Thursday, May 11, 2006

Journal: Flunking Lyrica

I checked in with the nice people at the Pain Clinic yesterday. Although I'm taking the maximum dose (600 mg per day), I'd been feeling I was getting much less benefit from the Lyrica than I had initially. This afternoon, I go a call from Steve, a nurse who works with the doc at the Pain Clinic, asking if I wanted to schedule an appointment to come in for an IV infusion of Lidocaine.

The appointment (Steve called it a "trial") lasts four hours. They'll administer small doses of Lidocaine, and will track the effect, if any, that each dose has. The first dose is double blind: neither the patient nor the nurse who administers it knows if it contains Lidocaine or saline. After they're done, they'll send me home (I'll need to arrange for a driver in case I get light-headed) with a pain journal. Based on the pain journal, the doc will decide whether, going forward, I'll need to receive more infusions or whether I should start taking an oral medication called mexilitine, which has an effect identical to that of Lidocaine.

After talking it over with my wife, I made the appointment. The deal is, if I respond to Lidocaine, it might give me only a few hours of benefit, or the effect might last for weeks. Subsequent treatment might be regular infusions (go to the hospital for an hour every week?) or it might mean adding another pill to my daily regimen. I'm thinking to myself, Does it really hurt that bad? What if it interferes with my ability to do my job?

And, most importantly, will it somehow affect our decision whether to buy a shiny new car? We drove a 2006 Civic EX yesterday, and I liked it a lot. It feels like a lot of car for the money: great driving feel, lots of safety features, good gas mileage, pretty nifty to look at, though my wife really disliked the enormous dash created by the big swoopy windshield.

Here's a link to the abstract for the pain doc's study on IV Lidocaine. Snip:
CONCLUSIONS: Lidocaine at 5 mg/kg/h was more effective than placebo at relieving neuropathic pain. The effect started 4 hours after the onset of treatment and continued for at least 4 hours after the end of the infusion. Additional research is needed using higher infusion rates with larger sample sizes to confirm these results and to explore the role of MEGX in the relief of neuropathic pain.

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