Pregabalin for neuropathic pain, and if so, what did you find to be the optimum dosage? I'm aware that I can go up to 600mg, but am already feeling a tiny bit spaced out on 300mg so am worried about becoming a zombie, especially as I'm still working and need to be able to concentrate. Weight gain is also a concern of mine and I have already put some on quite rapidly. The potential risk of physical dependency and subsequent discontinuation symptoms is also bothering me, but the need for pain relief currently outweighs these concerns.

Any comments or advice gratefully received. Thanks in anticipation.

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  • Hi, thanks for the reply.

    That seems sensible re the Pregabalin dosage, I should imagine that 600mg would potentially have some pretty hefty side effects so I'll work my way up to around 400mg and see how I get on. I have asked my GP about alternatives to Pregabalin however she claimed that it's the best she could offer, so like it or lump it basically. As you say, Amitriptyline is mean't to be quite effective so I might push for that in a few weeks if I don't have any luck.

    I'm already taking Omeprazole alongside Naproxen. I've been taking it for two years now and do find it to be effective so willing to stick with it, although I'll probably get an ulcer to contend with on top of my Ill-behaved spine!

    I hopefully should get a date for my surgery soon-ish so might be able to stop my pain meds altogether, or at least cut down if it's a success and I don't re-herniate, again!

    Thanks so much for the advice :)

  • Thank you for the link - I haven't had a chance to read the entire article yet but it looks very interesting and informative judging from the abstract.

    Yes, max dose of Tramadol - or as required - but I very rarely take less than 400mg, and am on 1g of Naproxen per day. I have a good regime with them and take the Naproxen for grumbling, consistent pain, and the Tramadol helps with the acute, sharp/shooting type pain. Just wish I could find something to alleviate the searing leg pain, but with surgery looming ever closer I don't really want to be chopping and changing medications, but the pain is making life difficult at times - especially at work, therefore I have little choice other than to persevere I guess.

    Speaking of work, I can't afford to be too drowsy and/or fuzzy headed which would effect my capabilities and performance, so that is an important factor to consider. Quite the balancing act really. Dependency also concerns me as I am already physically dependent (not addicted, and I have spoken to my GP about this) upon Tramadol which I found out the hard way after reducing the dose following my first discectomy. I'm going to have to titrate the dosage down at a snails pace if my upcoming surgery proves to be a success, which fingers crossed it will be. I can't believe that I'm looking forward to spinal surgery haha!

    Thanks for taking the time reply again

  • Hi I have stopped taking pregabalin I was on 900mgs a day also I was taking 200mgs of amitriptyline at night. I think u should not take more than 300mgs special if u are feeling spaced out and make shore u keep u gp informed on how it is making u feel.

    Best wishes

  • Hi,

    Yes I take it.I took it a couple of years ago but stopped it because I felt sick,dizzy and kept sleeping.However,I have recently been recommended to take it again.This time working my way up from 50.mcg to250.I am currently failing on 100 mcg.I have been advised to stagger the doses.I suspect that everyone has an individual tolerance to medications.

  • I take 300g per day of pregablin and have been doing ever since it was licensed in the UK however I combine it with dihydrocodiene and paracetamol to ease my diabetic neuropathy ( severe leg pain ) I can just about tolerate the pain on a daily basis. If you can I would suggest you drop the tramadol as I was on it for a short time and it left me unable to function. In addition when I did come off it I took about two weeks to recover from the withdrawal symptoms. Anyway I would suggest you continue with the pregablin which has a little or no side effects. Good luck. Chris

  • Hi

    I'm pleased that you find the Pregablin to be of some help and gain a bit of relief. I have similar neuropathic leg pain caused by a disc prolapse so it's good to hear that it is somewhat effect in alleviating the pain.

    I actually don't have any problems with Tramadol and have been taking it with no difficulties or major side effects for two years. I would be very reluctant to discontinue it to be honest as it does help with the pain in combination with Naproxen, and I would really struggle to function without it. As you noted though the withdrawal symptoms are undesirable so I'm going to have to be careful if/when I can reduce or discontinue it; hopefully after my upcoming surgery should it be a success. Fingers crossed!

