I have relatively mild RSD in my foot for about one and a half years. I have four sympathic blocks that helped some but may be wearing off a little; last one was a few months ago. I went to a different pain doc who is also in a neurological clinic at the local medical center. He put me on neurontin (gabapentin) and voltaren, plus a little physical therapy. He wants me to back off on the voltaren because the swelling is not so bad now (most of the swelling went away with the blocks). So he put me on 300 mg neutrontin three times a day to see if I could tolerate it and if it would help. Some days it helps with the pain a lot, and these have been the best days I've had since this started. Those days I also feel a little lightheaded and sleepy, which isn't great at work. Other days, I am not light headed, but it also doesn't seem to touch the pain. The doc said it was probably due to day to day differences in metabolism of the drug, and to add one more dose at night on those days. He also said we can increase the dose quite a lot as needed, but we should go slow because of the little headedness, which will get better. And he said that the effect of neurontin will wear away eventually.

So I have a few questions about it for those of you who have used it and had success. I want the neurontin to work as long as possible, because I never know what the future holds. Would it make sense to live with the bad days in order not to up the dose too quickly? Will that make to long term approach to this better? Since my RSD is on the mild side, I am still able to work and do necessary things like grocery shopping. With the neurontin, these things are easier, but without I just push through. Can I prolong the positive effects of the neurontin by keeping the dose as low as possible?

Second, on the days I have good pain control, should I push myself and do a little more? Like go for walks? I would love to start to do some more leisure activities, but am afraid I shouldn't push my luck.

Third, is there anyway I can change things to have more of the good days? If it is due to metabolism, can I change other things like caffeine or alcohol? (I don't drink a lot, but pccationally a drink with dinner or one or two with friends some weekends).

Fourth, is lyrica better enough to pay an extra $50 a month? I don't have $50 a month to throw around (who does, really), and since the neurontin is working okay, I'd rather stick with the lower cose generic drug then the higher co-pay drug. But if the long term control etc is better, is it worth it?

Sorry this is so long, and thanks in advance for your help.