Neurontin decreases the effectiveness of PO pain meds?

[TeleRN311]

Ok my dad takes a pretty large dose of neurontin. I think like 300mg tid. He had a wreck about 10 years ago and broke his back and the neurontin helps the tingling in his legs. Well two weeks ago he had a CABG. He was on IV morphine for about 12 hours but he was still sound asleep from the anesthesia. Once he woke up he wad changed to lortab for pain. He was in excruciating pain. The lortab didn't touch it. They tried PO dilaudid and it didn't stop the pain. Now I know that lortab nor dilaudid would not have completely taken away all of his pain. But they should have given him some relief so he could rest. It didn't touch it. Finally a doctor suggested the neurontin was decreasing the effects of the pain medicine. Has anyone ever heard this? I tried researching it but found nothing.

[MunoRN, RN]

It would be interesting to hear the MD's rationale, but I've never heard even theoretical rationale for why neurontin would decrease the effectiveness of opiates. The common wisdom seems to be that neurontin potentiates the analgesic effects of opiates, not lessens them.

In general, patients with chronic back pain will have much worse pain post-op due to lying on a hard metal table, usually in an awkward position, for hours on end. Males in their 50's and 60's seem to have difficult to control pain after CABG as well, so if your dad is in his 50's-60's and has chronic back pain, difficult to control pain should have been predictable, although surgeons always seem surprised when patients have pain post-op.

It sounds like this was just overly conservative opiate prescribing (assuming he wasn't over-sedated), he may have gotten better effect from a dilaudid PCA and possibly muscle relaxers/benzos depending on the type of pain he was having. Pain control is extremely important post CABG not just for comfort, but also to allow the patient to tolerate the activity and pulmonary toilet required to avoid post-op complications.

[DookieMeisterRN]

I would think that IV medication, if tried, would be way more effective than an oral dose that soon postop plus his regular dose of neurontin. He sounds like he should be having post op pain which neurontin would be useless for. The nurses there should know better and the doc sounds like an idiot too......or resident. Unless there was a reason that hasn't been stated in the OP (over sedation, OSA, change in LOC) he was way under medicated.

[nurseprnRN, BSN, RN]

fwiw, when i did open heart surgery icu i never heard of neuropathic pain except for diabetic neuropathy-- it just wasn't on my radar. educate those nurses on why he needs his neurontin independent of his sternal/thoracic pain and how it isn't additive with or potentiate any opioids he's getting so it doesn't increase chances of overdose.