Adamo,

Just so you realize, not everyone has trouble discontinuing Gabapentin. I figure you won't read much about those who have no problems, as they don't need help so they don't need to reach out.

I have used up to 1800 mg Gabapentin. At one point I took 1200 mg for 2 years running, then tapered it by 300mg per day, every couple days -- basically in a week I was off it. I only tapered as a safety measure, because it is an AED, but I had no ill effects whatsoever.

I also use benzo's on and off, and I've tapered off them before. I have to taper very, very slowly. I've inadvertently messed up a benzo taper before (by forgetting to take meds) and I most certainly did run into problems then!

waves

I would avoid the word "addiction". There is no evidence here of addiction (e.g. craving, obsession/compulsion, abuse, etc.) I'd ask for instructions to avoid (another) dependence, or swapping one dependence for another, but I think that for all but an exceedingly few exceptions, once per week would not be enough to trigger dependence.

Doc

I was told, quite forcefully, when I said I was frightened of becoming addicted to pain drugs that I am not addicted, only dependent .. Because I need them to help with the pain. I am still a tad puzzled as to the difference.

I had my doctor tell me the same thing Saffy. I am not addicted, and you are not either. Addiction is when you use the medication, more than what is prescribed, doctor shopping, and other risky factors. Depending on a medication for quality of life, is far from being an addict. I use the meds. very carefully.
Hope your pain is less today. ginnie

Here are the technical definitions. Confusion can sometimes arise because in some instances there is some crossover, but basically, addiction is psychological, while dependence is physical.

There is also pseudoaddiction—drug-seeking behaviours that appear to be addiction, but actually indicate inadequately addressed/under-medicated pain.

Doc

Yes, that's better. Benzo's are considered addictive as people do end up with psychological dependence (with or without abuse), but asking about "dependence" makes much more sense in your situation; it does not open unnecessary cans of worms.

I would also avoid the word "dependence" when it comes to gabapentin. The reason many doctors resist the concept of "withdrawal" is they do not accept the notion of physical "dependence" on gabapentin at all.

In general I think what you say should not state or imply any kind of dependence on gabapentin. I think the most practical approach would be to focus on the anxious symptoms, their severity, and the need for help with these things.

It would be ideal to find a doctor who understands gabapentin withdrawal, but that might not be a realistic goal given that time is of the essence. Anyway, if you happen across such a doctor, they will make the gabapentin connection themselves.

waves

To avoid dependence on benzos for occasional use over an extended period, total clearance is recommended between doses, at least after every 2 doses. And that said, there is no guarantee. Expected clearance time is calculated by half-lives. Half-life ranges are statistical data; individual experience occasionally falls outside of statistically determined expectations.

Benzos with short half-lives such as alprazolam and even lorazepam will clear in a week or even 5 days, in a typical individual.

However, the doctor will choose a drug depending on the clinical picture they see and on their personal preference. With recurrent anxiety, some doctors might prefer to give a longer-acting agent so as not to produce sharp peaks and troughs from the medication itself. Klonopin (mid-acting) is often used for this purpose as well as to aid in suspending other substances. This drug is unlikely to clear in 5 days. You'd be on a low dose and there shouldn't be much accumulation, so there might not be an issue. Bottom line: let the doctor know exactly how often you plan to use the medication and for how long you expect to be using it, to help them choose the best med for you.

--------------------

Fwiw, your dependence on gabapentin is not necessarily predictive of a predisposition to dependence on a benzo: the pharmacokinetics are different. Gabapentin mechanism of action is still not well understood but it does not function as a GABA analog (although it was developed for this purpose). More recent data have shown it to be a calcium-channel antagonist, but even there it appears only to act at certain threshold levels. Some experiments have directly tied this mechanism to its GABA-agonistic activity. Benzodiazepines, on the other hand, have a direct chemical affinity for a subset of GABA receptors, producing a higher GABA affinity at bound receptors. I apologize for not giving sources. I don't have them on hand as the last I read up was maybe a few months ago.

"Psychological dependence"? LOL! What was that about opening an unnecessary cans of worms?

I know what you meant—it's a bonafide term—but with so much confusion regarding addiction vs. dependence (perpetuated/proliferated by sensationalizing and/or just plain confused/ignorant media & "authorities/experts") to begin with, I'm concerned that that term may be counterintuitive. I also think that in the average person's mind (due largely to the above), addiction implies abuse. YMMV.

I really don't know if these subtleties clarify or obfuscate for the average person.

Would it suffice to say that benzos are considered to have an abuse/addiction potential?

Well said, and thanks for the technical explanation.

Doc

For all of us in daily chronic pain and need relief from that pain, how important is all of this? Before I was in chronic pain, it seemed to matter more. I need relief from my chronic neuropathic pain, and I take Neurontin. It seems to help somewhat. Maybe I'm wrong, but I'm going with the relief. If my body becomes dependent, I guess I'll have to worry about that later.

Well, this thread is about someone who got better, found themselves dependent on the medication their doctor prescribed, and their doctor not believing them, or that it is even possible.

But it's a good/valid question. There are millions of people in daily chronic pain who need relief from that pain—at least 50 million if the figures are correct.

chronic pain facts

http://www.mtsu.edu/healthpro/docume...ronic_pain.pdf (50 million)
http://www.pain-research.org/intro.html (86 million)
http://www.painmed.org/patientcenter...aspx#incidence (100 million)

Many are reluctant to take (narcotic) medications that may relieve that pain out of fear because of misconceptions and misinformation—much of it centered around the confusion about terminology.

Some take medications (like gabapentin and pregabalin) they believe to be "safe"(er) because they're told they're "non-narcotic" only to find that they are more dependent on them (as hard or harder to discontinue or reduce) than narcotic medications. I think it's important that these medications have this potential, and doctors don't know/acknowledge the fact, or believe patients who report it, despite the abundance of evidence.

This is especially significant with these two medications because for some reason, for a number of people, they just stop working, and then some find that not only are they still in pain, but they cannot discontinue high doses of a medication that no longer has any therapeutic purpose/value.

Why is the difference between addiction and dependence important?

I can't/won't speak for anyone else, but I'm trying to clear up some of the misconceptions and misinformation so that people can make better educated decisions about their health care based on facts/science.

Doc