You may have become aware that common neuropathic (nerve-related) pain killers, Gabapentin and Pregabalin, have been scheduled to become controlled drugs. This article explores why…
Aims of this post:
- To talk about gabapentin and pregabalin
- To discuss why and how they are prescribed
- To discuss how why they are going to become controlled
- To talk about what this means for you!
What are Gabapentin and Pregabalin?
Gabapentin and Pregabalin are drugs that are mainly used to treat epilepsy and anxiety, but are also used off-label to treat nerve pain.
They both fall into a family of drugs called gabapentinoids, and are very similar in composition. You might know Gabapentin as “Neurontin” and Pregabalin as “Lyrica” which are their common brand names.
Pregabalin and Gabapentin are different in the ways that they are absorbed and used by the body. Gabapentin is absorbed more slowly than Pregabalin, with the peak plasma concentration of Gabapentin occurring in the bloodstream within 3 hours.
Pregabalin is absorbed quicker, and has a peak plasma concentration time of 1 hour.
The levels of absorption of Pregabalin are also much higher – up to 90% – while the levels of absorption of Gabapentin are as low as 27% in high doses.
Often, Gabapentin or Pregabalin are prescribed after an initial prescription of Amitryptiline fails to control a patient’s symptoms.
Why did I receive one and not the other?
From my experience, this comes down largely to cost. Pregabalin is extremely expensive compared to Gabapentin. The company Lyrica owns the rights to the compound Pregabalin, which means they can effectively charge whatever they want for it.
How do these drugs work to reduce pain from sciatica?
As Pregabalin and Gabapentin have been approved by the FDA in the treatment of neuropathic pain caused by shingles, diabetes and fibromyalgia, the medical profession assumes that the drugs will have the same nerve-calming effects on the source of the pain in sciatica – the sciatic nerve.
However, a study has recently shown that this largely isn’t the case. In 2017, Mathieson and colleagues trialed Pregabalin as a pain-killer for sciatica vs a placebo in 209 patients. The trial ran for a year and at the end, there were no significant positive effects of the medication over the placebo. However, the authors did note that some of the patients taking the Pregabalin had in fact suffered from significant side effects, including dizziness.
To see a list of natural supplements that can help with pain relief in sciatica, click HERE!
Why have the drugs been placed on the controlled list?
Unfortunately, there has recently been an increasing number of deaths in the UK related to Gabapentin and Pregabalin, usually as a result of abusing the drug. The official figures showed 111 deaths related to Pregabalin in 2016 and 59 related to Gabapentin, compared with 4 and 8 respectively in 2012.
These drugs have even been touted as being “the new valium” by some medical professionals.
The Advisory Council on the Misuse of Drugs stated: “pregabalin and gabapentin present a risk of addiction and a potential for illegal diversion and medicinal misuse”.
One of the reasons these drugs are abused is because they cause psychotropic effects – meaning they have the potential to cause a “high” when taken at high doses.
They may also have quite a nasty withdrawal effect – something I have heard a lot about anecdotally from my patients.
With this in mind, the drugs have been given a status as “Controlled Substance C Category”. It is worth bearing in mind that other common pain killers, like codeine as found in prescription strength pain killers like Zapain, are also commonly controlled.
What does this mean for me?
It means that it may be tougher now to get a prescription for Gabapentin and Pregabalin.
However, if you find that either of these drugs significantly decreases your pain, you should still make your GP aware of the fact they are helping.
A lot of the incidences of death and harm caused by abuse of these drugs are as a result of a “cocktail” of substances, so the risks haven’t changed per se since you were initially given a prescription for these drugs.
What are the alternatives?
I think that when there are big movements in the world of pharmacy and drug-control, it highlights the need for us to have other methods of controlling our pain without relying on pain killers.
In many trials, exercise has been shown to be as effective if not greater than drugs for the control of pain.
The key is obviously choosing the RIGHT exercise, the RIGHT amount and making it fit with YOUR life.
I am a big advocate for seeking out natural, healthy alternatives to prescription pain killers.
One way of doing this is to make changes to your diet and lifestyle.
See this article HERE for a healthy anti-inflammatory smoothie idea.
Alternatively, see HERE for a complete guide on what foods to include as part of an anti-inflammatory diet.
It is undoubtedly important to understand the risk of any drugs that you have been prescribed. It is equally important to seek out alternatives to prescription pain killers where possible. Try some of my suggestions above and see if they work for you.
Essentially, try not to worry if you are taking Gabapentin or Pregabalin and are seeing positive effects. I feel these drugs will still be prescribed for pain relief for those who they are truly working for.
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