Hi Seahorse,

I agree with this for the same reason and another - that we should always take the least amount of anything required to acheive the desired results. Dosages are usually determined/recommended by the pharmaceutical companies based on averages derived from their studies/trials. Doctors tend to follow these guidelines unless they have experience/reason not to. But this also means "one-size-fits-all" medicine, and since we're all different, those guidelines are going to be too much for some and too little for others (which is my main argument for titrating from lower to higher).

The deal with gabapentin & Lyrica, as I understand it, is this: Gabapentin is an older medication now out of patent (generic). It is often used as a firstline treatment for PN and other neuropathic pain because it sometimes works (despite side effects), and because it is generic, it's cheap.

Lyrica is similar to gabapentin in several ways (some say an improvement on or improved form of - I'm not a chemist/pharmacologist), and ostensibly has (generally) less/fewer side effects, but it is still under patent, therefore more expensive. Some insurance companies/policies will approve Lyrica right off, some will approve it only after gabapentin is tried (and sufficient reason shown for prescribing Lyrica instead) and some will just flat out refuse it.

I have no bias/preference between the two - whatever works - but if cost is an issue, I think I'd give gabapentin a try.

I'm not sure (now) when Lyrica's patent is due to expire; one site says late next year ('13)
http://epilepsy.emedtv.com/lyrica/generic-lyrica.html
while another says '17 - '18
http://www.uspto.gov/patents/resources/terms/156.jsp
(2 patents near bottom of page)

I found this on the FDA's classification of Lyrica as a controlled substance.
http://www.mmm-online.com/setback-fo...article/22504/
This is the first I've heard of this, so I think it's worth pursuing further (factchecking on both patents and this controlled substance issue).

Google: lyrica patent expiration
Google: lyrica controlled substance

Doc

Dr. Smith - I've seen great MRI's turned into laymen's terms from you and others. Would you mind deciphering mine as well? please

Grade I degenerative subluxation at L4-5 with bulge, annular tear, prominent facet arthropathy. Mass effect on the right lateral recess nerve root w/crowding of the left. Stress injury of the pedicle & pars region of L5.

Monday from.....well ya'll know from where.
Got to the pain clinic, nurse got the i.v. needle she was putting in my hand hung up in her latex glove somehow (I didn't see as I was talking to the dr.), pulled it out of my hand youch!!, bled like crazy, popped up the size of a walnut, which she put pressure on, aaaarrrggh the pain! Errrr, shall we say not a good start? Wrapped my hand in ice. Put another iv in my arm - success this time! Due to lots of drug reactions/allergies, doc decided to use fentanyl at 1/2 dosage as anesthesia and 1/2 dosage of epidural steroid. Klonopin script written up to counter my usual reaction to steroids. Injected right lower lumbar. Went smoothly. Couldn't put any weight on my right foot going up steps when I got home, tho hours later the right side felt much better, but made me sooo much more aware of how badly the left side feels. As I've whined before, both PS and previous OS said that they did not think epidurals would do any good in this case anyway, but at least when I see the neurosurgeon in a couple of weeks he will see that I've already tried this. Permanent nerve damage a concern for the pain specialist doc, and for me as well. Said to take it easy for a few days, and just do things as I feel I can, nevermind what I WANT to do (see I'm one those hyper, irritatingly busy sorts - if I'm awake I'm in motion). I will call the neurosurgeon's office daily between now and my scheduled appointment to see if they can pop me into any cancellation spots they may have. Time goes by so fast UNLESS one is in pain doesn't it?!

Umm... your lower back is really messed up and hurts like cuss?

Seriously, I'm flattered, but I think it must have been someone else, and there are several people here who are much more knowledgable/experienced than me (I?); I'll have to look most of those terms up myself, but I'll take a stab at it and defer to others' corrections/different interpretations.

I think you know what degenerative means; it's deteriorating, and will continue to get progressively worse over time. This progression may be the natural result of aging; very slow (taking years to decades), and some natural healing may occur in the interim as the body tries to protect itself.

