Neurontin or Lyrica…which one would you reccommend for my husband??? how many mg should he start with? Also when John d id take Amitriptilyn I do not think it was a high doese…maybe 10 mg? Also Gabapentin I think I spelled that wrong…what mg should that one be. Reason I’m asking because at this point I just want John to start these medicines to get relief as fast as he can. I know Gabapentin and amitriptilyn take awhile to work…does Lyrica or neurontin work pretty quickly???
I just read that neurontin is gabapentin…interesting. Thinking we should give this one a try. Wondering how many mg we should start with?
Red I have been trying to find more detailed info about ‘atypical odontalgia’. Specifically whether it can mimic symptoms such as tooth being sensitive to heat, cold and sometimes sweet things, also hurts on chewing (but not all the time). Could all these tooth specific symptoms be atypcial odontalgia? Do you know about this, or know of any leads in finding this information? Anyone else have experience or knowledge about this condition? Many thanks!
Lyndsay: I'm not a medical doctor. What I hear and read is that Gabapentin (Neurontin) is commonly prescribed initially at relatively low doses -- perhaps 300 mg per day administered at bedtime. It is then rapidly tapered up to a range of ■■■■■■■■ mg per day while observing both its intended primary effects and its side effects. Though it is tolerated better than Tegretol, there are still people who don't do well with side effects, and a few people who are hyper-sensitive to a wide range of medications. This med passes out of the bloodstream quickly, so maintaining a regular dose schedule can be important.
Maximum recommended dose (from http://www.rxlist.com) is on the order of 3600 mg/day. Although medical trials did not indicate significant benefit for doses above 1800 mg/day, many doctors prescribe above that level and many patients in uncontrolled non-trial situations report benefits. As otherwise noted above, some patients experience depression or weight gain. Others may be sleepy much of the time, or find their short term or long term memory is compromised. All of the anti-seizure drugs have these characteristics in varying degrees.
My spouse has been taking Neurontin since 2001, having switched from Tegretol at her own request when she learned that Tegretol is sometimes associated with toxic reactions, bone marrow suppression, or major suppression of Vitamin D in the body system. She has acclimated well to Neurontin, has no significant sleepiness issues and only occasional word-finding difficulty. She has gained 5 pounds or so in the past 10 years, but she's also 73 years old, so that isn't necessarily a drug effect. The medication "takes the top off" the pain, reducing electric shocks to tingles, and deep, boring, burning pain to a tolerable ache. She has bilateral pain of different types on the two sides, but finds that she can manage on this med.
In fairness to all, be aware that Pfizer, the maker and patent holder of Gabapentin, has been accused of "fudging" medical trials of the drug, falsifying claims concerning its bio-availabilty when used in pain treatment. In my personal view, however, this excess of zeal does not invalidate the experience of tens of thousands of patients who have been treated with the medication, to good effect.
I am significantly less familiar with Lyrica (pregabalin) than with Gabapentin. Lyrica is also prescribed for post herpetic neuralgia and peripheral diabetic neuropathy, but it is now perhaps most widely used in fibromyalgia. Maximum recommended dose is 100 mg three times a day (300 mg/day total). I've heard patient reports of good results in reduced pain levels when this med is used in poly-therapies of multiple drugs. I believe it would be unusual for a neurologist to prescribe Lyrica alone for neuropathic face pain, though it seems to be fairly common for fibromyalgia patients.
My apology Maggie... I intended to add something on Atypical Odontalgia but got called away from my computer terminal. The work by Dr Vickers seems to be unusually thorough -- though still written for dentists and quite long. He has also refused to accept the categorization of "atypical facial pain" as definitive, which is a definite plus. I must take an hour or two and thoroughly re-read these papers.
FYI both: Dr Steven B. Graff-Radford, early in his career, set up an experiment in his practice, to assess whether Atypical Odontalgia could be correlated to standardized psychiatric test measures such as the paranoia and anxiety scales used in the MMPI. He found no correlation at all, demonstrating rather conclusively that this variety of dental pain should never be addressed as "psychogenic."
Regards and best,
Red
Thanks for the link to Dr. Vicker’s report. It’s a fascinating and informative read. There are some slight differences, but this sums up what I have been facing quite well. If it turns out that I have AO instead of ATN, can I still be part of the group? ; )
Thanks for the reassurance. That's very kind of you! I've read your profile too, and it certainly sounds like you've been through the ringer. It seems so much worse than what I've gone through and my heart goes out to you. I'm glad that you have recovered somewhat from the worst of it and hope that one day you will be pain free.
Just to clarify, I never truly thought in a million years that I wouldn't be welcome here if I didn't meet a specific criteria. If that were the case, we wouldn't have many members, since we all cross such a wide spectrum of symptoms/diagnoses. Pain is pain, in my book and I hope that anyone who is dealing with these types of challenges joins in with all of us in trying to find answers. I was really just making a quip about the nuances of terminology after reading a long and fairly dense document (for a layperson, anyway) but perhaps my humor was too subtle or even insensitive. I'm truly sorry if I gave anyone the wrong impression.
One of the differences that I have from the definition of AO that Dr. Vicker's lays out is that I actually benefited from the dental work rather than it increasing my pain. The pain from the decaying fractured teeth and the underlying neuralgia seem to be two separate entities in my case. One of my doctors summed it up quite simply when she suggested that whatever caused so many of my teeth to fracture also damaged my nerves, causing the neuralgia. While having root canals done momentarily aggravated the neuralgic component, I have had a huge reduction in pain from having the decayed pulp cleaned out and the teeth stabilized with crowns. I seem to be an oddity here in that all of my dental work has been necessary, but I might also be one of the few people who has landed on their head after being thrown a far distance. I have to credit my dentists, too, for being so conservative in their approach. Even before the pattern of neuralgia emerged, they needed clear evidence of decay/damage before performing any invasive procedures on my teeth. I am very grateful to them for looking after me so well.
So, perhaps I have AO or perhaps not. It could be ATN or something else entirely that they haven't figured out yet. All I know is that I'm complicated, LOL.
Take care,
Chris
There is a real possibility that AO may in fact be a localized form of ATN which occurs in the nerve endings of the mandibular nerve. AO tends to respond to many of the same medications as ATN (mostly, the tricyclic antidepressants and sometimes opoid drugs), and the character of the pain is highly similar even if it seems more like "bone" pain or dental pain.
So the terminology really doesn't matter.
It's good to hear that at least one patient has received competent dental care in a case that was later diagnosed as AO. So many seem to experience a series of root canals and dental extractions for which there is NO supporting X-ray evidence of abscess. People affiliated with the US Trigeminal Neuralgia Association have been attending national conferences of dentists and orthodontists for much of the last 15 years, urging better education for dentists in neurological face pain. It's hard to see whether dental school curriculae have changed, though.
Regards all,
Red
Thank you all for very informative links and info. Am going to read through the report now, will be really helpful for when I finally see the consultant next month! meanwhile my GP has changed medication from neurontin to nortriptyline so hoping for some pain relief! Best wishes to all…