Following my appointment with Mr Sepahi on Monday, I rang the GP surgery to get an appointment to discuss the proposed change of meds. However, last night and again this morning I had an increase in pain again, so I rang the practice to get seen today. Following the triage call I was booked in with duty doctor.
I explained my situation and she read back through my recent notes and a copy of the MRI report I had on my phone. She then reviewed each of my medication in turn. She was surprised that Mr Sepahi had only recommended I start on 100mg gabapentin, as the usual starting dose is 300mg, rising to 900mg on day 3. Having checked a few things she decided to stick with the prescribing recommendation rather than Mr Sepahi. I might’ve misheard him, but I’m sure he said 100mg and cut my amitriptyline down to 25mg, which I am now doing for the first week of taking gabapentin, before stopping the amitriptyline completely. The doctor’s view is that, if my pain is increasing and preventing me from doing my exercises, I should increase the amount of tramadol again. I’m reluctant due to the long term effects, and the fact my body will become used to it and I’ll potentially have to increase the dose again to get the same benefit. I need something though so she gave me a plan to take 50mg of the sustained release morning and evening, but if I know the day before was particularly active and I might suffer in the 24 hours after such a day, take an extra 50mg in the morning dose. I then still have the normal tablets as a further top up during the day if I need it.
I mentioned that Mr Sepahi had recommended reducing the amount of ibuprofen due to the risk of stomach ulcers etc, but that his advice contradicted what Dr Godwin had given a couple of months back. The doctor agreed with Dr Godwin, pointing out that as an anti-inflammatory, it performs a different role to the tramadol. She also feels it is better to take ibuprofen and less tramadol, particularly given that I also take omeprazolday to counteract the effects of ibuprofen on the stomach lining.
I’m starting the gabapentin this evening so it will be interesting to see how that changes my nerve discomfort.