From: http://www.spine-health.com/conditio...ndylolisthesis
From: http://www.arachnoiditis.info/conten...listhesis.html
I would think that traumatic injury would be an exception to the above.

Paraphrased from: http://en.wikipedia.org/wiki/Subluxation
Subluxation implies the presence of an incomplete or partial dislocation of (in this case) a joint. A spinal subluxation is relatively rare, but can sometimes impinge on spinal nerve roots, causing symptoms in the areas served by those roots. In the spine, such a displacement may be caused by a fracture, spondylolisthesis or severe osteoarthritis.

From: http://www.mdguidelines.com/spondylolisthesis
Since we're talking about the joint between L4-L5, the bulge and annular tear are in the disk. A bulge is just that.
From: http://www.laserspineinstitute.com/b...ular_tear/def/
*(I have this type of annular tear at L5-S1)

The facet joints are the joints of the spinal column - between the vertebrae. Facet arthropathy essentially means arthritis of the facet joints. I believe prominent in this context means severe (subject to correction).

I'll need some help (or much more time) on the rest of it. Your doctor should be able to decipher and explain all this. Be firm and perseverent until you get satisfactory answers.

HTH,

Doc

Dr. Smith - perhaps I just thought you had interpreted others' mri's, but you seem to always make well-informed posts well worth reading. My issue with my own mri is that I pretty much understand what each sentence means but as a whole and taken all together, I'm a little lost (but not in space :)). I wish I knew which of the issues were caused by natural aging and which were caused by hitting the kitchen floor from a standing position with one foot in the air at 6 feet, AND what it all means as a WHOLE.
See, I was bragging about how strong and healthy my legs felt after power walking every day for 3 years, said I'd like to take up kickboxing or hiking (note to self - never, ever brag). My significant tormentor said that I could never kickbox because I couldn't get my leg up high enough, I said I could, he said let's see, when I showed him that I could, he caught my heel for just a second and I hit the tile floor on my upper butt. Might have been funny if we were both 6 years old. Regardless, shortly after that is when I began having pain - and I have never ever had any problem with my lower back before.

Thanks though, for your informative post! Great explanations! Does yours hurt like a "cuss" too?

D'oh! :Doh: What a cuss cavity! (Your "tormentor")

I think a lot of orthopedists and neurologist would have a difficult time with that, but I really don't know. If you're asking in contemplation of litigation, I don't blame you and I wish I could help more. That would definitely require the opinions of several qualified physicians. An attorney could/would help you find them, because this also sounds like a good candidate for a contingency case (meaning it wouldn't cost you unless you won).

Yes, I'm in pretty much constant pain, and couchbound more than I'd ever want to be, but I do get out - good days and bad days.

Doc

Hi seahorse
 

I too am still thinking about you. I hope you get some resolution to both the pain issues and insurance. Doc is super good with the information and research. We all wish there was a way to figure out exactly what happened to you. Soemtimes it does take the opinions of many doctors to get the Whole picture. I wish you all the best seahorse. You are in my prayers. ginnie

I hear you
 

I had an L4-L5 lami nectomy and my back is fine now. I had all your problems. Cleaning out that area with surgery finally worked for me. Screw Pain Management.
Good Luck

pain
 

Hi seahorse, sorry the shots hurt. Hope the coming appt. with neurologist answers all the questions you have, and can resolve the issue. ginnie

Yes, "cuss cavity" is a graceful way of stating the adjective I have in mind for him at this point. No contemplation of litigation, that would be much like cutting off my nose to spite my face, as I do have to live here for the time being. Every evening (prior to hitting the kitchen floor) I'm walking my big boy (the one pictured in my avatar) while ole "cuss cavity" is bending his elbow repeatedly. Mismatch is an understatement, and I take the blame for that - BUT not for falling in the blipping floor. In summary, the straw that broke the camel's back......... Fodder for an entirely different forum.
Now I just want my back well - and lose the daily stressor.