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Stabbing pain due to neuropathy. Already on lyrica. Need a solution

May 2014
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Practicing since : 2002
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What can I do about my stabbing pain due to Neuropathy....I'm already on Lyrica which has sopped helping the pain at night trying to sleep?
Posted Thu, 31 Oct 2013 in Brain and Spine
Answered by Dr. Vivek Chail 1 hour later
Brief Answer:
Please find detailed answer below.

Detailed Answer:
Thanks for writing in to us.

I have read through your query in detail.

Research on Lyrica (pregabalin) in treating diabetic peripheral neuropathy has been done and following is some information which was drawn from data collected in many patients:

▴ Oral pregabalin at fixed dosages of 300 and 600 mg/day, administered three times daily, was superior to placebo in relieving pain and improving pain-related sleep interference in three randomised, double-blind, multicentre studies of 5–8 weeks' duration in a total of 724 evaluable patients with painful diabetic peripheral neuropathy (DPN).

▴ Significant reductions in weekly mean pain scores (primary endpoint) and sleep interference scores were observed at 1 week and sustained thereafter. A significant reduction in pain was apparent on the first day of treatment with pregabalin 300 mg/day.

▴ Twice daily fixed (600 mg/day) or flexible (150–600 mg/day) pregabalin was also effective in reducing pain and sleep interference in two 12-week placebo-controlled trials in a total of 733 randomised DPN patients.

▴ Pregabalin was well tolerated in DPN patients; mild-to-moderate dizziness, somnolence and peripheral oedema were the most common adverse events.

It is noteworthy to say that Pregabalin might not work to the same extent in all patients and there is a small group of people as you who still experience moderate discomfort inspite of taking the medication in prescribed doses.

Further, another study on treatment of Peripheral Neuropathy has given the following guidelines on the medications to be used:

1. Analgesic agents recommended for first-line treatments are certain antidepressants (tricyclics) and anticonvulsants (gabapentin and pregabalin).

2. Second-line treatments recommended are serotonin noradrenaline reuptake inhibitors and topical lidocaine.

3. Tramadol and controlled-release opioid analgesics are recommended as third-line treatments for moderate to severe pain.

4. Recommended fourth-line treatments include cannabinoids, methadone and anticonvulsants with lesser evidence of efficacy, such as lamotrigine, topiramate and valproic acid. Treatment must be individualized for each patient based on efficacy, side-effect profile and drug accessibility, including cost.

I suggest you have a detailed discussion with your doctor concerning the possibility of change in dosage/ medication combinations which will work best for you.

Hope your query is answered.
Do write back in case of doubts.

Dr. Vivek
Above answer was peer-reviewed by
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