Neurontin v Lyrica for Nerve Pain

[RUKrisJ]

I am a 27 year-old female.  I had my first laminectomy and discectomy at age 22 for an L5-S1 herniation. About six months ago, I had the same procedure again at the same location.  Surgery seemed to go even better this time as I was much less sore and back on my feet in less time.  I completed six weeks of physical therapy and shortly thereafter began working out on my own, including using an elliptical (which my physical therapist told me would be okay) and light weight-training.  I lost about twenty pounds, which I thought should help with my back problems; however, about two months ago I started having nerve pain on the left side of my lower back and buttock.  When I talked to my neurosurgeon, he basically blew me off and said that after two back surgeries, I should expect pain.  When it didn't get any better, but actually worse, in the next couple weeks, I called him back and requested an MRI.  After the MRI, he immediately called me and said that a nerve root on the left side was twice its normal size, but said he didn't know why (he thought perhaps scar tissue).  He prescribed Lyrica, which my insurance declined to pay for so I tried Neurontin for a month.  It helped a lot at first, but was less effective as time went on.  It also made me short-tempered, almost downright mean.  Today is my first day on the Lyrica.  I've read that it causes a lot of weight gain, which I'm less than thrilled about, but if it stops the pain it will be worth it.

My questions are:

1)  Has anyone had this kind of pain following a back surgery and it had it improve over time?  Or is this something that will only get worse?  (My neurosurgeon has acted like this could be temporary, but everything I've read makes it sound permanent).

2)  Has anyone experienced nerve pain following a back surgery that was just as bad as the nerve pain that resulted from the herniated disk that resulted in the surgery?

3)  If the Lyrica works for a little while but then becomes less effective over time like the Neurtontin, has anyone found a supplemental drug that when added to the drug regiman takes care of the residual pain?

4)  Any other suggestions that help with the pain?  (I currently use ice packs a lot),

Any insight or advice would be appreciated.  I've found that this pain has become a huge part of my life (a part that people, even closest loved ones) simply cannot understand unless they've suffered themselves.  Thanks!

[Tuckamore]

Hi RUKris,

Welcome to the Pain Management Forum. I am very sorry to hear that you now have nerve pain issues. Your physician is correct that it is not uncommon to have pain post  laminectomy and discectomy to say nothing of two surgeries. And yes unfortunately there are occasions that it can be just as severe as prior to surgery.

I am not an expert nor have I had spine surgery but I have seen many ppl that have undergone these types of procedures. Nerve pain can be temporary if it is the result of inflammation, minor injury or an impingement that is treated. If it is due to scar tissue it may remain with you until or unless there is surgery to remove the scar tissue. That is not often done because usually as your body heals there is normally a certain amount of scar tissue that develops. Some ppl are more prone to this than others.

It is difficult to say if the Lyrica will remain effective. What works for one does not always works for another. Your condition may also improve which would play a part in your medications. Our bodies are wonderful machines and can heal even in spite of damage that may appear permanent. And just as importantly every one's system is different.

Yes chronic pain (CP) often does become a huge part of our lives. The journey through CP is challenging to say the least. If it is life long than learning how to deal with it and not allow it to rule our lives is important. We should not be defined by CP.

You're correct, ppl that have not been there often have no concept of the challenges we face. In time some of your friends and family will come to understand at least in part, your CP. Offering them educational articles can sometimes help as well as sharing medical reports if you feel comfortable doing so. Obviously I would suggest that with a co-worker but I have shared them with my husband, parents, sons and best friend. Those that truly love you will support and stand by you. After years of dealing with CP my oldest son still dismisses with "it's all in your head."  CP is never easy. Why some of the ppl that we love would beleive we would make this up is beyond my comprehension. We learn to put these ppl in proper perspective and not allow their ignorance to stress us.

Others will post with their opinions and suggestions. Please let us know how you are doing. Our members are supportive, understanding and kind. We are here to offer you support and information. We all know that sometimes just venting helps. Please consider joining us and become an active member of our community. We will look forward to your updates and participation. Best of luck to you.

