Lyrica and pain management

[addicted2harleys]

Hi, everyone.  I guess I am looking for some opinions on a couple of things.  I am undiagnosed.  

I am on Lyrica, 150 mg twice daily.  I believe this is helping for my nerve pain in my legs and right arm...just not enough.  I try to keep all of my meds on auto refill.  But periodically the Lyrica doesn't go through and I find myself running out of it for a few days.  Grrr.  This happened on Thursday.  The pharmacy was waiting for dr. authorization and it didn't happen until today.  So, I didn't have any Lyrica from Thurs. morning until this morning.  

Saturday through today has been pretty rough.   My right arm and legs usually rate a 5-6 on the pain scale.  Saturday it changed to about an 8-9 and has stayed that way since.   Wouldn't the Lyrica have stayed in my system for these few days?  So did the pain increase because of the Lyrica issue or for some other reason?

  I am also having a couple of different issues with my back.  A couple of months ago my lower back started hurting real bad when I would stand for more than a couple of minutes.  The pain just increases and increases until I sit down.  I guess I would call it a pressure pain.  When I sit it is like instantly gone.  Weird.  

My pcp put me on orphenadrine cytrate, 100 mg twice daily.  I am already on Baclofen, 10 mg three times a day and have Vicodin, 650 mg., which I have been taking regularly since the back pain started. This was also when and why I started PT.  Something about gravity.  Lol.  I was going three times a week and was given home exercises too.  I have enjoyed going because it sure feels good when the therapist stretches my legs out.  I have yet to be able to do all the home exercises.  Two weeks ago I had a different therapist who actually did a lot more with me during her session.  It was hard for me to do and I was absolutely exhausted when PT was over.  It seemed to have been too much as I ended up back in my chair and having severe fatigue.  I went that next Friday but my regular therapist was concerned with how I was.  He just stretched my legs, expressed to me that he thought I overdid it on Wednesday or was beginning to flare.  He thought I should visit my doc and take a week off PT to see how things go.  

I did go to my doc.  He wanted to get some blood and agreed with me when I told him I thought it was time for pain management.  I went to my first appointment for pain management and feel very comfortable with him and look forward to him helping with my pain.  He scheduled me for a nerve test on my right arm (I have only had them done on my legs) and started me on Tramadol, 50 mg every 6 hours.  

Now back to Saturday (for those of you still with me!!).  On top of my regular nerve pain increasing, I have a new issue...also with my back.   On my right middle of my back, I feel like I have pulled some muscles but I haven't done anything to cause it.  My lower back is now hurting even when I sit, well it is constant.  I can't get comfortable.  My shoulder area (both sides) ache along with my neck.  Heating pad seems to help for just a few minutes.  I think it might work longer if I could stay on it longer.  I start getting overheated and feel nauseous so I have to turn it off.  

Off and on, I have been experiencing a vibration in my torso for about the last 6-8 months.  It is pretty constant right now.  Over the years I have also experienced a pain in the bottom of my rib cage on the right.  It feels like something is trying to get under my ribs but it is too tight to get there....does that make any sense??   Well, I am experiencing that since Saturday along with excruciating pain across the front of my chest.  It hurts to breath and I feel like I can only get in half a breath.  This has happened to me before, but not as strong.  Before, I got EKG, ultrasound on neck and C-Scan.  All normal.  I have had swallowing-choking issues in the past year or so, too.  Speech Therapy taught me how to swallow differently.  Since Saturday I am having those issues again, plus it's like I can feel everything I swallow including saliva.  It hurts.  Feels like I took a huge bite of food and swallowed it without chewing.

So, as I try to analyze the things that are going on with me since Saturday I wonder:

1. Am i experiencing all these things because I ran out of Lyrica for 4-5 days?
2. Shouldn't all the other drugs I am on for pain help with the symptoms I have been experiencing since Saturday?
3. Am I in a flare?
4. Should I go see my doc again or just wait it out?
5. Am I having my own little version of the MS Hug?

I also want to say that I have been reading all the posts but just haven't replied.  Hopefully I will feel up to responding soon. :/

Typing this message took me far too long.  Lol. And I apologize for always being so long winded.  

Addi

[figuerpa]

addicted2harleys,

I think everyone else answered your first post. I am going to answer your question as far as other pain meds. My nuero just put me on cymbalta for nerve pain. I thought it was weird since it is a med for depression but it is also used for nerve pain.

I hope you get some relief.
Paula

[addicted2harleys]

That is kinda what I was thinking too, Bob.  I will call my neuro tomorrow and see if I can get in there.  Thanks...

[COBOB]

If the cognitive issues are new, it sounds like a flare.  Cognition sounds like you have symptoms in a new neurologic domain.  Time to call the Neuro.   Might be a good time to get your medications straightened out at the same time.  

