Yesterday, I was back at the pain clinic for an appointment with the nurse practitioner who does medication management. It was a follow-up visit I'd scheduled months ago, but the timing ended up being just about perfect. For the last month or so, I'd been feeling more than a little bit unraveled: the pain was starting earlier in the day, it was more intense, it was spreading from my legs to the bottoms of my feet. I was struggling to concentrate at work, and I noticed I was avoiding social contacts, I was avoiding physical activity, I was irritable and depressed. I also started to notice that as I was trying to fall asleep, my legs were playing this odd involuntary soccer match, which I was told was a consequence of the large quantities of Neurontin that I've been taking for the last couple years.
So I was happy to hear the nurse practitioner say that there's a brand-spanking-new drug available to treat neuropathic pain called Lyrica (pregabalin), that they've had good luck with it, and that it has fewer side effects than Neurontin. I was not happy, though, to learn that Navitus, the pharmacy benefit manager for my HMO, would not pay for Lyrica unless and until I've tried 1) Neurontin + imipramine, 2) Neurontin + nortryptaline, and 3) Neurontin + amitryptaline.
Now, I understand the valuable function that pharmacy benefit managers serve in the system in ensuring that the HMO's pharmacy dollars are spent wisely. I understand that if the HMO paid every time somebody wanted the latest-and-greatest drug, maybe a drug that was advertised on TV, instead of trying effective, cheaper alternatives first, my premium would be a lot higher than it is.
I wish I could talk to one of the medical directors at Navitus. I wish I could explain that over the last three or four years, I've been through a succession of drugs to deal with the ever-increasing burning pain in my lower extremities, that I started out with imipramine, tried a handful of different anticonvulsants before settling into a Neurontin habit that has me taking a pill every 2 1/2 hours, on the suggestion of my neurologist, shelled out a few hundred bucks to try acupuncture, started meditating and doing yoga, and I still feel like pain has been a significant factor in the way I've lived my social and professional life. I still feel like most difficult part of living with MS for me is not the end of the physical, active life I used to live, not the indignities of bladder problems or sexual dysfunction, or the looming uncertainty of increasing disability in the future; the most difficult part right now is that every day at about 3:30 in the afternoon, my legs start to burn so badly that I want to chop them off.
So I need to wait. Maybe it will turn out that the neurontin + tricyclic combination is effective and doesn't leave me feeling dopey and sluggish. Maybe, but I'm still mad as hell.
technorati tag: multiple sclerosis