Pain meds and cognitive functioning

[Maria]

edited as necessary

[ans]

I want to know too! I'm on Percocet a lot now and am incredibly stupid and can't complete one thinking task at all.

I wonder if suboxone is less mentally debilitating than methadone - assuming methadone is the culprit.

Important question Maria!

[Maria]

ans,
Buprenorphine (Suboxone Subutex) treatment and opioid addiction resources from The National Alliance of Advocates for Buprenorphine Treatment - NAABT - Home page
interesting stuff.

[Maria]

ans
was going to edit the above to add that I'm not sure it's the Methadone as it's low dose (12.5mg/day) and on one website I read there is no mental fogginess and people work while on this medication (doing what?).

Most people that take Neurontin report this mental cloudiness but I've not really read about persons only taking Methadone (probably ex heroin users vs. pain patients) though my guess is those particular drugs act together to create a bit more mental fog. Perhaps.

From what I'm reading about Suboxone because it's not a full agonist it doesn't have the same effects as Methadone and I'd be interested to know if anyone is taking it and how they feel mentally. Or if anyone is taking that and Neurontin and feel more cognitively alert...

One thing I have read is that if Methadone is working well for one in terms of pain there's no real reason to switch to Suboxone. My PM and I discussed the use of Suboxone to get off Methadone if I have surgery and do well (at some point).

[ans]

Maria: This is fascinating and thanks for your time!

I hope that you find the answers you need. Thanks - ans

[dshobbies]

I switched to Lyrica because of the side effects of Neurontin. I was not taking anything for pain at the time. Lyrica has the same side effects but to a lessor degree which for me, wasn't all that different. Both caused an inability to concentrate. Both took away previous desires and passion (no I'm not talking about sex). Both took away short term memory. Neurontin caused the weirdest dreams. Both handled my nerve pain at the source.

I traded pain for getting back the above. I'm artistic and this release was/is my sanity. I'm happier since giving it up but definitely have more discomfort, sometimes (like now) outright pain. I now have pain pills and muscle relaxers which were unnecessary while on Lyrica but I'm me again. I'm writing and painting again.

There are times when I second guess myself but I can deal with the pain, I can't cope without my artistic release.

So, from my own personal experience, both N & L rob you of mind, those things that make you you. Having said this, age also robs you of you. When these drugs finally left my system, I discovered my short term memory was only slightly better However, depending on the amount of pain you may experience and/or your own personal priorities, this is a personal decision (please discuss your options with your doctor(s).

But as good a job as these drugs do in controlling nerve pain, make no mistake, they take a little or a lot of you with it.

[Maria]

Thank you for your reply and glad you've gotten *you* back. Do you think that you were able to get more of yourself back since you had your surgery with Dr.B so more of your pain was taken away even if there were residual problems or different problems (ie nerve pain)?

I remember before I took Neurontin I couldn't hardly walk a block w/o a terrible burning sensation in a rather unmentionable body part as well as my quads. Now I walk several miles/hours at a clip w/o low back pain but my feet might be killing me...

[dshobbies]

Maria,

Before my surgery I still had my desires even if I pain stopped me. After my surgery I simply didn't want to. My sense of concentration was completely gone. Even when my pain was completely controlled and my abilities mostly restored, I couldn't achieve the concentration level necessary for my work or play. I could walk and swim, play with my grandchildren but it wasn't until these drugs were out of my system, about 3 months after I stopped taking them, that I realized the full magnitude of what they took from me.

Personally speaking, I used to concentrate so hard I'd forget to breathe. It's the same level where you purse your lips or stick out your tongue. It's involuntary. Creative thinking is necessary for my pursuits but that was the trade off in choosing no pain. Don't get me wrong, I hate the pain but everyone has something that they love doing. My surgery gave me back the ability to sit, pain free, for the hours needed to paint. Neurontin and Lyrica took away my desire and the ability to concentrate.

I'm not minimizing the life my surgery gave back to me. Though still fearful that I won't be able to endure this or that, so far I've encountered few problems. I see friends, eat dinner with my family, walk my dog, play with my 'babies' but for me, I wanted to do those things for which I had a passion. By nature I'm a passionate and imaginative person. That is what N&L took from me. If your passion is more physical then you shouldn't have difficulties with either drug.

Yes, Dr. B gave me back a life. Not taking N&L gave me back MY life. Hope this answers your question????

Dale

[nopain]

Consider for a moment that no one has a biological Drug Deficiency.

Now take the pills or capsules you are currently consuming. Lay them on the counter in your kitchen. Now put next to them the equivalent amount of ordinary table salt.

Next envision a full years supply - multiply that pile of table salt by 365.

That's what you are dumping on your Brain each year. And it doesn't just hit the brain, it goes to everywhere in your body blood travels.

The brain receives an effect from those drugs for a limited time - a few hours ordinarily. Then it has to do something with all that foreign matter. It has to get rid of it.

Your primary organs of detoxification are the liver, the kidneys and the skin. It's all got to go somewhere, so you can put it all back inside yourself again.

How could you expect this process to NOT have an effect on the Brain?

Neurontin is a very scary drug. I have taken it. I have also read numerous clinical trials. 7% is the most common number reported of those with Adverse Effects so severe they had to withdraw from the study.

And the Effects spread a broad spectrum of problems in all areas of the body.

Neurontin/Gabapentin is only officially approved for 2 conditions (Partial Seizures 1994 and Postherpetic Neuralgia 2002) by the FDA, but is aggressively prescribed for a whole host of problems.

