I'm new to the forum. My dog Ilsa was officially diagnosed with SM yesterday by MRI
She is not in much pain and only has an episode about once a week. She was prescribed neurontin 50 mg twice a day.
Needless to say I am very upset, but I am also very concerned about side effects of the drug
Anybody have problems with it, would love to hear your experiences
Jennifer and Ilsa
Hi and sorry to hear you have had this diagnosis. :flwr:
What do you mean by 'episode'? Pain episodes? Just to give some context, a once a week episode would not be severe, but would definitely be significant as far as pain goes. You can download the pain scoring sheet that some neurologists are using here:
And you'll see that a once a week pain episode would be a medium, not a low score, a 2 on a scale from 0-4 (assuming there aren't other signs as well).
Gabapentin is widely used and one of the more effective painkillers for SM pain with very few side effects (sleepiness generally, and you do need to test liver function annually -- see the treatment diagram noted below) but tolerance does tend to build up, and dosage tends to need to be increased over time and can eventually stop working (as the condition is generally progressive).
There's a lot of information on the treatment options on my site here:
where you can also download the latest treatment diagram from Dr Clare Rusbridge (just revised). 50mg 2x is a quite low dosage so if you are not seeing improvement go back to your vet or neurologist. For context, I have a small cavalier, only about 6kg, on 100 mg 3x plus omeprazole 2x and he has never had obvious pain episodes -- he scratches, and about once a month or so may show some tenderness if touched but that is rare (if he misses his medication, this doesn't worsen, he scratches a bit more). Also many neurologists will also use a CSF inhibitor (like omeprazole) alongside a painkiller. The diagram outlines all these options.
Thank you for your reply
She has about weekly (or slightly less) and twice daily scratching episodes.
What I am primarily concerned about is the loss of her quality of life.
She is a happy, active dog who loves people, playing and going to the park. I would hate to watch a drug make her lethargic and unhappy, and that terrifies me most of all.
Have you found this to be the case?
Well, the issue is really to relieve her pain and discomfort, as that is really the bigger picture for quality of life. The SM is likely to compromise her far more than the drugs that help relieve pain.
Unfortunately there is no cure for this condition and are only a limited range of drugs and surgeries that help relieve the pain and in some cases might control progression. If you feel the neurontin is compromising her life then you can try the range of other drugs -- but the NSAIDS have far more likely side affects than neurontin, and not giving anything is cruel -- it would be leaving a dog to live with considerable pain that can at least be controlled to some degree at least for a while (it is very hard to say what may happen for any given dog, as some mild cases seem to never progress or progress very little, while others can progress quickly. Also there's plenty of evidence that the dogs simply gradually adjust to living with greater levels of pain, just as people do, without necessarily showing this outwardly, so that has to be considered when giving pain medications. In humans, severe headache is one of the hallmarks of SM but it is hard for a dog to express that it has a severe headache).
Many of us with SM dogs find their initial dosage of any painkiller either isn't adequate or will only be adequate for a period of time and you will need to go to 3x or a higher dosage 2x or 3x -- that is the general pattern. It took about a year for my dog to need to move from 50mg to 100mg with neurontin. That was fine 2x for about a year then he went to 3x. At the moment he would do better on around 150mg 2x or 3x I think, but am trying omeprazole to see if that picks up the slack before raising the dosage again.
Any adjustment to painkillers and dosages should always be done with your vet or neurologist advising of course. :thmbsup:
Thank you again
I hadn't thought that she could be in constant pain as she is so healthy and active, just as i never considered how uncomfortable the scratching may be. I only thought of the pain when she had an episode.
I also heard back from the pharmacist who assured me I could discontinue at any time with no permanent damage if the effects were crippling. She did advise that I give her 10 days to adjust first.
I just gave her her first pill, and cried while i did it. I'll give her one in the morning and hope that she'll have her usual long walk, and maybe even feel better then usual.
I am grateful for your advice and hope all of all dogs feel better soon.
I'll keep you informed
I'm not saying she is in constant pain at all, but this is generally a serious condition by the time it is symptomatic, and chronic pain is generally a part of it; animals are very good at hiding pain as well. Most neurologists I've spoken to believe the dogs experience more pain than we outwardly see (like people with neuropathic pain), as much of the pain is of a type that would have no outward expression until it gets quite uncomfortable. Many neurologists believe scratching is itself a sign of discomfort and sometimes, pain. I've got some information about what humans with SM experience here. That might be helpful for better understanding the condition -- I have found the human sites to be very informative and insightful.
Keep in mind your dog was having enough pain to be sent for an MRI, and she needs pain relief; so don't feel bad for providing what must be a comfort to your dog. Gabapentin has hardly any side effects for most people or seemingly for dogs either -- grogginess is the worst, when the dose is too high -- so really, I would not be worried giving it. That's an extremely low dose -- it is the lowest level they begin with. I've had a dog on neurontin for three years with no issues, ever. I don't know of anyone with a dog that has had problems with gabapentin.
Thanks again for all your help!!!
I read such terrible things about this drug online that I panicked but she seems to be doing fine so far!!!
As happy and active as normal!
She's also seeing an acupuncturist on tuesday.
I feel so much better having found this group.
My Mum's dog Rex has been on Gabapentin for two years on a higher dose. He sleeps quite a lot but he is 11 now! He also still loves to go for a walk and I suspect his slowing down is due to other consequences of old age as much as the drug.
I hope your dog stays well and happy.