“The Pain That Never Stops,” which ran in our March 2017 issue, elicited several helpful responses from readers who shared their experiences in dealing with neuropathic pain. That story focused mainly on interviewees’ drug choices for pain relief. Also, many of the respondents reported relying heavily on activities that distract from pain (exercise, listening to or playing music, enjoying nature, doing internet research, etc.).
But some readers contacted me after reading the article and reported using different drugs than those mentioned. One reader, Ken Braswell, wrote that he has been having good results with Lyrica (pregabalin), which was FDA-approved in 2012 for treating neuropathic pain in SCI. Tom VanderMolen also uses Lyrica regularly as one of his treatment meds, as well as hydrocodone, and when the pain gets super bad, he will use a low-dose fentanyl patch (Warning: fentanyl is one of the most powerful and addictive drugs).
Research has shown that quite often taking more than one drug for neuropathic pain is more effective than relying on a single drug. The latest research indicates that three types of medications are most effective in treating neuropathic pain: anti-seizure meds (gabapentin and pregabalin); antidepressants (amitriptyline); and opioids (hydrocodone and tramadol). However, since each person’s response to drugs varies, other non-FDA-approved meds may work, too. Further studies dealing with the SCI population are needed.
Margaret Mann finds that intrathecally delivered morphine, as well as baclofen, controls her pain, which is both neuropathic and musculoskeletal. She says that these drugs, when delivered by way of an implanted pump, do not make her drowsy, whereas taking them by mouth does. Most of the drugs mentioned above have a known side effect of causing drowsiness or sometimes temporarily impaired thinking. Deborah Gregson echoes Mann’s experience in a second-hand way: “My mom has had good success with a baclofen pump, too, and it greatly reduces side effects of oral meds.”
The most surprising report came from Roanne Kuenzler, who participated in a 2006 clinical trial run by Dr. Christine Sang, director of Transitional Pain Research at Brigham and Women’s Hospital in Boston. Dr. Sang is an expert in SCI and neuropathic pain, and much of her research focuses on trying to find new pharmaceutical treatments, like dextromethorphan, a common cold medicine ingredient. Mucinex DM, for instance, contains just 30 mg of this ingredient, but Kuenzler, as a subject in Dr. Sang’s research, found that a high dose of 700 mg/day of dextromethorphan does a good job of controlling her neuropathic pain. This does not mean we should all run out and buy up massive amounts of Mucinex DM. Consult your doctor, and remember, everyone responds differently.
If you are thinking we are relying too heavily on drugs for pain relief, the good news is that both massage and acupuncture have been shown to give neuropathic pain relief as well. But, as it is with meds, one treatment is not enough. This kind of pain just keeps coming. Finding out what works best for you requires diligent research and careful collaboration with your doctor.