I’m a paralegal at a firm specializing in Workers Compensation. The majority of cases we get are for spinal injuries and psychiatric conditions. Among my duties is interviewing new clients and recording all relevant case info, including any prescription drugs they might be taking. Well, it turns out a good 70 percent of our clients are taking this drug Neurontin. The odd thing is they are all taking it for different reasons; seizures, migraines, nerve damage, vertigo, joint pain, even depression.
So I ask my father the doctor what’s the story with this drug. How can it be prescribed for so many things? He says that it’s prescribed because it’s fairly innocuous and in cases where nothing seems to be helping it can’t hurt to try it. I say it’s a placebo and a cash cow for the pharm industry.
Hmm, the article seems to be about doctors prescribing the drug for unapproved uses, not that Neurotonin is a placebo. Neurotonin works for the uses it is meant for, an Anticonvulsatory drug used for epileptics. The lawsuit is for the unlawful promotion of this drug, getting doctors to prescribe it for ways it was not meant to be prescribed.
Some information from the EBSCOhost database:
The conditions that Neurotonin is approved to treat are what the drug is shown to work at. The a lawsuit in the article is not about the drug not working at all, but for using it in ways that it is not approved by the FDA. Such as headaches.
Neurontin is approved to treat epilepsy and neuralgia. It has also been used to treat depression, but as that article said, this was not FDA approved, and as this article shows, seems to be largely ineffective as a long range plan in studies. http://www.psycheducation.org/depression/meds/neurontin.htm
-Lil
I was being hyperbolic, but I suspected all along that this drug couldn’t possibly be a treatment for so many conditions. Besides, I get the feeling that for many of our clients Neurontin truly is little more than a placebo. Hazy aliments like fibromylgia have no set treatment, and some patients just want to know something is being tried, and I think nerurontin fills that role often.
The great majority of the Neurontin I’ve seen has been used to treat neuropathic pain, particularly diabetic neuropathy. There have been three good clinical trials that I know of (two in JAMA in 1998, one in the Archives of Internal Medicine in 1999) showing it to be effective in this regard. I cannot recall anyone who is on it for seizures alone, though to be fair I see much more diabetes and other neuropathic pain than epilepsy.
That’s not to say that the lawsuit was wrong–the laws are there for a reason. It doesn’t mean that Neurontin is not effective for other syndromes, as the evidence is pretty clear that it is.
I have a friend who takes it in part for his raging manic depression and in part for the chronic pain from his Crohn’s disease. He’s a suicidal mess without it (but this doesn’t necessarily mean the drug really works, it’s very likely the placebo effect).
I take it for neuropathic pain. It works.
My sister took it for headaches. It made them worse.
My sister-in-law took it for neuropathic pain, and it did nothing.
I am highly dubious about its effectiveness for pain (except for placebo effects, of course). As a chronic pain patient, I’ve had doctors try to get me to take a weird assortment of stuff, particularly includinig anti-depressants (which make me bounce off - not the wall, but - the ceiling. The physiatrist (physical medicine, for those who haven’t encountered this specialty before; you get one, following a joint replacement) I had back in Michigan insisted I try several different anti-depressants. When I finally had him convinced that, as a class, they all had bad effects - and besides, I’m in pain, not depressed (or at least, very seldom) - he then induced me to try Neurontin. In four days I had horrendous side effects.
Further, Neurontin has been being prominently mentioned (probably the reason the OP started the thread) in the ongoing investigations about NIH researchers also getting grants and goodies from pharmaceutical companies. The docs who “published” the off-list success stories were putting their names to reports written by the manufacturer. :rolleyes: As a class, I greatly admire doctors. (AAMOF, if my step-mother hadn’t interfered with my going to college out of HS, I might well have become one {and have had many doctors over the years tell me I shoulda been one}). However, there was a period of at least 20 years when many bright individuals with no altruistic passion were admitted to medical schools. Deo gratiae that this seems to be no longer the case. However, there are all too many doctors in practice, in the prime of their years of practice, whose main motivation is the money, not relieving suffering.
However, I do understand the financial pressures a doctor in private practice is under. I don’t think many people realize how high the overhead is, especially with malpractice rates starting around $100K most everywhere, and going ‘north’ at accelerated rates for various specialties and/or dense population areas and/or “high risk” states like Mississippi. Not to mention the cost of office space, or the payroll (including health insurance of course), with practically everybody having to have at least one employee whose sole responsibility is insurance billing. (Credentials: I worked for both insurance companies and agencies in underwriting for about 7 years, then I worked in accounting for about the same period. And I grew up in a family-operated business.)
I know it’s anathema to (what appears to be the overwhelming majority of) US doctors, but I think that a national health insurance plan would be good for everybody in the long run. Then the only people who studied medicine would be those with a desire to heal (IOW, whose gratification is not primarily money, as exemplified by the businessmen in this thread . The money grubber$ could then become entrepreneurs, or something else appropriate.
Cainxinth, you are saying “I suspected all along” as if you were shown to be right; you weren’t. Doctors prescribe medication for off label use all the time, and there is nothing wrong (or illegal) in doing this. As DoctorJ points out, there is evidence that Neurontin is effective for syndromes other then it was approved for.
