It's amazing how so many people are still given Gabapentin for neuropathic pain instead of Pregabalin. I needed huge amounts of Gabapentin to treat my neuralgia in my foot, I was taking 3000mg x 3 / day and even though I have the best insurance you can get (in my country), they would only pay for 800mg total / day because they had never heard of a higher amount. I ended up paying about equiv of $800 / month out of my own pocket.
It only even became effective after 1800mg x 3 but that was only just enough to keep me screaming out in pain when my foot brace was removed or put on. When I switched to Pregabalin, the difference was amazing, I only need 150 x 2 / day but I try get my doc to Rx me 3x daily especially since it's winter here and that increases the pain in all my plates and pins so I like to have a bit extra every now and then.
I'm also amazed to see people Rxed opiates for neuropathic pain, opiates didn't touch my pain, only neuropathic drugs worked (Elavil, Neurontin, Lyrica), even IV morphine didn't really make a difference to the neuralgia when I went into hospital for operations before it was treated with . Maybe some people are different??? I didn't know that opiates helped, with the exception of Methadone and maybe some other more exotic opiates.
I'm also scripted durogesic patches (25ug/hr) because I've had 3 botched operations on my arm and after the latest one (no 4), I shifted a screw and it was extremely painful. Although it treats my pain quite well I'm going to ask my PM doc to change it to something else, after about 48 hours of wearing the patch I start to go into minor w/d. By the 3rd day when I replace it I'm already experiencing minor muscle cramps, extreme anxiety, cold sweats and an upset stomach. The first time it happened I thought I had food poisoning or flu. After a pattern emerged, I worked out it was the patches. So I've been through minor w/ds practically 10x in the past month.
Sorry for the rambling on and the long post... Where is the best place to put on a patch? I put them on my wrists now, I've tried hip, chest (shaved a patch) and neck but all the other places were not very effective and once the patch fell off after a few hours and I went into full w/ds and 36 hours of hell before I noticed it was gone. I think I was actually past the worst part of w/d before I put another patch on I was already starting to feel better, but the pain was too much to cope with.
The patches are clear durogesic name brand, there's no gel in them. They look like clear stickers with red writing. I don't heat them up or try to abuse them, well not after I'd experienced some w/ds. I tried to heat one once and it didn't make a difference. These things are 24 hours shorter acting than they're supposed to be!
My pain that is treated with opiates is acute (roughly 10 months worth - but I've almost made it to no pain and 95% normal functioning a few times, before some setbacks and broken plates but I think I'm past the worst parts), the neuralgia is chronic but I think I could taper the Lyrica down to 150mg - 75mg / day and not be in unbearable or crippling pain.