Bob

[addicted2harleys]

Alex -

My pcp also manages my symptoms.  My neuro is the same as yours.  I very rarely go see him. I don't feel like the Lyrica works as well for me as the Gabapentin did.  I thought those were really the only two nerve pain drugs.  There are more?  I, too, take the Baclofen and 2 antidepressants at night for pain.   My pcp is very open minded, as well.

Addi

[addicted2harleys]

Lol, D!  My bags are packed!

I know, I know...when I look back over my last six years and everything that has gone on, I truly can't understand why I can't get a dx.   If I let it, it drives me nuts.

Maybe when I get to AZ the soca there will be more helpful.  I sure hope so.

How are you feeling?

Addi

[addicted2harleys]

Thanks for the response, Bob.  The only new thing I have been experiencing is cognitive issues.  This has never been an issue for me besides memory.  Now I have trouble with word recall, I think that is what it is.  Where I am talking and forget a word. And sometimes I will throw a wrong word in my sentences.   I started noticing this right about the time that I ended up back in my wheelchair after PT, two weeks ago.   Well, the back issues (not lower back) are new.  The other things I have going on right now I have experienced before...it just seems stronger this time.  Oh, I am getting muscle spasms in both legs.  I forgot about that.  That is new.

I am sure that I know the answer to this question but for some reason it is failing me right now.  With flares, will you ALWAYS have something new?   I was thinking a flare could happen with an increase of your symptoms.  Am I mistaken?

With the Lyrica...I do know it is a GABA drug and used for nerve pain.  And that the muscle relaxers and or the Vicodin doesn't do anything for that.  Those were prescribed for my back issues.  This is why I wanted pain management.  I don't want to be on the narcotic drugs, if I can help it.  My new pain doc is considering trying the TENS unit on me.

If what I am experiencing is the MS Hug, shouldn't the Baclofen and muscle relaxer help for that?  

As for the MRI.  That is a whole other issue.  I have had several done in the last six years.  I would have to look and see when the last Thoracic one was done.  I believe it has been over two years.  I can't seem to get answers for the slices that were used for any of them.  And they were taken on a 1.5T machine.  I found a 3T machine in Santa Barbara and have been trying to get new MRI's done there.

Addi

[Zacksmomi]

I know everyone swears that Lyrica takes time to work and time to leave your system, but I can tell you personally that if I miss a single dose I pay for it and if I run out for the weekend, FORGET IT!!!  Does that mean this is not a flare??? Notify the Dr for sure.  Get u that darn dx already.

The things you are experiencing definitely sound like a possible t-spine issue (maybe lesion) which is so hard to see on am MRI.  I have had 4 Drs tell me they think I have 2 T-spine lesions and none have shown on any MRIs so again for you another tough situation.  

Your rib pain seems to be pretty close to what I experience and I am still confused as to whether this is an MS hug or what.  UGH!!! Lets go to Hawaii to see if they have the book of answers and write it off as a medical expense :)

D

[HVAC]

When I started Lyrica after I took it all my areas of nerve pain would go nuts then calm down. This lasted for the first week or so. The Doctor said that meant it was working. I also needed to get on medication for spasticity the muscle pain. I got on Baclofen. I had to get off Lyrica for financial reasons. They put me on the generic Trileptal. It does not work as well as the Lyrica did for me. I sometimes have to take a small amount of opiate on top of the baclofen to get my muscles to relax. I also take depakote and seroquel at night so I can fall asleep with the pain. Everyone is different and different things work for different people. Luckily my Doctors are willing to try different things. My PCP manages my symptoms. My Neurologist is too hard to get in touch with let alone get an appointment with.

[COBOB]

Have they ever done a Thoracic MRI?  There is a theory that say you want to "get in front of the pain, not try to catch it."  There are a few studies that have shown that medicating before PT requires less pain management post PT.  Same goes for surgical pain.  If they can keep the pain under contol rather than treating the pain when it happens, the total dose of pain meds can be kept lower.  This is the theory behind the use of PCA  pain pumps.  So if you  go off meds for just s few days, the levels fall and sensitivity to pain increases.  It can take a while to catch back up.

I'm not using narcotics or any of the GABA pain medications at this point.  Just Tegretol for TN and Flexeril for spasticity.  The Tegretol takes a few weeks to titrate up, so I don't think I'd want the levels to fall on that.  I can feel it if a miss a dose within a few hours.

So:
1.  I think you let your Lyrica levels fall and it may take a bit to get them back up and the pain under control.

2. Not really.  Lyrica is one of the GABA drugs and is similar to some of the antiseizure medications.  It is specific to neuropathic pain.  Neuropathic pain doesn't respond well to opiates and typical pain control.

3.  It can always be a flare, but are there any new symptoms?  If not, it could be just "breakthrough pain" and you wil have to get it under control.  Ask your neurologist what they think.

4.  Give your doc a call.

5.  If you have any spasticity and you have spinal lesions, the odds are good that it may be MS hug.  Again, ask your doc what they might think about it being MS hug.


Bob