    Conversely, I personally find the Pregabalin to be worse in terms of side effects, primarily nausea, a slight decline in cognitive function and feeling a bit dizzy and fuzzy headed. I've also gain weight since I started taking it which doesn't fill me with joy. These effects may settle and I'd willing to accept them if it helps with the pain, so I'll see how I get on over the next few weeks, although it's yet to have the slightest effect so I'm somewhat sceptical :/

    Thanks for replying, hope you're well.

  • Hi Cymraes84

    Im on Gabapentin for neuropathic pain which i bleieve is an older product but i find it suits me.

    Also Diazepam is a muscle relaxant as well and again i find it workbig betterr fro me than Baclofen which just zonked me. The Diazepam is sediative but not as much as the Baclofen for me.

    Anyone else findibg the same?

  • Hi I have taken so many different pills I have to say you can take a Lorre load of pills but the pain will not go away you just have to manige it best you can do thing in little bits not all at once the pain is worse at times you just have to put up with it Iam afraid to say

  • Hi There

    Pregabalin can be very effective for some and less for others .

    Gabapentin is also available for neuropathic pain, your GP can't say no to trying others if one doesn't suit . We don't all wear the same clothes because we come in all shapes and sizes . Meds are the same. Try a different GP if you get no joy.

    My motto is , this is about me not the GP !!!

    Your dosage of 300 mgs I'm assuming your taking 150 twice a day?

    If you are why don't you try breaking it up in to 4 x 75mg dosages during the day .

    This could help with feeling spaced.

    You are taking tramadol with Pregabalin which will accelerate your feeling of being spaced .

    Pace your meds. You could keep a diary that will help you keep track on how your feeling what you've taken and how effective it is with your pain and how fuzzy you'll feel .

    Expect to have a slower thinking process unfortunately comes with the territory .

    Addiction and dependence are different

    Addiction is poor control over drug use ,

    Compulsive drug use

    Continuing using the drug despite the harm physically or mentally

    Craving for the drug .

    Dependence

    This Is when the body adapts to the drug , receiving regular doses of same medication

    When meds are stopped abruptly or dosage reduced too quickly this is when withdrawal symptoms are experienced .

    The chance of someone suffering from chronic pain becoming addicted is extremely small about 7 per 24.000 people .

    Addiction normally happens when a person may have a genetic predisposition.

    Hope this helps

  • Hi

    I'm aware of the difference between addiction and dependency; thankfully not afflicted with the former but the latter is an issue with the Tramadol - I get hideously restless, it's horrid. It took me a couple of bad nights to figure out it was the Tramadol, but it helps with the pain so hey ho!

    Definitely feeling spaced out, sometimes worse than others, but it's not too bad. The worst for me is feeling cognitively, well, useless. I just do silly things, misspell words and my short term memory is terrible. Dosing wise I take Naproxen twice a day, Tramadol periodically throughout the day up to the max dosage, 100mg of Pregabalin both morning and early evening, then 175mg (I've bumped it up!) at bedtime.

    I agree with you about my GP. I'm a bit miffed with her overall to be honest, she hasn't really taken my condition seriously (I re-herniated June 2014 and took until September 2015 to eventually get an MRI. She was all over it like a rash after what the scan revealed mind you) and if weren't for me using my initiative (and forking out £300 with my physio to actually get an assessment and medical opinion) I would probably just still be bumbling along to appointments and listening to her telling me "you don't need an intervention," despite having classic symptoms or re-herniation, increasing pain and the opinion of my Neurosurgeon who adamantly said the cause of my pain was the disc.

    With regard to meds for neuropathic pain she's told me that Pregabalin "is the best that she can offer" but as you say, everyone responds differently to medications. I might just give her a call if I don't get any success with the Pregablin and ask to change to Gabapentin or Amytriptylene. There's no point in me taking medication that doesn't help and frankly it's a waste of the good old NHS's dosh too.

    Keeping a diary is a great idea - thanks! That would be particularly helpful with the Pregabalin as I am already well established on my other painkillers, so it would be handy to keep track of things now that another med has been introduced.

    Gosh, sorry for rambling on! But I don't really rant away about this to my friends and family, and even when I do they can't really relate.

