I have neuropathy in my right leg, was recently taken off gabapentin (neurontin) without taper, and am experiencing discomfort and bruising due to a thin mattress, what are my treatment options?

Treatment Options for Neuropathy After Abrupt Gabapentin Discontinuation in a Correctional Setting

You should immediately restart gabapentin or an alternative first-line neuropathic pain medication, as abrupt discontinuation without tapering is inappropriate and leaves your neuropathy untreated. 1

Immediate Medication Management

Restarting Gabapentin (Preferred Option)

• Gabapentin remains a first-line treatment for neuropathic pain and should be restarted at 300 mg three times daily, with titration up to 1800-3600 mg/day as tolerated 1, 2
• Effective doses typically range from 1800-3600 mg/day, with approximately 3-4 out of 10 patients achieving at least 50% pain relief 2, 3
• The medication requires 6-8 weeks for adequate trial, including 2 weeks at maximum tolerated dose 1
• Abrupt discontinuation was medically inappropriate; gabapentin should be tapered when stopping to avoid withdrawal symptoms 1

Alternative First-Line Medications (If Gabapentin Cannot Be Restarted)

If gabapentin is unavailable or contraindicated, the following are equally valid first-line options:

• Pregabalin: Start 50 mg three times daily or 75 mg twice daily, increase to 300 mg/day after 3-7 days, then titrate up to 600 mg/day as needed 1
• Duloxetine: Start 30 mg once daily for 1 week, then increase to 60 mg once daily (maximum 60 mg twice daily) 1
• Nortriptyline or desipramine (secondary-amine tricyclic antidepressants): Start 25 mg at bedtime, increase by 25 mg every 3-7 days as tolerated, up to 150 mg/day 1

Addressing the Mattress-Related Discomfort

The thin mattress causing bruising and sleep disruption is a separate but important issue that requires administrative intervention:

• Request a medical accommodation for a thicker therapeutic mattress through the correctional facility's medical department 1
• Document the bruising and sleep impairment as they worsen your overall pain condition and quality of life 1
• Poor sleep quality can significantly worsen neuropathic pain perception and should be addressed as part of comprehensive pain management 1

Combination Therapy Consideration

If monotherapy with first-line agents provides inadequate relief (less than 30% pain reduction), combination therapy should be considered:

• Gabapentin combined with low-dose morphine shows enhanced effectiveness compared to either agent alone, allowing lower doses of each medication 4
• This approach is particularly relevant in settings where opioid use must be minimized 1

Critical Pitfalls to Avoid

• Never abruptly discontinue gabapentin without proper tapering over several weeks 1
• Doses below 1800 mg/day of gabapentin are often subtherapeutic; inadequate dosing is a common reason for treatment failure 3
• Gabapentin requires dose adjustment in renal insufficiency 1
• Allow adequate trial duration (4-8 weeks at therapeutic doses) before declaring treatment failure 1, 2

Expected Outcomes

• With gabapentin at 1800-3600 mg/day, approximately 32-38% of patients achieve substantial benefit (at least 50% pain relief) compared to 17-21% with placebo 2
• Common side effects include dizziness (19%), somnolence (14%), and peripheral edema (7%), which typically subside within 10 days 2, 3
• Most patients who respond show improvement within the first few weeks of reaching therapeutic doses 3