Health Organization for Pudendal Education

Hey all,

Was just wanting some advice on medication. At the end of April I was advised to switch from gabapentin to lyrica. I changed because my primary symptom is deep aching and I was told lyrica works better for this symptom than gabapentin. Plus i was experiencing unpleasant side effects with gaba. However I am now 5 weeks into taking lyrica, minimal side effects and on a 200mg dose and my pain levels are high. The burning has returned and the ache has spread down to both legs. Is this because I have not given the lyrica enough time to work? I don't really know what to do, as my symptoms were some what controlled on gaba but now the ache has gotten worse on lyrica. Any suggestions? I am due to start university in sep so really need some form of pain control!

Thank you everyone

Jess

Jess, how much gabapentin were you taking a day? Maybe you are not yet up to an equivalent dose of lyrica.

Violet

Hey violet,

I was taking 1800mg of GABA before the burning reduced but then went up to 2500 to try and reduce the ache. I am on 225 of lyrica now but I am not sure of the difference in dosage between the 2 drugs.

Best
Jess

Here is an article that might help with the transition from gabapentin to lyrica.

http://www.ncbi.nlm.nih.gov/pubmed/21692969

"PURPOSE:
Although both gabapentin and pregabalin are first-line drugs for neuropathic pain including postherpetic neuralgia (PHN), no report has directly compared the magnitude of pain relief and the incidence of side effects of both drugs. By substituting gabapentin with pregabalin in postherpetic neuralgia therapy, we can compare the two drugs.
METHODS:
In 32 PHN patients being administered gabapentin, without changing the frequency of dosing, the drug was substituted with pregabalin at one-sixth dosage of gabapentin. After 2 weeks, an interview was conducted about the visual analog scale (VAS) pain score, changes in the time of onset of action and duration of action after the substitution of drug and side effects (such as somnolence, dizziness, and peripheral edema). In addition, the dosage was increased while paying careful attention to the side effects (titration) in 22 patients who requested a dosage increase among those whom VAS pain score of ≥25 mm remained even after the substitution.
RESULTS:
No significant changes were observed in VAS pain scores after the substitution of gabapentin with pregabalin. Regarding the time of onset of action and the duration of action after the substitution, the highest number of patients answered that no change occurred compared with the previous drug, followed by the patients who answered that the time of onset of action became quicker, and the duration of action became longer. The incidence of somnolence and dizziness showed no significant difference before and after the substitution, but peripheral edema showed a significant increase after the substitution. The level of side effects of both drugs was mild, and continued medication was possible. In the patient group where pregabalin dosage was increased, the VAS pain score decreased significantly compared with that before and after increase the dosage (P < 0.05). On the other hand, in nine out of 22 patients in the group where the dosage was increased, side effects appeared or were exacerbated. In two out of nine patients, it was necessary to reduce the dosage to the initial volume.
CONCLUSION:
It was suggested that the analgesic action of pregabalin in PHN was six times that of gabapentin in terms of effectiveness in dosage conversion. Regarding the side effects, although the incidence of the peripheral edema was higher with pregabalin compared with gabapentin, this finding is not conclusive because the present study was conducted in a small number of subjects. Although pain reduction can be expected to increase with pregabalin dosage, it is necessary to increase the dosage gradually and carefully because of exacerbation of side effects.
Wiley Periodicals, Inc."

I am currently on 800 mg per day. I worked my way up to this amount over a couple of years.

I take 3,000 gabapentin daily. 6 vicadin. I took myself off of oxycontin 4 months ago. I also take cymbalta. 90 mg at night. Wouldn't you think that would be enough.? I still feel I need something if I need to stand or sit for any amount of time. My GP will not give me any thing else. There has to be something between vicadin and oxycontin that I could take . I
Need to pace myself if I want to do anything standing or sitting. I joined the community choir.we have practice today and will be sitting for an hour and a half. I asked for oxycodone, no luck. I had a crash yesterday. There are times I just can not do this for one more minute. My sciatic pain is miserable also. A good cry always makes me feel better,and I try to get my head straightened out again. :?Any ideas,? I try alleve and it is like putting acid in my stomach.doesn't do anything for the pain... This pain has just become my normal. How else can we deal with this?

If I had a gp that refused to address my pain, I would get another gp. There are a lot of doctors out there. Just saying.

I'm sorry you're having a rough time, Ellie. Are you thinking of oxycodone as a temporary solution while you are still recovering from surgery? I don't remember how long ago your surgery was but oxycodone may not be the answer as a permanent solution if it's been awhile since your surgery.

Violet

I have to agree with you Violet. I broke my ankle from falling on ice in Feb. Had surgery 2 weeks after the break. Do you have any suggestions Violet?

Well then it's still pretty early days for you post-op, Ellie -- just 4 months. In that case, if oxycodone works it would make sense to use it temporarily during the healing stage. I used it for 9 months post-op. Maybe a pain management specialist would be more likely to prescribe it for you than your GP. Possibly your GP just isn't very experienced with pain meds and that's why they aren't comfortable prescribing it but there are docs out there who will.

Violet