Most of my life, I’ve been lucky in terms of my health. I’ve never broken a bone, despite some serious tumbles. I’ve suffered a handful of typical running-related overuse injuries, easily fixed with physical therapy. The only surgeries I’ve had were the removal of all four wisdom teeth when I was 21, and in the 1990s, two surgeries to remove Morton’s neuromas from between toes on both of my feet (in my case, a running-related condition, but it’s also common in ballerinas).
Until recently, those neuromas were the only nerve-related pain I had experienced. It was excruciating, like a hot knife slicing through the balls of my feet with each step. I got temporary relief if I took off my shoe, mid run, and massaged my foot, but it always returned a mile later. I also figured out, by accident, that taping my feet a certain way and wearing shoes with thick soles (to protect from sharp rocks on the trails) and extra-wide toe boxes allowed me to run farther before the pain started. But ultimately, the nerve pain became so bad I sought surgery to remove the neuromas (tumors) that had grown around the nerves to protect them but pinched them when I ran, causing the pain.
To manage the pain after that wisdom teeth extraction, the oral surgeon prescribed Percocet. I took one dose and felt so woozy and out of control that I vowed to never take painkillers again. Thereafter, including after the neuroma surgeries, I relied on ibuprofen for pain relief.
When my SI (sacroiliac) joint dysfunction started four years ago, ibuprofen and/or acetaminophen didn’t address the nerve pain I experienced. Still, I turned down all painkillers offered by pain clinics, relying instead on PT and slow improvement. But I kept re-injuring the joint. Once I moved back to Idaho, I sought help at a pain clinic in Boise. There, to get the pain under control, my doctor prescribed oral steroids, a muscle relaxant, and gabapentin. Despite my aversion to prescription medications, I was desperate to sleep, so I started taking them all.
The oral steroids quickly helped, reducing inflammation around the SI joint that was putting pressure on the nerve. The muscle relaxants didn’t help, so I stopped taking them after a few days. I was unsure whether the gabapentin was helping, given I started it at the same time as the oral steroid, so I continued to take it, 300mg at bedtime to help me sleep.
I quickly learned that, for me at least, gabapentin doesn’t make me drowsy enough to sleep until several hours after taking it. I started taking it earlier, in the late afternoon, and by bedtime I was usually drowsy enough to fall asleep. Unfortunately, I usually awoke to pain a few hours later, but getting even a handful of hours of sleep each night was a huge win.
For me, and most people, nerve pain is worse at night. Why? One’s anti-inflammatory hormone levels (cortisol) are lower; there are no distractions; and nighttime stillness increases inflammation, with added discomfort from immobility. During the day, activity and mental focus distract the brain from pain signals and keep joints warm. (“Motion is lotion,” as one pain doctor told me.) I found that listening to music, reading, writing, watching videos, light exercise on my stationary bike, and eating were all pleasant distractions, making my nerve pain less noticeable.
I kept taking gabapentin, more as a sleep aid than for any reduction in pain. I refused prescriptions sleep medication because of fear of addiction. While I’ve never suffered from an addiction, during my 30-year family law practice I was frequently involved in cases where addiction caused a family’s disintegration. Often, a physician initially prescribed the drug causing the addiction for pain. I vowed not to ever go down a similar path unwittingly.
Gabapentin relieves nerve pain by binding to specific calcium channels in the central nervous system, reducing the release of neurotransmitters that send pain signals. It acts as a “calming” agent for overactive nerves, reducing pain, improving sleep, and easing discomfort. Studies show that 30-40 percent of people with chronic nerve pain achieve at least a 50 percent reduction in pain intensity, but it’s not a cure.
I continued taking gabapentin to help me sleep while I pursued what is the only long-term “cure” for SI joint dysfunction: stability (also known as fusion) surgery, usually involving implanting screws to hold the joint in place. Turns out there aren’t a lot of surgeons trained in the most recent methods, especially here in rural Idaho. Finding one was frustrating and time-consuming. In the meantime, I got amazing but temporary relief from two steroid injections directly into my SI joint.
In February of this year, I found a surgeon not too far away and scheduled an appointment with him for March 10th. Encouraged that I finally had the ball (slowly) rolling toward surgery and a cure, I decided to stop taking the gabapentin.