Why do you feel this way?
Your friend is a suicidal mess withou it and you feel its “very likely” a placebo effect? Why?
Again, why the dubiousness for its use for pain relief? Have you read or heard of evidence to the contrary?
I use it mainly to treat neuropathic pain, particularly diabetic neuropathy. It certainly works better than aspirin, tylenol, and ibuprofen. I suspect it works better than amitriptylene, but I can’t cite any concrete studies about that.
Of course, if I’ve got a patient who’s just been put on it for chronic low back pain of no clear etiology who also states he’s allergic to ibuprofen, toradol, and tricyclics and knows a few lortabs would help him, or maybe some oxycontin; then I know that neurontin will not be diminishing his complaints of pain.
And BTW, I work in the public sector, get paid the same whether I use neurontin or not, and never have drug reps in my office!
QtM, MD
I took Neurontin for almost 3 years to control my migraines, and it generally did a very good job. I had no noticable side effects. It stopped working eventually, but that’s typical for me - once I find a good preventative, after a while it stops being effective or I start to get intolerable side effects due to increased dose.
Most medications that are used to prevent migraine were originally developed for something else. As a matter of fact, I can’t even think of a single drug originally developed for prevention of migraine.
My friend’s dad (recently deceased) was given Neurontin (for about 4 years) for pain caused by spinal stenosis, but they could never really tell if it was working consistently. He also had Parkinson’s.
Perhaps this is striking a bit close to heart (my father has fibromyalgia), but I’m wondering a few things about this comment:
What do you mean by hazy?
Given the pain of fibromyalgia, and the fact that currently (AFAIK) there is not much that can be done treatment-wise that’s been observed to be effective in a substantive number/type/whatever of patients, does it make you wary of seeing Neurontin being used to treat it, or is this more a case of seeing it being used to treat so many different forms of pain and wondering if (as turns out to be the case sometimes) it’s being prescribed in a sort of fix-all manner? I can’t speak for my father, obviously, since I ain’t him, but at this point (and really at any point; knowing yer dad’s gonna pretty much hurt until further notice ain’t fun to know, but he’s the sort who tells me stuff he figures I ought to know. The list of shitty stuff didn’t start with fibromyalgia) there’s a part of me that wants them to try stuff until something works. A little outside the bounds of rationality, certainly, but that’s where the road takes me.
The studies I’ve cited earlier, while not large, showed improvements over placebo with significantly low P-values (that is, the odds that this result is a fluke and there really isn’t a difference are very small). Two of the studies were placebo-controlled; one was a head-to-head against amitriptyline (there’s only one y in that word, and damn if I can ever remember where it goes). The latter found the drugs to be equivalent, and amy…ami…dammit, Elavil has been shown pretty conclusively to be better than placebo. My experience is that when I start pushing the dose of Elavil up to high enough doses to be effective, the side effects become difficult to bear.
To say that it doesn’t work for everyone goes without saying. I have had several patients who got no benefit from it whatsoever, and others who clearly benefited.
I can assure you that I have no financial benefit to prescribe Neurontin. In fact, it is more work for my office, as the drug is expensive and we usually have to jump through a lot of hoops to get it for our (largely indigent) patients.
I’m surprised by that. I figured they’d follow us to the ends of the earth, or even into maximum security. Does the prison forbid it, or do the reps just not consider it worthwhile?
How about this? I would like to see some proposed pathway this drug employs to relieve pain.
I haven’t thought about it in a long while, but given the peculiar nature of my side effects, I wonder just how it is supposed to work. I am fully aware that there is a need for more treatment alternatives for seizures, and I feel great compassion for those who have hard-to-control seizures. I’m a control freak, and the most horrible thing I can imagine is not being in control of my own body. So I’m willing to cut some slack for drugs developed to treat seizures.
I’m not a cynic. However, I think that in claiming it to be useful for as many different problems as, say, aspirin is, the manufacturer has engaged in exploitative behavior by promoting its use for so very many off-label conditions. I’m glad for anybody with an off-label condition which responds (or appears to) to this med, but I have trouble believing it is the drug itself which is causing the improvement in all of those cases.
I am a chronic pain patient. I have been at the same dosage of my pain med for more than five years now.* I spend most of my days at pain levels (after drugs) between 2 and 5 (on a scale of 10). I try very hard not to use breakthrough meds when I can possibly avoid it. I would be delighted if someone came up with a non-addictive drug that actually would reduce my pain levels without impairing mental function.
*TMI warning: I have managed to keep it that way through using annual bilateral radiofrequency treatments for my neck, my low back, and my sacroiliac, plus caudal injections of steroids. (Neck and low back were separately injured; the one in an automobile accident, the other in a slip-and-fall. My SI/pelvic problems are probably related to a patent malformation of the neck of my left femur, which the ortho who did my hip replacement said probably wrecked first my knee, then my hip.) And, just to complicate matters, I have DISH (Diffuse Idiopathic Skeletal Hyperostosis).