Study finds patients may be taking pregabalin at lower levels than possible to reduce neuropathic pain.

Doctors often prescribe pregabalin, also sold as Lyrica, to help their patients with diabetic neuropathy, to get relief from pain.

A team of researchers found, “Higher doses of pregabalin have been shown to be more effective in improving pain outcomes but, in practice, failing to appropriately increase the dose can leave patients under-treated.”

One source lists the currently recommended dosage levels as, “50 mg three times a day (150 mg/day). The dose may be increased to a maximum dose of 100 mg 3 times daily (300 mg/day) after one week.”

In this study, the doctors used levels up to twice that amount, “150 mg/day only; 150 to 300 mg/day; 150 to 300 to 450 mg/day; 150 to 300 to 450 to 600 mg/day; 150 to 300 to 600 mg/day; 300 to 600 mg/day.”

When the dosages were compared to the amount of pain relief from each amount, everything else being equal, the graph below illustrates the clear-cut benefits of the higher doses.

pregabalin dosageImage and text below courtesy of Dove Medical Press Limited 

“Estimated change in pain score from baseline by marginal structural model showing that increasing doses of pregabalin result in a greater reduction in pain score.”

The evidence above contradicts the generally held consensus amounts seen elsewhere.

“Although LYRICA was also studied at 600 mg/day, there is no evidence that this dose confers additional significant benefit and this dose was less well tolerated. In view of the dose-dependent adverse reactions, treatment with doses above 300 mg/day is not recommended.”

For people taking, or thinking of asking about pregabalin, consult with possibly several professionally licensed physician regarding the maximum amount that can be safely tolerated without severe adverse effects.

This latest study concludes,

“Many patients who do not respond to lower doses of pregabalin will respond with notable improvements in pain outcomes when the dose is escalated.”

“These data should encourage physicians treating patients with neuropathic pain to escalate pregabalin to the dose that delivers optimal analgesia and tolerable side effects.”

Each case presents its own challenges since patients often take numerous other medications, including supplements, which could create dangerous interactions when combined with Lyrica.

Your physician has the final say on the safest dosage after he or she weighs all the possible outcomes of risk versus reward.

Relief from neuropathic pain with phenytoin cream according to new study

phenytoin cream in jar

Phenytoin provided temporary relief from neuropathic pain reports a recent study in the Journal of Pain Research.

The doctors, Jan M. Keppel Hesselink and David Kopsky, from the Institute for Neuropathic Pain in Amsterdam, summarized their findings on the benefits of a 10% topical cream with phenytoin as the active ingredient as follows.

“We, therefore, developed a new topical cream based on 5% and 10% phenytoin and described three successfully treated patients suffering from neuropathic pain.”

“All patients were refractory[resistant] to a number of other analgesics.”

“In all patients, phenytoin cream was effective in reducing pain completely, without any side effects, and the tolerability was excellent.”

“The onset of action of the phenytoin creams was within 30 minutes.”

Looking further into the details of the study, the subjects applied the cream on their body several times a day in a maintenance program.

Case #1:  diabetic neuropathic pain

“The pain reduction appeared within 5 minutes after application and was maintained for at least 12 hours. The patient applied the phenytoin 10% cream two times daily during a period of 3 months.”

Case #2: chemotherapy-induced polyneuropathy

“The patient applied the cream three times daily during a period of 2 months.”

Case #3: chemotherapy-induced polyneuropathy

“The patient applied the cream two times daily during 1 month.”

The pain from the neuropathic conditions returned  once the daily applications ended. However the cream provided temporary relief for the patients cited above.

Another paper titled, Dilantin (Phenytoin) for Pain Management in Multiple Sclerosis, reviewed the traditional use of phenytoin for MS patients living in a state of constant pain.

“Dilantin (phenytoin) is a hydantoin anticonvulsant that is commonly used for the management of epileptic seizures.”

“In MS patients, it is used for pain management to reduce painful sensations caused by demyelination in the sensory pathways in the brain and spinal cord.”

However the topical cream avoids the many harmful side effects which present themselves when the drug travels throughout the entire body.

Common Dilantin side effects include nausea, vomiting, constipation, tremors, slurred speech, loss of balance or coordination, rash, headache, confusion, dizziness, nervousness and/or sleep disorders.

Phenytoin isn’t sold over-the-counter, and must be prescribed by a licensed doctor. For more on the benefits of applying phenytoin as a topical cream, read the article Topical Pain Creams for Management of Acute, Chronic, and Neuropathic Pain, which describes its advantages and the challenges of overcoming pain from neurological conditions.

“Neuropathic pain is an extremely difficult type of pain to manage. The symptoms experienced by the patient with neuropathic pain differ from those experienced by patients with acute pain. Neuropathic pain usually fails to respond to standard analgesic interventions. Opioids may provide a degree of relief, but only at doses impractical for what may become lifelong therapy. People with neuropathic pain can experience anything from mild discomfort to excruciating torture.”

Thoughts on problems children with neuropathy face in school and everyday life.

kids neuromuscular test

Although neuropathy, or nerve damage, is often associated with diabetes, it can strike a person at any age.

 wrote an article, 9 Things Parents of Kids With Neuromuscular Diseases Wish Teachers Understood, about how best to cope when kids have neurological issues as they enter or return to school. She writes,

“As we start a new school year, The Mighty teamed up with the Muscular Dystrophy Association to raise awareness about neuromuscular diseases and the challenges students and their families face when teachers and school staff do not understand their condition. We asked parents in our communities what they wish their children’s teachers understood about neuromuscular diseases this school year.”

Among the nine points she cited, some were,

  • Neuromuscular disease can affect how you concentrate because you are so tired.
  • My daughter wants nothing more than to blend in. See her, not just her wheelchair.
  • It’s not contagious. People [with neuromuscular diseases] are just like everyone else.

Read her insightful article, in its entirety, in the link above.

Another type of neuromuscular affliction to strike youngsters is Charcot-Marie-Tooth disease, which is a hereditary sensory and motor neuropathy. The video below shows some of its early signs, such as:

  • clumsiness
  • slight difficulty in walking because of trouble picking up the feet
  • weak leg muscles
  • fatigue