31 July 2008
A couple of weeks ago, I read this article in the New Yorker by Atul Gawande (an associated podcast can be found here). The primary case he discusses in the article is that of a woman with chronic & severe itching, but the main thrust is about how much we don't yet understand about how the brain functions and what happens when its sensory mechanisms go haywire.
This is basically what is happening to people such as myself who deal with fibromyalgia pain and restless legs syndrome. The off switches for certain sensory pathways stop working properly, so we feel pain (or a crawling sensation in our legs) when there is no physical reason for that sensation. Sometimes, as in my particular situation, we even have abnormal motor activity, also - meaning that my limbs move involuntarily, thankfully only when I'm asleep. And nobody really knows why that occurs or how to go about repairing that faulty wiring, which is frustrating as all hell.
Fortunately, despite our lack of insight into the mechanisms, there have been some advances made over the last several years in terms of treatment. Unfortunately, the treatments carry their own set of problems. For over a year now, I have been on ropinirole for the restless legs and periodic limb movement (the twitching in my sleep thing). The problem is that eventually the brain gets accustomed to the dose and the problems start recurring, requiring higher doses.
The other problem is that this particular drug attaches to dopamine receptors, which is one of the pathways stimulated (via a slightly different mechanism) by amphetamines. So as the dose gets higher, you run a greater likelihood that the drug, rather than helping, will actually start to ramp up the problem by causing excessive stimulation. Oh, and did I mention the nausea? Yeah, really.
Fortunately for me, I've been on a really low dose, so my recent need to increase the dose isn't likely to run me into too much trouble. Even though the higher dose seems to be managing the restless legs part of the equation, though, I've still not been getting very restful sleep lately, likely because of the fibromyalgia pain. My irregular schedule doesn't really help, either, but for the moment I'm focusing on the things I can change easily, and that's not one of them.
To that end, I sat down with one of the physician's assistants at my local family practice today to get a prescription for gabapentin. This drug has been around for a while now as an anti-epileptic. It's newer cousin, Lyrica, is labeled for treating fibro pain.
Gabapentin won't be labeled for this, since it went generic a few years ago and there's no financial incentive to do the research, but the National Institute of Arthritis, Musculoskeletal and Skin Diseases (NIAMS) published a study last year that found it to be effective for this purpose. It's also been shown to help with restless legs. Since, as a generic, I can get it for a much lower copay than the Lyrica, this is a good thing.
The downside - because of course there had to be one - is that it can cause problems with concentration and it causes physical dependency. Those are probably the top two reasons I've avoided trying it before, but I finally decided that putting up with the pain and the lack of sleep was probably the worse option of the two. Of course, on the label it says that I should be wearing a medical ID bracelet saying I'm taking it, which is not particularly reassuring, strangely enough. I shall, however, soldier on and hope that it does some good.
Oh, and I also somehow managed to bugger up my bad knee while mowing the lawn the other day. Good times, I tell ya.