DrJEDtalks: Nerve pain Treatment, Lyrica.

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In a previous video, we talked about the various causes

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of neuropathic pain.

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That is nerve pain. Here we’ll focus primarily on

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the medical treatments.

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So to review, in general, causes

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of nerve pain may be from the neural entrapments,

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the pinched nerve in the, the neck, the low back,

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or other places in the body versus the neuropathies,

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peripheral neuropathy, diabetic peripheral neuropathy.

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So what do we do about this?

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Well, the treatment of nerve pain can be very difficult.

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Nerve pain can be very resistant to standard medications

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to treat pain such as ibuprofen,

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Tylenol doesn’t really seem to do much.

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Even the narcotic pain medicines don’t treat

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nerve pain very well.

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So what are the standard treatments for nerve pain?

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Lyrica slash pregabalin, I term it oftentimes

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as gabapentin, new

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and improved cousin is supposed to be cleaner,

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have fewer side effects, maybe work better,

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and that’s not always the case.

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I have had some patients that had titrated up, Lyrica,

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wasn’t working for them, went back to gabapentin,

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and gabapentin seemed to be the better medicine.

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However, in general, it seems

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that Lyrica is a little cleaner.

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Fewer side effects works a little bit better.

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So the dosing on Lyrica is very different.

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Uh, the max daily dose for Lyrica is 600 milligrams per day.

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Uh, oftentimes if a person has not had Lyrica yet,

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I’ll begin maybe the 25 milligrams three times a day.

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Uh, maybe at the 50 milligrams three times a day.

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So once again, you titrate this up to effect. Okay?

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So you might take that, uh,

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50 milligrams once in the morning and once in the evening.

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And maybe for those first few days, if you take,

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if you took it all three times,

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maybe you’re very sleepy in the afternoon.

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So perhaps it works best for you

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to take 50 milligrams in the morning

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and then 100 milligrams at bedtime.

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So you can get a good night’s sleep,

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whatever the case may be, 50 milligrams three times a

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day, that’s reasonable.

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Say for example, you’re taking that dose,

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it’s helping a little bit, but not enough.

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You come back to your doctor,

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you have the talk, you can increase.

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Maybe you just go to 75 milligrams three times a day.

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Maybe you go to 100 milligrams three times a day.

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There’s no particular magic.

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There’s a discussion with your physician

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and then you advance as appropriate, uh,

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as a team working together.

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Okay? Eventually you might get get up as high as

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100 milligrams three times a day,

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150 milligrams three times a day.

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That used to be the max dose

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of Lyrica is 450 milligrams, uh, per day.

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These days, the max daily dose for Lyrica is 600 milligrams.

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So you might take 200 milligrams three times a day.

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I do have a couple patients

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that take 300 milligrams twice a day, sticking within that,

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uh, cap of 600

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Milligrams of Lyrica for the day.

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So that’s a quick review of the medication dosing

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and the medication use to treat neuropathic pain.

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Now there are many other specific treatments

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for neuropathic pain,

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however, those are very specific to very

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specific pathologies.

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If you have neuropathic pain, you begin with gabapentin,

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Lyrica, Cymbalta.

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If you continue to have neuropathic pain, you speak

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with your physician and see if there are other options

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that you can treat your neuropathic pain

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to help you live your life, less pain,

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improve your function, improve your mood,

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just improve your quality of life.

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So hopefully you find this helpful.

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Once again, continue to take care of yourselves and be well.