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Can Gabapentin interfere with physical evaluations for back pain

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Posted 8/11/2016 5:51 PM (GMT 0)
Can Gabapentin interfere with physical evaluations for back pain? I have had constant/recurring back pain for about 1 and a half years. I have been on Gabapentin for about 6 months (300mg 3X daily) recently I tried to come off gabapentin but the pain returns... I go back on it mostly goes away again; now when I am evaluated (neck bending and twisting stuff) it does not aggravate the condition like before. Can the Gabapentin be masking the pain to the point that it interrupts the physical evaluations?

I have been through Chiro, P/T, ESI (X3), and currently still on Gabapentin and Celebrex. I had a VERY active lifestyle before all this...weight lifting, SCUBA, soccer, surfing, hiking... I'm no stranger to pain but this is very different.

MRI below 5 months ago..

TECHNIQUE: Routine cervical spine MRI was performed with the following sequences: 3 plane localizer; sagittal T1 TSE, T2 DRIVE SENSE; axial T1 TSE, T2 TSE CLEAR.
FINDINGS: Motion on the sagittal T2 sequence slightly limits evaluation. Within this limitation, straightening of the usual cervical lordosis is likely due to positioning and/or muscle spasm. Vertebral body heights and alignment are maintained. There is a subcentimeter T1 and T2 hyperintense focus in the C6 vertebral body consistent with an intraosseous hemangioma. The cervical spinal cord is normal in caliber and signal intensity. Prevertebral and paravertebral soft tissues are within normal limits. Imaged portions of the posterior fossa are unremarkable.
C2/3: Normal disc height without disc bulge. The central canal and neuroforamina are patent.
C3/4: Normal disc height with minimal disc bulge resulting in slight effacement of the ventral thecal sac. The central canal and neuroforamina are patent.
C4/5: Mild disc height loss and disc bulge with minimal bilateral uncovertebral joint arthropathy results in effacement of the ventral thecal sac and mild central canal stenosis. There is moderate right and mild left neuroforaminal stenosis.
C5/6: Mild disc height loss and broad-based posterior disc protrusion with minimal left uncovertebral joint arthropathy results in effacement of the ventral thecal sac and mild central canal stenosis. There is moderate left and minimal right neuroforaminal stenosis.
C6/7: Minimal disc height loss and broad-based posterior disc protrusion results in effacement of the ventral thecal sac and minimal central canal stenosis. Minimal right uncovertebral joint arthropathy results in mild right neuroforaminal stenosis. The left neuroforamen is patent.
C7/T1: Normal disc height without disc bulge. The central canal and neuroforamina are patent.
IMPRESSION: Minimal to mild degenerative disc disease and facet arthropathy of the cervical spine as detailed above.
Lumbar MRI;
TECHNIQUE: Routine lumbar spine MRI was performed with the following sequences: 3 plane localizer; sagittal T1 TSE SENSE, T2 DRIVE; axial T1 TSE, T2 TSE SENSE; oblique axial T2 TSE through the lumbosacral junction.
FINDINGS: There is slight dextrocurvature, which may be positional. Vertebral body heights and alignment are maintained. Bone marrow signal is appropriate. The conus medullaris terminates at the level of the T12/L1 intervertebral disc and is normal in configuration and signal intensity. Nerve roots demonstrate a normal distribution within the thecal sac. Tiny right L4 perineural cyst is noted as well as tiny left L5 perineural cyst. Paravertebral soft tissues are within normal limits. Imaged portions of the retroperitoneum are unremarkable.
T12/L1: Normal disc height and hydration signal without disc bulge. The central canal and neuroforamina are patent.
L1/2: Normal disc height and hydration signal without disc bulge. The central canal and neuroforamina are patent.
L2/3: Normal disc height and hydration signal without disc bulge. The central canal and neuroforamina are patent.
L3/4: Disc desiccation with mild disc height loss and mild disc bulge as well as minimal bilateral facet joint arthropathy and ligamentum flavum hypertrophy results in flattening of the ventral thecal sac and mild bilateral neuroforaminal stenosis. The central canal is patent.
L4/5: Disc desiccation and mild disc height loss with disc bulge slightly eccentric to the right with minimal bilateral facet joint arthropathy and ligamentum flavum hypertrophy results in flattening of the ventral thecal sac and mild right lateral recess stenosis as well as mild left and mild-moderate right neuroforaminal stenosis. The central canal is patent.
L5/S1: Normal disc height and hydration signal without disc bulge. The central canal and neuroforamina are patent.
Posted 8/11/2016 8:51 PM (GMT 0)
Dave:
Gabapentine acts as a neuro-modulator . . . meaning that it dampens hyper-excitable sensory nerve endings and "quiets" incoming sensory signals. Incoming sensory signals can be pain signals, as well as the intensity of lights and sounds and the sense of touch. Gabapentein lowers the volume, as in lowering the volume on a radio station.