    Thanks so much for the advice :) actually, I think I might take heed of your motto and call my GP tomorrow to see if I can get an alternate to the Pregabalin.

  • Hi Cymraes84

    You're not rambling on sometimes only those that have similar problems can understand what's going on and how you feel to an extent please feel free to rant on here lol.

    Your pregabalin dose times will be adding to your 'feeling spaced out' you've increased your dosage, at night when you're already tired and again in the morning when trying to find energy to start your working day.

    Maybe a little food for thought if you've not already done so but maybe the time scale of taking 325 mgs of pregabalin at bedtime and again in the am might be contributing to you're slower thinking process.

    I found spreading them out during the day helped a lot as like you I'm still working daily and long hours and my job depends on 100 % brain function.

    If you don't mind how long have you been taking the dosages prescribed?

    I popped in the details of the differences between addiction and dependence as I was responding to your original comment I didn't mean to suggest anything that would offend.

    I'm sure we all have a fear of the effects of the meds we take.

    Like you we all need to take control of our own health that's the one thing which has been a huge learning curve from all of my health issues .

    GP's are there to help but when you have a poor relationship which affects you're right to treatment due to their poor attitude it adds to our stress and they have no idea how much.

    If you can try gabapentin first , amitryptilline can have even more of a drowsy effect than the latter.

    I've kept a diary and found it extremely helpful not only in writing down my dosage times effects workability reliability of the drug how long I've been on a med etc but also venting and it meant my frustrations were taken out on a piece of paper instead of those around me .

    If you feel like chatting venting or just plain old moaning carry on we won't be offended.

    I don't talk to people about my stuff they just don't get it.

    Have a good day

    SA

  • Permission to rant accepted!

    I've been spacing the Pregabalin out throughout the day with the largest dose of 175mg at night so that I sleep through the worst effects, then 100mg of a morning morning and another 100mg at tea time. Sorry, my fuzzy brain probably didn't explain that too well! I think Tramadol contributes to feeling spaced out at times too, but it's not all that bad really and preferable to the pain. Plus the fact I'm used to it after two years I guess.

    I wasn't offended at all, but just wanted to clarify that I know the difference and am more concerned about further physical dependence as opposed to addiction. I know you mean't well, especially as the two terms are often used interchangeably. Sorry if my response seemed a little brash.

    I asked to speak to one of the other GP's at the surgery yesterday as I've been on Pregabalin a good few months and deriving little to no positive effect. I've taken it previously for a while too and again, it didn't help then either. So I asked to switch to an alternative; she was more forthcoming and recommended trying 25mg of Amitriptyline at night and then increasing to 50mg if I feel the need. She thought that perhaps Gabapentin wouldn't help as it's chemically similar to Pregabalin, which makes sense I guess. Pretty concerned that Amitryptyline might be too sedating, but I have taken a similar tricyclic type AD at a higher than usual dose before today and was fine ocne I got used to it so I might be ok. And if not at least I wont have any trouble sleeping, always a silver lining! In the grand scheme of things 25mg is a relatively low dose too in comparison with the dose required for depression. I'm actually going to be a child and tell my regular GP that it's way better for the pain than Pregabalin, even if it does bugger all!

    Not sure whether I've been a little quick to jump ship but I'm just feeling fed up, fobbed off and as though I haven't been taken seriously and just left to it. I'm in quite a lot of pain by now and do think that this should have been taken addressed sooner. There's a risk of permanent damage to the nerves too depending on the length of time they are compressed for, certainly not too overjoyed at that prospect. Admittedly I could have pushed for an MRI sooner, but you tend to go along with the opinion of medical professional. Well, to a point anyway. If I get any symptoms after my upcoming surgery I'm going to pretty much demand a scan.

    I would really like be able to eventually stop taking Tramadol or just use it for breakthrough pain, and it might be a tad unrealistic to expect to discontinue all of my pain meds after surgery, but I should be able to cut down dramatically if it's a success, so fingers crossed. Although I'll be needing Oramorph for the first couple of weeks so I'll be a happy camper, and yay for six weeks off work too haha! Don't know why I said that mind you as I know the novelty soon wears off...

    Thanks for the reply, and I hope you're well.

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