What no one told me is that gabapentin can be addictive, especially at high doses. My dose of 300mg once a day is considered quite low, but stopping can still cause withdrawal symptoms, especially if stopped abruptly.
One evening, I skipped my usual 300mg dose.
That night, I was wide awake. All night. No sleep at all. Worst insomnia I’ve ever experienced.
The next day, I researched gabapentin withdrawal symptoms.
I learned that common physical symptoms include sweating, nausea, headaches, dizziness, irregular heartbeat, fatigue, and various pain sensations throughout the body.
Sleep disturbances are another prevalent symptom, including insomnia or restless sleep patterns. Some people experience nightmares or vivid dreams.
Mental health symptoms include anxiety and agitation, often accompanied by irritability and restlessness. Confusion and disorientation may occur, affecting cognitive function and decision-making abilities.
Add to all the above the risk of seizures.
Yikes! I felt lucky that my only symptom was a night of insomnia. But I should have researched all this before I stopped gabapentin cold turkey.
I decided to stay on gabapentin until I met with the surgeon on March 10th. He agreed that at such a low dose, it probably wasn’t doing much good and suggested I do a quick taper off.
Given the severe insomnia I experienced, I was wary of too quick a taper. I researched how to wean myself off gabapentin to lessen the risk of withdrawal symptoms and opted to reduce from 300mg at night to 200mg for a week, then down to 100mg for another week. Slow and easy.
Gabapentin withdrawal symptoms typically emerge within 12 hours to seven days following the last use, and commonly persist for 5 to 10 days, although some individuals require up to 18 weeks. The timeline varies widely based on individual factors, including dosage, duration of use, age, and overall health status.
So, how did my slow taper off gabapentin go?
Strangely. Vivid dreams. Night after night, for a good three weeks, then sporadically for another couple of weeks. Yes, I was sleeping, but… wow.
Historically, I’ve rarely had nightmares of the sort where I wake up trying to scream. When I’m actively leaking CSF fluid from a new leak in my spine, I sleep deeply all night, with vivid dreams, but they’re almost always fun, happy dreams. I welcome them.
These gabapentin withdrawal dreams were different. A clear pattern, or theme, emerged. They were neither fun nor happy, just shy of being full-blown nightmares.
The common theme: I can’t find my car. The setting was usually after dark, and I searched through a mall parking lot, or a parking garage, or a residential street, always in vain until all the other cars drove away and I was alone, panicking. Sometimes a stranger would arrive on foot, offering help, but they often seemed as menacing to my safety as being alone. Then I’d wake up, without ever finding my car.
Twice, besides not being able to find my car, I also lost my cell phone, leaving me without a way to call for help. Additional panic before finally awakening.
Over this series of dreams, every single vehicle I drove as a teen or owned as an adult played a central part. I don’t recall any one vehicle appearing in two dreams.
Finally, I had a dream that I lost a tooth. Not one of my molars, many of which have cracked around old fillings in real life and had to be extracted or crowned, but one of my canines.
Musing on what these dreams said about my current state of mind, I decided they reflected my loss of mobility because of the SI joint dysfunction and pain.
I’ve never been one for dream interpretation, but this series of dreams was so strange yet consistent that I felt certain my subconscious was telling me something more. I turned to Gemini for some interpretation hints.
Repeatedly dreaming about being unable to find your car in a parking lot:
Lost Motivation/Direction: You may have lost your drive or feel uncertain about how to proceed with a current goal.
Feeling “Stuck”: You may feel stagnant or unable to move forward in a specific area of your life.
Loss of Control: The inability to find the car can reflect anxiety about losing control over a situation.
Overwhelmed by Choices: The parking lot often represents too many choices or a complex situation where you are struggling to make a decision.
Need for New Paths: The dream suggests that old ways of thinking or acting are no longer serving you, requiring you to find a new approach.
Check, check, check, check, and check.
Gemini also noted some common symbolism details:
Nighttime settings suggest anxiety, lack of clarity, or fear regarding the situation.
Different cars/locations show you are trying different paths.
The search suggests you are trying to figure out how to regain your motivation or path.
Sounds right to me, along with my initial interpretation: loss of mobility.
I asked Gemini about my dream of a tooth falling out.
Dreams of teeth falling out often symbolize high stress, anxiety, powerlessness, or significant life transitions. Common interpretations include feelings of insecurity, loss of control, fear of judgment, or navigating major changes. It can also physically reflect teeth grinding or jaw tension, and in some cultural contexts, an omen of loss.
