Hello there,
I take both Neurontin and Lyrica. Lyrica has really helped with my allodynia (the extreme skin sensitivity), and it does help with the burning pain. Both of them are anti convulsant medications and are in the same "family".
Overall I like Lyrica better than Neurontin.
I haven't had any bad side effects like sleepiness or weight gain either.
Here is something from the RSDSA:
Quote:
Antiepileptic Drugs
Gabapentin is one of the most commonly prescribed pain
medications for neuropathic pain in general, and in CRPS
specifically. One of earliest reported uses of the drug was
in a case report for the treatment of CRPS [3]. Gabapentin
is thought to work by modulating calcium channels at a
specific alpha2delta subunit [4]. The drug has been studied
extensively in painful diabetic neuropathy [5] and
postherpetic neuralgia [6], with demonstrated efficacy. In
one randomized, blinded trial in 58 patients with CRPS,
gabapentin had a mild effect on pain [7•]. In the largest
placebo-controlled trial of gabapentin that included
CRPS patients (85 of the 305 studied), gabapentin was
shown to cause a significant reduction in pain, compared
to placebo [8]. Of note, although there was a 1.5-point
improvement in pain with the gabapentin group, there
was only a 0.5-point difference (0–10 point pain scale)
Pharmacologic Therapies for Complex Regional Pain Syndrome Mackey and Feinberg 39
between the placebo and gabapentin groups. This is less
a reflection of lack of efficacy with gabapentin (or many
other antineuropathic pain medicines), but more a testament
to the power of placebo. In a placebo crossover
study of gabapentin, van de Vusse et al. [7•] noted a mild
benefit with gabapentin as well as a reduction in mechanical
sensory deficits. More formal quantitative sensory
testing studies need to be done to replicate this finding
and assess its mechanistic implications.
Most analgesic trials use a monotherapy design to
investigate efficacy. Recently, a novel study by Gilron
et al. [9••] investigated gabapentin, morphine, or their
combination for neuropathic pain. The authors found
that better analgesia was obtained with lower doses of
each drug used in combination than with either drug
used alone. More pharmacologic combination studies
are needed.
Pregabalin, (Lyrica)
a new antiepileptic drug (AED) that has
a similar mechanism of action as gabapentin, has not
been studied in CRPS. It has been extensively studied in
postherpetic neuralgia [10] and diabetic neuropathy [11],
with good efficacy. Its primary advantage over gabapentin
is thought to be its more linear pharmacokinetic profile
and twice-daily dosing. Its side effect profile is similar to
that of gabapentin, and it is generally well tolerated.
Sodium channel–blocking AEDs may have some
utility in CRPS patients; however, there are few studies
directly demonstrating efficacy. Carbamazepine is an
older AED indicated for trigeminal neuralgia that has
been studied in CRPS in a randomized, controlled trial
(seven of the 38 neuropathic pain patients studied had
CRPS). Administration of 600 mg/day of carbamazepine
over 8 days resulted in significant pain reductions,
compared with placebo [12]. Typically, in our clinical
practice, we use oxcarbazepine instead of carbamazepine
because of oxcarbazepine’ s similar mechanism of action
and efficacy, as well as reduced side effects and drug-
drug interactions [13,14]. Oxcarbazepine has not been
studied in CRPS patients.
Antidepressants
There is ample scientific evidence to support the use of tricyclic
antidepressants (TCAs) in neuropathic pain [15,16].
Although the literature for use of TCAs in CRPS is
lacking, the drugs are commonly used for CRPS management.
The antihyperalgesic effects of TCAs are probably
related to enhancement of noradrenergic and serotonergic
descending inhibitory pathways and partial sodium-
channel blockade [17], mechanisms that are independent
of their antidepressant effects. TCAs are not benign drugs
and, in an intentional overdose, can be toxic as compared
with serotonin-selective antidepressants. Although there
is literature supporting the use of TCAs in a variety of
neuropathic pain conditions, there is only anecdotal evidence
supporting their use in CRPS.
The clinician should be aware of several different TCA
drugs, as they have varied side effects that may sometimes
be used to the patients’ advantage. For the overweight
patient with lethargy, the clinician may choose a TCA
with more noradrenergic selectivity (eg, desipramine) ,
which may be activating and can cause some appetite
suppression. For patients with poor sleep hygiene, the
sedating properties of certain TCAs, such as amitriptyline,
are recommended [18].
Selective serotonin reuptake inhibitors have been disappointing
for neuropathic pain in general and CRPS in
particular. Most studies of the serotonin-selective type
(nontricyclic) antidepressants have shown little or no
analgesia [18]. Newer antidepressant agents such as duloxetine,
venlafaxine, and mirtazapine show some promise
and have the advantage of a different, more benign side
effect and toxicity profile.
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I hope this helps. I sure hope that Ali starts doing better!
Baclofen has helped me quite a bit with my muscle problems, so I hope that it does the same for Ali. There are others out there, if this fails.
I know that this is NOT easy especially being young. I am sorry about the spreads too... sounds like me, and it is no fun.