I’m having neurological discomfort below my knees and in my feet stemming from lumbar stenosis and spondylolisthesis (say that five time fast), and after two injections failed to help at all, my doctor suggested diclofenac gel, since we both agreed gabapentin was not a good idea.
I’ve been applying it just twice a day for over a week now and am already seeing some benefit from it. It doesn’t relieve the sensations entirely but does diminish them.
I’ve been taking pregabalin for a couple of years now because of pain resulting from two spinal stenoses. Pregabalin and gabapentin are similar drugs. I don’t recall the details but there can be fewer undesirable side effects from pregabalin depending on the condition being treated. I’m also getting spinal steroid injections and actually scheduled for that again tomorrow. It looks like I may need these shots a couple of times a year. The pregabalin helps with a variety of pain sources from extensive arthritis.
Pregabalin (Lyrica) also has a slight addictive potential and is a controlled substance, schedule V (5). I’m glad it’s working for you.
Interesting article on pregabalin misuse and the fact that gabapentin is not a controlled substance per the Feds while pregabalin is.
As a physician who treated a lot of addicts I tended to get the sense that for many of folks inappropriately using pregabalin or gabapentin, it’s often based on the fact that those drugs mitigate opioid, benzo, and stimulant withdrawal. However, many patients who were well past the withdrawal stages still requested the drug, citing its efficacy for them in relieving sleeplessness/pain/anxiety.
As a recovering opioid addict (over 33 years clean) I have been prescribed both gabapentin and pregabalin for significant neuropathic issues and found they both just made me groggy without significant benefit and without euphoria or ‘liking’. Not a data point, just my two cents.
The GABA system is pretty complex and more investigation is needed.
My friend’s husband was prescribed it and had to stop taking it because it gradually zombified him. One of my cats was given it for chronic pain – one dose (the only dose!) and he was shambling.
How on earth would a topical NSAID work better than an oral one? I don’t think anyone has really answered that. The medication is absorbed into the skin, then goes… somewhere, wherever the blood flows. Or maybe it just diffuses through local tissues? (seems like it’d be tough to affect an arthritic joint that way, though).
Would you need to use enough that you’d absorbed something equivalent to what you’d have absorbed by taking it orally? What about systemic effects?
One of the products that acts locally on the nerves - e.g. Icy Hot, or something based on capsaicin - seems to work by interrupting local pain signals, or overwhelming the pain transmission with a counterirritant.
My understanding is that when you apply a drug topically, you create a gradient of the drug in your body, with a higher concentration near where you applied it, and less farther away. With a highly vascularized location, like under the tongue, that gradient is fairly shallow, and the drug is pretty well distributed. But with a less vascularized location, like a leg, there can be a steep enough gradient that you have a higher concentration of the drug in your knee, for instance, than in your liver and kidneys. So in theory, you could get an effective dose in your knee or foot with fewer systemic side effects.
Gabapentin saved my mother’s life. She had trigeminal neuralgia, and that basically cured it. It’s been about 15 years, and it hasn’t come back. She also did not experience any side effects, although she was in a fairly low dose (IIRC 100mg TID - 3 times a day).
My brother, OTOH, was given it when he had shingles, which was precipitated by his daughter being an exchange student in Indonesia and he’d put off getting the vaccine. He found the SEs so unpleasant, he refused to take a second dose.
Nah.
Oh maybe a gradient from the skin into the subcutaneous tissue, but it is not getting into the joint space or the bursa from there. Even to local muscle I highly doubt. There are fibrous sheaths in between.
Again no problem with utilizing harmless placebos but pretty sure it is the act of applying something especially something that causes a local skin sensation that delivers the strong placebo response.
That’s kind what I thought - that there’s almost no way a therapeutic dose could get into the joints.
Wikipedia article on counterirritants:
Counterirritant - Wikipedia
Though I’d quibble with this: “Heat and cold therapy and massage relieve pain by counterstimulation.” - they also have a more direct effect (cold reduces inflammation, heat can improve blood flow and thus, I gather, help healing; massage presumably also improves blood flow).
Quite possibly literally true there , TG is called the suicide disease because of the severity of the pain. 
Well, the stuff never worked for me, and I’m a huge fan of ibuprofen and naproxen. So maybe it’s just a placebo. I dunno.
I’m pretty certain the topical steroid cream i put on itchy skin and the antibiotic cream i shoved into my vagina both delivered clinically effective doses of medication, but those were both treating conditions on the surface of my body, and the drug didn’t have to migrate more than a couple of millimeters to impact the relevant tissues.
I’m not taking anything else with the pregabalin for pain, except for the spinal steroid injections. My doctor was willing to prescribe opioids but thought pregabalin was a better step for the moderate pain levels I have. Since the steroid injections are very effective for the worst pain I’m considering getting off the pregabalin because it does slow me down and I’m too slow already due to other issues. I’ve heard stories about pregabalin helping with sleep but I think the opposite is the case. It certainly doesn’t do much about anxiety for me but I have a terminal case of that.
This is the first time I’ve heard it described as addictive. Withdrawal effects are well known, but I haven’t heard about people craving the medication. As I mention above, I may try to stop using it and I’ll keep an eye out for any cravings.