This is a good thing. If Gabapentine brings you relief from pain in lowering the volume of the pain signals in your neck/back, good.

Gabapentine is in the same class of medications as neurotic, Lyrica, and pregabalin.

It almost sounds in your post that you wanting a "worse" finding on your physical capacity evaluation than you had?

Sensory nerves can be hyper excitable for a variety of reasons. Pain is pain. And the experience of pain can range from annoying and a mild nuisance to excruciating and intolerable.

My personal opinion: If you are able to find a moderating of your pain with gabapentine, take that as a Win. And be grateful that you are finding a measure of relief.
- Karen-
Posted 8/11/2016 9:58 PM (GMT 0)
I'm certainly not looking for a 'worse' finding and Gabapentin does provide relief; however, due to professional concerns I cannot stay on Gabapentin. I just seems that Gabapentin dulls the pain to the point that I can not determine if the underlying causes have remedied and repeatedly going on and off that stuff just to have the pain return is CRAZY. The withdrawals are as debilitating as the pain.
Posted 8/11/2016 10:24 PM (GMT 0)
Dave:
If you have injury to sensory nerves (for whatever reason - physical injury to sensory nerves, diabetic neuropathy, chemotherapy neuropathy, et. al) the class of medications that include gabapentin can be helpful.

The watch word is "can" be helpful. Not in all cases helpful.

The drugs work by lowering the threshold at which the nerves are sensitive or excitable to an incoming stimulus (ex. pain). The drugs dampen the threshold.

Not all injury to nerves are notable by MRI or CT scan. In the majority of cases, nerve injury will not be seen on imaging scan.

Sheering forces, in particular, are damaging to sensory nerves - sheering and friction forces cause dendrites to separate from the body of neurons, a type of decaptitation. Also, sustained pressure to a nerve will cause it to loose function or to become hyper excitable.

Yes . . . you are correct. The withdrawal of coming off of this class of medication can be horrific. Enough to may anyone go back on the medication.

Work with your MD on finding a dose that quells your professional concerns. Does it make you overly sleepy or drowsy?

Try one of the other class of medication to see if you have less side effects. Pre-gabatlin is often an easier medication than gabapentin, per say.

My mother had a knee replacement surgery that left her with damage to the perineal nerve (of the lower leg). My mother is very slender and the surgeon inadvertently used a tourniquet that was too tight for the circumference of her small leg. Grrr. . . knee replacement surgery has almost become a convery belt type of surgery. Anywho . . due to the nerve damage she sustained drop foot/paralysis and extreme nerve hypersensitivity. Without gabapentin, I think she would go insane due to the constant neuropathy. She, too, has tried to discontinue the gabapentin. Like you, the pain in her lower leg rebounds and the withdrawal symptoms are marked. My mother is 84 and has no other health issues. Quite a lady.

All to say . . . work with your neurologist or primary care physician. The side effects of gabapentin (sleepiness, drowsiness, motor slowing) usually disappear as the body fully acclimates to the drug.

I think that you are lucky that you are able to find a measure of pain relief, although I am sorry that you have to have any dysfunction that causes pain.

I am 54 years of age and have stage IV avascular necrosis of both hips (actual dying of bone) due to prolonged use of corticosteroids. It is a living nightmare. I take a strong narcotic "cocktail" which affords me limited relief. I am most active on this site when my pain is at its highest, as I try to find ways to distract myself.

Work with your MD . . . try on of the other medications in the same class as gabapentin to see if you have fewer concerning side effects. Pre-gabaline would be worth a discussion.

It sounds like you have tried a number of alternative approaches.

Nerve pain is difficult pain to ameliorate/lessen. If you are getting some measure of relief from the gabapentin, that is a Win. Gabapentin is lowering the threshold at which your nerves are irritated and send reply information to the brain that registers as pain. Gabapentin is lowering the volume of your nerve pain.

I am sorry, genuinely, that you hurt. Hang around this forum. People here all experience pain, to lesser or greater degree. Your experience will pain will be validated and that, in its own way, can be healing.
- Karen -
Posted 8/12/2016 8:48 PM (GMT 0)
Seashell is right, you need to prioritize your goals. Are you seeking to manage your pain? Or manage your professional concerns? Why can't they be managed concurrently? Your MRI is basically normal,
coveted IMO, at least by me.

If gabapentin works for your pain, what's the problem? Not to minimize your concerns but you are fortunate to have found something that works for you, its a WIN.
Posted 8/18/2016 4:01 AM (GMT 0)
I am assuming you are referring to side effects from Gabapentin when you mention professional concerns. You need to talk to your dr about what is realistic regarding your conditions and no longer needing Gabapentin for the pain.
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