Take Care,
Tuck

[OtisDaMan]

I have used Lyrica for thoracic back pain and neck pain. I have found that it is a tough drug to use because of the side effects; but then it blocks a lot of the pain that I otherwise experience. While neurontin and lyrica are considered to be of the same class of drugs, they do behave in sufficiently different ways to be worth trying one if the other is not adequate.

Weight gain, sedation, and motivation are the three principal side-effects that are difficult to control when I'm on lyrica. Mentally it causes me to feel somewhat fogged out and to have trouble with memory. On the other hand I have stopped using it several times now, and each time all side effects have gone within a week or so (except the first time I took a break - for some reason I had a tougher time), but any weight gained will need to be shed in the traditional manner, unfortunately. My lowest working dose is 450mg/day and it typically requires 600mg/day to get the best pain relief to side effect trade-off. My advice with lyrica would be to trial it for 2-4 weeks at a smallish dose, to get an appreciation of any side effects that you may be prone too. If it seems okay, try increasing the dose somewhat to get improved pain relief or until side effects start causing some irritation.

My pain specialist has also tried out amitriptyline with me and that does seem to cause a small but handy reduction in pain. Use of both lyrica and amitriptyline may assist in keeping doses of both low enough to avoid side effects - amitriptyline is a tricyclic antidepressant and has analgesic properties (stick one of the pills under your tongue for a minute or so and it will go numb). Depression and moodiness are often consequences of persistent pain, so use of amitriptyline or a related antidepressant is probably going to be useful in more ways than one.

All the best, we know what it is like;

OtisDaMan

[RUKrisJ]

First, I am so sorry that I haven't responded.  I assumed I would get an email when there was a reply, but I just happened to stumble across your responses today.  Thank you SO MUCH for taking the time to offer your advice and support.  It always helps to know that you're not alone.

I've been on Lyrica for a couple of months now.  At first it was VERY effective.  As time has gone by, the effectiveness has lessened gradually to the point that now my pain stays at a 6-7 even when I take it regularly.  My doctor has scheduled me to have a nerve block.  I hope that it helps, but I'm getting more skeptical about its success the more research I do.

I've decided that if it doesn't provide the relief I'm seeking, I'm going to make an appointment with a pain management doctor.  I don't feel like my neurosurgeon is remotely invested in resolving the issue or even helping me manage the constant pain.  I'm also back to the point where I have to use a cane on my bad days.  Its odd, but often each step I take feels like its stubbing my leg into my hip joint resulting in shooting pain.  The pain is obviously neuropathic but I am perplexed to say the least about its affect on my mobility.  It only affects my left leg.  Has anyone else had an experience like this or know someone who has?

Again, thank you so much for your responses!!  Stay well.

[Tuckamore]

You should have gotten an email notification when we responded unless you hit the "stop watching" icon. Could it have gone into your spam?

At any rate I am glad that you decided to see a PMP if this procedure is not effective. Your hip pain sounds like mine when I get a trochanter bursitis flare. The leg feels like it is stabbing into my hip joint and the pain is shooting hot and near unbearable. It will even give out. Have you been evaluated for bursitis?

Please let us know if the nerve block is successful. We all learn from one another. I wish you the best of luck and will watch for your updates.

Tuck

[OtisDaMan]

Lyrica can be increased up to 600mg/day so long as side effects don't knock you around too much. In fact, I have recently found cases of US doctors prescribing up to 900mg/day. Anyway, if 600mg/day isn't enough, it is certainly possible to add in a standard pain reliever like codeine or a stronger opioid, but the rule is take it carefully. The effects are typically additive in the sense that the opioids act independently of lyrica and they don't interfere metabolically. I've needed to add panadeine or nurofen plus to my daily dose on many a day, when the lyrica isn't enough.

