Gabapentin for Pain Drove Patient to Brink of Suicide

http://www.peoplespharmacy.com/2015/08/03/gabapentin-for-pain-drove-patient-to-brink-of-suicide/

To this day the FDA has only approved gabapentin for treating epilepsy and the lingering nerve pain caused by shingles (postherpetic neuralgia). Nevertheless, doctors prescribe gabapentin for an amazing array of conditions ranging from bipolar disorder, fibromyalgia and headaches to diabetic neuropathy, restless leg syndrome and insomnia. (Find a list of unapproved off-label uses at the bottom of this article).

None of these uses has received a green light from the FDA. How well it works for all the off-label conditions remains quite controversial. The evidence supporting some of these uses leaves a lot to be desired…

In 2009 the FDA realized that gabapentin and other anti-seizure medications could cause depression and suicidal thoughts. Some doctors must not have gotten that memo…

Many other people have also reported serious gabapentin adverse reactions on this website. At last count there were 286 comments at this link…

PAUL, WA, AUGUST 4, 2015 AT 9:29 AM
RA has caused me intolerable cervical spine pain. About 15 years ago Gabapentin was prescribed for this condition. It has proven to be a near miracle by reducing the pain to tolerable levels and making my life worth living. Recently, as part of an effort on my part to reduce the amount of meds I was taking, I reduced the Gabapentin to none and once again suffered terrible cervical spine pain. I now take one or two 100mg capsules per day and can once again live without constant pain. At age 82 I can still enjoy life and am thankful for Gabapentin for making that possible.

There is a legitimate need for Gabapentin. Apparently it is not for everyone but the scary dialog in this segment should not be allowed to cause panic and possibly lead to the demise of a useful drug. We long time readers and proponents of Peoples Pharmacy are surely better than that.

I think it’s important for patients to know the possible side effects of any drug they take. Usually, one wouldn’t think that a medication prescribed for pain could cause depression or suicidal thoughts — unless we’re talking about antidepressants.  Since anti-seizure medications work on the brain like antidepressants, it’s not surprising that they also have this possible side effect.

http://health.usnews.com/health-news/news/articles/2012/12/03/antidepressants-may-lead-to-fewer-seizures-in-people-with-epilepsy

http://myelitis.org/symptoms-conditions/medical-approach-to-the-management-of-neuropathic-pain/

Medical Approach to the Management of Neuropathic Pain
Joanne Lynn MD
The Ohio State University MS Center

Adapted from a presentation at the 2006 Rare Neuroimmunologic Disorders Symposium

This article focuses on the medical treatments for neuropathic pain. I am not a pain specialist or an anesthesiologist. I am a neurologist in an MS clinic; my experience derives from treating people with neuropathic pain who come to our clinic. I am going to describe the types of pain and clinical manifestations of neuropathic pain, the various ways that pain neurons respond to injury and how different medications may modulate the pain pathways. Finally, I will describe the first and second line medications that we use for the management of neuropathic pain…

Hyperpathia or hyperalgesia refers to prolonged or exaggerated pain from a pinprick or other lightly painful stimulus. For instance, when I am doing a neurological exam and touch the skin with a pin that might evoke a sensation that is briefly, transiently uncomfortable, for someone with this type of pain, it might cause a spreading or prolonged painful feeling…

I haven’t seen hyperalgesia described this way before. And what this doctor is describing sounds like what I think of as “referred” pain.  When you put pressure on a painful area, the pain spreads out to other connected areas.  And when you put pressure on an extremely painful area, that pain is referred  — stronger, longer, and further — to other connected areas. Pressure on these very painful areas creates an after-effect — like an after-shock — of pain that lingers past the point of when the pressure began.

For instance, after taking my glasses off, the pain in my face makes it feel like I’m still wearing them.  Depending on how many hours I’ve worn them, it can take anywhere from a couple of hours to a whole day for that additional pain to fade.  This is what referred pain feels like for an intractable pain patient, although I usually call it after-pain.

I took opioids for 10 years, so maybe they caused this type of hyperalgesia? No, because I’ve always had referred pain, even before I took opioids.  In fact, most people have experienced referred pain, but many probably don’t notice it as much as pain patients.

We need to treat the associated depression which is found in high percentages of people with chronic pain…

I don’t think Major Depressive Disorder is found in a high percentage of pain patients.  And I would say that a lot of depression is caused by the chronic pain — it did not exist before the pain. While treating the depression is a good thing, I think it makes more sense to adequately treat the pain.  If the pain is adequately treated and the depression still remains, then treat the depression.  Treating the depression while leaving the pain under-treated will not work as well, if at all.

Opioids have generally been underutilized for the treatment of neuropathic pain. In addition to working on opioid receptors, opioids also decrease glutamate receptor activity…

Opioids may be associated with tolerance; there may be a need to increase the dose over time to maintain effectiveness. It may also be associated with physical dependence and with unpleasant withdrawal symptoms when stopping the drug. Less often, there may be addiction; drug seeking behavior to satisfy drug craving despite harm. For most people with a pain syndrome, they do not develop addiction or drug seeking behavior when using opioids as a legitimate treatment…

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