Common interpretations and meanings:
Anxiety and Lack of Control: Frequently indicates feeling overwhelmed, helpless, or losing control over a situation in waking life.
Significant Life Changes/Transitions: Represents a major change such as a new job, moving, or ending a relationship.
Insecurity and Self-Confidence: Reflects feelings of insecurity, shame, or worries about appearance and how others perceive you.
Personal Loss or Grief: Symbolizes the loss of something essential, ranging from a job to the death of a loved one.
Communication Anxiety: May represent fears of speaking up, saying the wrong thing, or regret over past words.
Again, check all the above.
This entire pain journey, insisting on getting an actual fix versus temporary Band-Aids, having to rule out every possible alternative source of pain, has been overwhelming, mixed with a keen sense of loss of control over my body and healthcare decisions. (When did we ever agree to let insurance company adjusters tell us what care we can have, and when?)
I constantly feel shame that I can’t walk normally, or far, can’t sit or stand for long, can’t take part in normal social activities. I have guilt over my inability to provide my dogs with the walks, hikes, and runs they need and deserve. I’m grieving my ability to be outdoors with my dogs in the ways I have always done, which always provided me with joy and peace. And yes, I’m afraid to rattle cages among healthcare providers and/or my insurance company for fear they’ll deny me the surgery, a procedure I’m certain I need because… I know me.
Strange as it sounds, maybe my slow taper off gabapentin was necessary to help me reflect upon, process, and accept the true impact my pain journey has had on me. A sort of internally fueled therapy.
***
Twice in the recent past, a veterinarian has suggested gabapentin to one of my dogs. With Finn, it was when he suffered from Old Dog Syndrome, or vestibular disease. After seeing how groggy it made him, when balance was already an issue, I stopped giving it. He improved on his own, as most dogs do. Later, gabapentin was suggested for Conall, although I can’t remember why. I asked for an alternative based on what I observed in Finn.
Having now gone through gabapentin withdrawal myself, I wondered if dogs suffer similar withdrawal symptoms?
More research.
In a word, yes. Like in humans, withdrawal symptoms in dogs are more likely if gabapentin is halted abruptly. The most common symptoms:
Agitation and Anxiety: Increased restlessness or pacing.
Tremors or Seizures: Shaking or, if used for epilepsy, a sudden return of seizures.
Rebound Pain: A return or increase in pain, particularly for dogs with nerve pain or mobility issues.
Gastrointestinal Distress: Vomiting or diarrhea.
Behavioral Changes: Confusion, increased lethargy, or vocalization.
I wonder if they also experience vivid dreams or nightmares? They can’t tell us.
The big takeaway for me? Prescription drugs can have real benefits, for us and our pets, but healthcare providers need to do a better job of discussing all the pros and cons up front, including possible addiction and withdrawal symptoms, so a decision whether to take them is truly informed.
***
As I thought about recurring dreams and their meanings, I reflected on those I had in college and as a young adult during some high-stress times in my life. They mostly stopped when I was in my forties. I asked Gemini for interpretations of the two most common categories I remember.
Missing an important college exam speaks to feelings about being tested or evaluated.
Or it might mean that you need to solve problems in your real life. If you’re dreaming about taking a test that you haven’t studied for, this—like dreaming about being late—might reflect worries you have of being unprepared or not planning properly. [These dreams usually happened when I was preparing for a trial.]
Stuck in a falling elevator signifies difficulties in life, being pushed into a situation that you do not want, or losing emotional ground.Dreams about falling more generally symbolize the fear of failure. [I remember always waking up just before the elevator hits the bottom.]
What recurring dreams have you had in your life, and how have you interpreted them?
***
In addition to my most recent post about living with the chronic pain of SI joint dysfunction, I wrote about dreams twice in early 2020, here and here, when COVID was on the near horizon, casting dark clouds on the world; the stock market was fluctuating wildly, endangering those of us with meager retirement plans; and political upheaval where common stressors, making for some vivid dreams. I hope this is my last post about living with pain; I hate thinking and writing about it. I don’t want to whine. My wish, and expectation, is that if I write about my SI joint again, it will after a successful stabilization surgery and quick recovery. Wish me luck.
Wild Sensibility 