Regards,

OtisDaMan

[concerned621]

I've had 7 surgeries on my spine 2 of which were just like yours.  And yes I've had this kind of pain and it sub sided in about 1-2 years after surgery.  It takes time for everything to heal and calm down.  Often time after a surgery like this and something a surgeon fails to mention I think because it doesn't always happen you can rupture above and below the site they operate on.  You can also develop arthritis and inflammation above and below the site they operate on.  So it does take time for everything to settle back down. I had lumbar surgery in 2006 and had what I thought was left leg nerve damage after wards.  1.5 years later it started to calm down.  Having said that nerve pain is intense and can really affect your life.  I've taken Lyrica and Neurontin. I don't like either and will not take Lyrica and will take neurtontin only when I am in in so much pain I can't speak.  Another pill to consider if Methocarbonal.  It helps me with when I get really ache.  Lyrica has way too many side affects not the least of which is weight gain. But I had such blurred vision I had to stop taking it immediately.  Neurontin causes weight gain, hair loss, behavior issues.  But it is a little better than Lyrica in my opinion.  I've also found getting in the water, a warm pool where I can exercise a few times per week helps alot.  You can do a lot in the water with very little pain, lose weight and it helps get that back conditioned again.  I recommend trying to avoid any future surgeries.  As I said I had 7.  Two of them were to correct the first two that didn't seem to work.  Now something they may advise is fusing what they operated on. It the nerve pain gets too intense they may recommend it and you might consider it.  I will think long and hard before doing that.  There are doctors doing "disc replacement" and if you aren't already fused that is an option for you.  So please do your home work and give it a lot of time prior to having any additional surgery.  These surgeries changed my life.  I developed fibromyalgia and chronic pain.  I had to stop working at 41 years of age.  So best of luck.  Keep moving your body, the more movement the better.  But slow easy movement until it really heals is best.  There is a topical cream called "Nutra" check it out online. It's the best topical cream I've ever used.  I used it all the time and have recommended to so many people with pain.  Good luck.

[thistimeimean]

Hi,
I'm 25 and had L5-S1 surgery when i was 19.  My pain was actually worse from about 2months after surgery until about 1-2 years later.  Before my surgery i could not move my toes or feel my left leg.  

I know at 27 it seems crazy to get a fusion and i refuse to give up and have more surgery.  In the mean time i focus on being positive and working with many doctors to manage all of my symptoms.  Like you my Neurologist didn't seem to give a crap, but i went to a D.O and I learned cancer patient type mental pain relieving things which have helped me more than i expected.  

You are not alone.  Keep pushing.  Don't take no or pain meds for an answer.  

[Armistead1424]

My wife had three back operations. She has left over pain from built up scar tissue. She even needs another operation, but Doctors won't do it ...yet, because of all the scar tissue she now has. She is on a pain mangagement program, but get's around fairly good. The right exercise like in a pool has helped her. You don't want to do the wrong things, but it seems proper movement has really helped. You got really down about it for several months and stopped moving or doing much and the pain got much worse. She has done better since trying to move. She also had two neck operations, so a total of 5.

[concerned621]

The scar tissue can create it's own set of problems. I need another surgery too, cervical. I have found the longer you wait the more healing occurs.  Unless of course there is instability, that is a different issue. Why does your wife need another surgery?  Take good care of yourself, it's also hard being a care giver. All of my surgeries have been hard on my husband and kids.  So always be sure to take good care of yourself as well as your wife.

[saynono]

I have tried both Neurontin and Lyrica for facial nerve pain from a badly botched root canal.  Neurontin seemed to work for awhile but made me really stupid.  Lyrica never did anything except make me cry all the time.  I finally found some relief with Tegretol XR (extended release).  You may  also want to try a homeopathic whatever called "nerve fix".  I've never been a fan of natural supplements because they go thru no FDA approval and when I did take them they didn't seem to work.  That nerve fix stuff works probably better than anything I take except Elavil.  I take 2 bottles a month (max dosage) and have for years.  I recently cut back when the place I bought it from (vitacost) had it on back order and then discontinued it.  When I went back on it full dose I could tell that the burning/stinging pain lessened.  I found it on the internet somewhere else for $16.  Well worth a couple of bottles to see if it helps you.  I think I took it for about 2-3 weeks before I felt any relief and it was noticeable.  Overall the effect has lessened over time but, again, it helps more than some of the prescrips I take.  If you try it, post back again and let me know how it worked.