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Switch in nerve pain medication: Pregabalin to Gabapentin

Hi all, as some may know I underwent an L4 / S1 PLIF in February this year, and have been making progress in my recovery over the last several months and beginning a phased return to work. I have recently been discharged by my surgeon who was very happy with my progress, but suspect the discharge was more so because my insurer closed my case as their policy dictates having undergone surgery that after 5 months I should have recovered, or else I must be suffering a chronic condition which they don't cover! I am now under my GP's care, although I can always get referred back to my surgeon should the need arise.

I have been taking Pregabalin since 4 weeks post op, to combat my nerve pain which if anything has gotten worse as I have pushed my recovery and return to work etc. At my recent refill request to my GP, they decided to switch me from Pregabalin (aka Lyrica) to Gabapentin, saying that it is their preferred medication over Pregabalin. I am just about to switch over, but wanted to ask on here whether anyone else has experience of these 2 drugs, I have read up a little on the 2 and understand that whilst of the same nature, Pregabalin appears to be an improvement, and it has me nervous as to their motives.

Appreciate any input,

Thanks, Nick


  • dilaurodilauro ConnecticutPosts: 9,875
    I've used both.
    I did not like Lyrica. At first it was ok at 75mg a day, but when my doctor up'd it to 150mg day, my legs,feet and toes started to swell a lot, plus I was always tired. I could fall asleep in the middle of a conversation.

    I switched over to Neurontin (Gabapentin) and have total sucess with it. Started at 400mg a day, peaked about 2800mg a day and now I am using about 1500mg a day, No real negative side effects. I have not notice that I am any more tired than with other medications. It has helped a lot with my nerve pain.

    It does , I believe have something to do with weight gain and short term memory. Though, I think I might just have selective memory as my wife tells me. As far as the weight gain. I did put on about 25 lbs using that over two years. But I really never tried to keep it off. In the past 3 months, I've lost almost 20 lbs just by eating healthy. So, if Neurontin can make weight gain a problem, you just have to be more careful.