Pfizer told it's sales force to push the drug to Doctors as a treatment for a number of conditions it was never intended to treat. The outcome was large fines, but to this day it is still promoted heavily for "off label" treatments.

The story broke in 2004 and was known as the "Neurontin Scandal" to some... I'm posting below a reprint of the outcome.

------------------------- Neurontin Scandal ---------------------


Huge penalty in drug fraud
Pfizer settles felony case in Neurontin off-label promotion


A division of Pfizer Inc., the world's largest drugmaker, has agreed to plead guilty to two felonies and pay $430 million in penalties to settle charges that it fraudulently promoted the drug Neurontin for a string of unapproved uses.

In an agreement announced by government prosecutors Thursday, Pfizer unit Warner-Lambert admitted that it aggressively marketed the epilepsy drug by illicit means for unrelated conditions including bipolar disorder, pain, migraine headaches, and drug and alcohol withdrawal.

A company whistle-blower, whose 1996 civil suit spurred government investigations of Neurontin's marketing campaign, will receive about $26.6 million through the settlement under legal provisions that reward citizens for helping to recover government money obtained by fraud.

The settlement includes $152 million to pay back amounts spent on Neurontin by the federal Medicare program and 50 state Medicaid programs for the poor. In addition, Pfizer will pay a $240 million criminal fine, the second-largest such fine ever imposed in a health care fraud prosecution, the Department of Justice said.

Prosecutors said Warner-Lambert turned Neurontin into a blockbuster drug with tactics like paying doctors to listen to pitches for unapproved uses and treating them to luxury trips to Hawaii, Florida or the 1996 Olympics in Atlanta. One doctor received almost $308,000 to tout Neurontin at conferences.

"This illegal and fraudulent promotion scheme corrupted the information process relied on by doctors in their medical decision making, thereby putting patients at risk,'' said U.S. Attorney Michael Sullivan, chief prosecutor for the federal district based in Boston.

Doctors are free to prescribe drugs for uses not specified on their FDA- approved labels, but the FDA forbids drug companies from promoting them for those off-label uses. Prosecutors said Neurontin's manufacturers decided not to seek an expanded FDA label for the drug, an expensive process requiring solid proof from clinical trials. Instead, the company boosted sales through aggressive promotional strategies, even when scientific studies had demonstrated that it was not effective, the Justice Department said.

The tactics included planting company operatives in the audience at medical education events to contradict unfavorable comments about Neurontin, and paying doctors to allow sales representatives to sit in on patient visits, prosecutors said.

Such methods were first revealed by the whistle-blower, David Franklin, a former medical liaison for Warner-Lambert who filed suit on behalf of the government. By some estimates, as much as 90 percent of Neurontin prescriptions were for off-label uses during the marketing campaign that prosecutors said dates back to about 1995. Neurontin's sales soared from $97.5 million in 1995 to nearly $2.7 billion in 2003.

In a written statement, Pfizer said the illegal practices took place before Pfizer acquired Warner-Lambert in 2000.

"Pfizer has cooperated fully with the government to resolve this matter, which did not involve Pfizer practice and employees,'' the company said. "Pfizer is committed to compliance with all health care laws and FDA requirements and to high ethical standards.''

Under the settlement with prosecutors, Pfizer agreed to bolster its corporate compliance program with measures to detect and prevent off-label marketing. The agreement also requires the firm to pay $38 million in civil penalties for harm caused to consumers in the 50 states and the District of Columbia. Part of that amount will fund an education campaign to dispel false information about Neurontin.

The settlement does not cover damages for any patients who may have been sickened by Neurontin, said Tom Dresslar, a spokesman for California Attorney General Bill Lockyer. Those patients can file personal-injury suits, he said.

Lockyer said California's share of the settlement will total about $15 million, of which $7.5 million will be used to reimburse the state Medi-Cal program for unnecessary Neurontin prescriptions. But California must return more than $7 million to the federal government, which covers about half the cost of state Medicaid programs.

Dresslar said Lockyer's office will continue to scrutinize drug marketing for evidence of off-label promotion. "We're not going to let drug companies profit by essentially making guinea pigs out of poor, elderly and other patients, or by defrauding taxpayers,'' he said.

The Pfizer settlement comes as government scrutiny of off-label promotion is widening and as public health insurance programs as well as private medical plans look for ways to deal with the rising cost of prescription drugs.

Pfizer faces a separate civil suit in California to recover amounts paid for off-label Neurontin by individual patients and private health plans. It also faces government investigations of the marketing of additional drugs it obtained when it bought other drug companies.

Pfizer disclosed two months ago in a regulatory filing that the Justice Department is scrutinizing the marketing of the Genotropin growth hormone and Bextra painkiller, two drugs the company added to its portfolio when it bought Pharmacia Corp. last year. Pfizer and a dozen other drug companies are also accused in a lawsuit by Pennsylvania Attorney General Jerry Pappert of inflating drug prices with marketing costs.

Pfizer also disclosed in March that a federal grand jury in Maryland has sought testimony from former Warner-Lambert employees about the diabetes drug Rezulin, which was pulled off the U.S. market in March 2000 after it was linked to at least 63 liver-related deaths.

[Maria]

Thank you Dale and NoPain for your replies.
If I can think much more clearly it would be delightful and yet, I think while I'm not all there at times, I'm definately relieved of pain much of the time which has to help with at least thinking more positively if not completely clearly. It's definately a trade off as we have mentioned previously and as individuals we have to deal with what works best for our situation.