Physiatrist/Lyrica Advice Needed

[basquat]

I have reoccurring grade 1 isthmic spondylolisthesis for the last 6 years. Flare-up's are now occurring 2x/year, lasting 2/3 months at a time. My PCP recently referred me to a physiatrist for pain management. After a brief consult the physiatrist switched my PT, stopped my rx for vicodin, and prescribed Lyrica for sciatica. He inquired about the vicodin I was taking. I explained that I'm allergic to aspirin and all NSAID's and it was the only form of relief I had for pain. He then told me that he "wasn't in the business of narcotics" and wouldn't refill my vicodin rx. He didnt explain the Lyrica and just handed me the pamphlet to read. He was also very vague about rx instructions, nothing in writing.  Just said 50-100mg/day to start and to call when the samples ran out. In general this guy had bad manners and I didn't connect with him. I'm waiting to see a new physiatrist in a week. Despite his bad bed-side manners I tapered off the vicodin and started the Lyrica, being open to anything that will help.

The Lyrica helps the nerve pain but I still have a lot of back and hip pain due to disc inflammation. In addition I recently read a warning about using Lyrica while trying to conceive and possible birth defects. My wife and I are trying to conceive after already having 1 miscarriage.

I'd really like to switch back to a narcotic but I dont know if, or how, I should present that to the new Dr. Even though I have images and a solid history of treatment I'm worried that I'll come across as dr. shopping if I ask about narcotics for pain management.

Is it me? Should I just deal with the breakthrough pain and stay on Lyrica? I mean, what are the real chances of a birth defect due to Lyrica anyway?

Thanks for any advice.

[Tuckamore]

Sorry I misread your post. I do know the difference, my brain just wasn't working. Your pharmacist is correct, only testing in animals have been done, just like most drugs. And though we are animals it doesn't also hold true that human animals will have the same reactions.

Don't be surprised if your physician knows less than your pharmacist, that often is the case. Best of luck to you. Thank you for the update. Please take care and let us know how you are doing. Tuck

[basquat]

Hi Tuckamore and BusyGrl,

Thank you both for your advice. I spoke to my pharmacist yesterday and unfortunately he couldn't advise me one way or another. In fact he wasnt even familiar with the issue until he searched his database. Animal studies show a link between birth defects and conception rate but no such study exists for humans. So perhaps the doctor will have additional information for me, or get me on something else.

I'm seeing a physiatrist, not a psychiatrist...lol! A physiatrist "is a medical doctor who specializes in physical medicine, rehabilitation, and pain medicine." So I'm seeing him for both rehab and pain management.

thanks again for your help.

[Tuckamore]

Hello Basquat,

Welcome to the Pain Management Forum of MedHelp. I am glad that you found us. I am also sorry to hear that you are having issues with your new psychiatrist. I am confused as to why your PMP would discontinue treating you and refer you to psychiatrist. Does he specialize in pain management?

Anyone that knows me on this forum knows how I feel about unsuccessful relationships with your physician(s). Physicians work for us. We hire them to do a job. Physicians are no different than plumbers, even though some of them have a God Complex. If you have a leaky pipe and you hire a plumber to fix it and he doesn't, what do you do???  I hope you answer is fire him. And if you are not obtaining results or answers that you are comfortable with than you should seriously consider termination your doctor patient relationship. I do not advise "doctor hopping," especially for narcotics. It can get labeled and in a lot of legal issues. But you have a right to a trusting, comfortable relationship with your PCP and PMP to say nothing of your psychciatrist. So begin your search OR return to the physicians and discuss the issue. But please do not tolerate and continue to pay for poor service. There are great PMP and PCP out there.

Busygrl offers great advice to use your pharmacist as a source of information on your medications. He/she would know that men being treated with LYRICA who plan to father a child should be informed of the potential risk of male-mediated teratogenicity. In preclinical studies in rats, pregabalin was associated with an increased risk of male-mediated teratogenicity. The clinical significance of this finding is uncertain.

In fertility studies in which male rats were orally administered pregabalin (50 to 2500 mg/kg) prior to and during mating with untreated females, a number of adverse reproductive and developmental effects were observed. These included decreased sperm counts and sperm motility, increased sperm abnormalities, reduced fertility, increased preimplantation embryo loss, decreased litter size, decreased fetal body weights, and an increased incidence of fetal abnormalities. Effects on sperm and fertility parameters were reversible in studies of this duration (3-4 months). The no-effect dose for male reproductive toxicity in these studies (100 mg/kg) was associated with a plasma pregabalin exposure (AUC) approximately 3 times human exposure at the maximum recommended dose (MRD) of 600 mg/day.

So you have a right to be concerned if you and your wife are considering pregnancy. I wish you the very best. Please keep us posted and let us know how this all turns out for you. And as always, take care, Tuck

[BusyGrl]

Your pharmacist can be a really good source of information. Do you have a good one?

I have no idea about Lyrica and birth defects, but you should be able to find something online or through your pharmacist.

Sorry about the rude psychiatrist insisting on taking away your vicodin. Doctors really like to do that for some reason, even if you maintain a low daily dose. I don't get that. That was the first thing my doctor did post-surgery.

Are you considering surgery at all? I wonder if that could be a solution. You might be feeling better in as few as 3 months.

Your psychiatrist sounds like a bad fit for you, too. There are caring people in the medical community if you just look hard enough for them. And try not to get stuck on the notion that you need vicodin. Maybe you will find another pain manager who can prescribe something that works. Some people get relief from injections, too.

I'm searching for a good pain manager myself right now and happened to see your post. Personally, I don't put up with bad treatment from medical providers. You are paying them to help you, not shame you. Keep searching for a solution, and best wishes.