    Ron DiLauro Spine-Health System Administrator
    I am not a medical professional. I comment on personal experiences
    You can email me at: rdilauro@veritashealth.com
  • Appreciate your experience of using both. I've been on 75mg Pregabalin to date, although I felt recently an increase was needed as late afternoons the nerve pain began to freshen. The Gabapentin is 3 * 100mg a day, so perhaps this will help even out the relief through the day. I guess I will see how I get on in the coming weeks, the GP nurse did say that if I struggle on it they would consider reverting back as necessary.
  • I have never taken Lyrica but have a compressed disc completely flat and my Physiatrist started me on 400 mg 3x daily and I have been since Feb been taking 800 3 x daily so 2500 a day. They can't seem to take care of the nerve pain from my knee to my ankle but seems to help with the other nerve pain. Hey, no wonder I have had some weight gain did not even know that came with the drug. It's my L5/S1. Since my cervical surgery in June I'm not sure I will have another surgery so for now I will still take it.
  • Well I'm sorry to say that having switched over from Pregabalin to Gabapentin I have been suffering a lot of nerve pain and have found the change in meds very difficult to tolerate. I spoke to my GP's practise after 3 days asking if this was to be expected and need to give it some time, but they just decided to revert back to my original Pregabalin. I am guessing things possibly would have settled down in time, but my GP doesn't seem to be overly concerned with me going back to Pregabalin - just hope it doesn't take more than a day or two to get back to some normality!
  • I had much better outcome in treating my neuropathy with Lyrica than I ever did with gabapentin, and sometimes, one medication works better for us than another. The 100mg dose, is just a starting dose, but the side effects can be a bit intolerable for some of us....usually the dose is somewhere between 600-3600 mg a day for neuropathy treatment, so if the Lyrica is a better fit for you, I am glad that they put you back on it.
  • Thanks Sandi, I don't know if its just psychological but I did feel a little better this morning having restarted on the Lyrica last night, although later morning the nerve pain had begun to return. Prior to the switch I was considering requesting a dosage increase as it felt like the more I pushed in my recovery, the worse the nerve pain later in the day became. I guess I will wait for a few days and if things settle, can consider an increase
  • what dose of Lyrica are you taking? I was taking 600 mg per day, but I know the normal dose for treating neuropathy is around 300 mg per day. It might be that you do need a dose increase, and if you do, I'm sure that your doctor will go along with it.
    I will hope to read that things are much improved for you.
  • I'm on 100 mg, so a really low dose by the sounds of it. Ie been on this same dose from about 1 week post op, so almost 7 months. In the early stages I was also on Tramadol and Paracetemol, so I guess the nerve pain itself was kept at bay. It's only been these last couple of months when I've been trying to get back to work part time that I am finding the nerve pain a problem, particularly after a few hours of activity. I'm going to speak to the GP and hopefully get an increase, thanks for your help :-)
  • Yes, you are on a low dose but if the neuro pain is worsening, it probably is temporary, but can be dealt with with even a slight increase in the Lyrica. Hopefully the neuro pain will subside some, and things will continue to improve. That's what I hope to see happen for you.
  • I'm seeing her today and have been reading. Like said before 2400 mg oh gabapentin since Feb but not taking care of leg pain. Maybe I should ask different today about different drug. I had PCDF on June 25th. 1 more week of rigid collar and the start weaning off. But still need L5/S1 for nerve pain in leg. Since I have been pretty inactive since surgery, can't say that pain has gotten any worse. Also have bakers cyst in same leg so relieved a cortisone shot on Monday. I guess I am just filled with arthritis but with fusion no anti-inflammatory . I wish this compressed disk would just go away instead of facing another surgery. Also was told my surgeon only 80 percent successful. Any feed back on this?
  • I haven't been on for a couple of weeks, and thought I should provide an update in case others are looking at a change of meds and need some perspective. As mentioned earlier, the first attempt to switch me from Pregabalin to Gabapentin failed dismally, and having reverted back I soon began to feel better. However, I visited my GP a couple of weeks ago to suggest an increase in my dosage as the more I progress at work, the more nerve pain results. Sadly my GP explained that she could no longer prescribe me Pregabalin, the NHS in the UK just won't support it as it is so much more expensive, and explained that the NHS policy is to prescribe the most cost effective drugs, not the best / most useful! Having explained my last attempt again, she opted to triple the dosage to 900mg a day and in addition prescribed me with prescription strength Paracetemol and Codein. I've been on the Gabapentin now for a couple of weeks and things have settled down, although now instead of suffering nerve pain late evening as I did with the Pregabalin, I now suffer this 3 times a day seemingly as each dosage begins to fade.

    I will speak to my GP again next week and see if perhaps an increase is needed to extend the period of relief.
  • Can you all describe nerve pain?

    Do you mean buzzing, tingling ,numbness?

    Or are you describing things like sharp shooting traveling down your leg pains?

    Please help me understand

    My surgeon wants me to start Lyrica for nerve pain, but I dont know if my buzzing, tingling ir numbness would be in the nerve pain category

    Help please

  • sandisandi Posts: 6,342
    edited 10/06/2013 - 7:02 AM
    that is nerve pain.........stinging, buzzing, electric zaps, tingling, like water running down your legs, or buttocks, weird sensations, crawlin ants....all of it is common signs of nerve pain.
  • I've been on Gabapentin now for around 2 months, starting this time around on 300mg 3 times a day, which I had increased to 400mg 3 times a day at last months refill. I asked at this months refill if I could again increase, as I am trying to step up my work activities further, and when I went to collect my prescription found they have doubled my dose to 800mg 3 times a day. That feels like a significant jump again, and I am already finding it is causing some side effects, but assume this will settle as I get used to it. Just wondering if anyone else had had such large jumps in dosage over a relatively short period?
  • 300 x3 daily, then 400 x3 then 800 x2. X3. No significant side effects except husband says I'm slower. My nerve pain still bad in leg. Started a round of epidurals. See what happens.
  • grammaof9 said:
    300 x3 daily, then 400 x3 then 800 x2. X3. No significant side effects except husband says I'm slower. My nerve pain still bad in leg. Started a round of epidurals. See what happens.
    Good luck Vicki, hope the epidural so help, don't think I will be permitted by my insurers to look at further options as I have already gone through everything leading up to my 2-level PLIF in February, so just a case of trying to find a level of medication to see me through each day as I continue to increase the load - a very gradual trial and error process
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