Sorry about all the struggles =/ It seems the response to gabapentin, the other antispasmodics and neuromodulators (aka antidepressants) are very individual, especially for people sensitive to medications. They’re easily accessible and effective for many chronic pain conditions, which I suspect is why many physicians offer them. But not everyone tolerates them well.

LDN is known for improving brain fog and cognitive function, but it’s also been researched for pain, as an anti-inflammatory, and for GI symptoms. It’s possible it still may help, and it’s much lower risk of side effects. Same with guanfacine and NAC—they can help cognitive function. You’re right and it may not be direct, but it could be like a tide that lifts all ships, so to speak. There’s also much less risk of side effects for any of the above (except maybe the guanfacine based on what I’ve read so far) as compared to gabapentin.

Have you considered options other than medications? For treatment of chronic pain conditions, medication interventions are limited and not risk free. Sometimes other interventions like CBT, mind-body practices, and especially working with a pain specialist or chronic pain rehabilitation program can make a huge difference because they can provide more guidance and support for the “biopsychosocial” approach to pain known to be most effective.

Could you see a gastroenterologist or establish with a GI dietician to help you expand your diet with things you could tolerate to help maintain your weight? This helped me very much with appetite loss and unintentional weight loss. My GI care team prescribed Kate Farms Standard 1.0 formula, which can be taken orally. It doesn’t have the additives of an Ensure and it’s GI friendly, and often covered by insurance. But if you need the feeding tube, that’s okay too. It doesn’t have to be permanent.

I’m not trying to pepper you with questions, just trying to brainstorm options that may be within reach.