Sounds like you have a good physical therapist that is willing to work with you and learn...that is very good news. Understand that it will just take time with the physical therapy. My second round of physical therapy was with a nurse who came to the house for at home physical therapy. We started out VERY small with very simple movements while I was sitting for therapy. My ankle is very sensitive to touch (and cold) so we stayed away from any therapy that involved weights on the ankle, bands on the ankle, or basically anything that TOUCHED my ankle. We were very focused on function so it was about getting me moving first, then getting me weight bearing, then getting me walking.

I know you aren't completely immobilized like I was the second time around...but one thing to focus on is about PROPER movements. No limping, no awkward walking with the crutches, etc. You want to walk NORMALLY and should be focused on only doing as much of it as you can do WELL because when you aren't walking normally you are stressing out other parts of your body. Every exercise was focused on that goal and with every exercise I asked the question: what is this exercise doing to help me meet my goal? The physical therapist should be able to give you an answer to this question which you can use to help motivate you to do it an work through (a reasonable amount of) pain. I had other goals besides walking too...my balance was terrible and I also had spread to my upper body so I had issues there to work on as well. Other things you are dealing with (from what I have gathered) are things like strengthening the ankle. Remember that if an exercise causes you so much pain that you can't function after or can't go on...then it is too much for you and your physical therapist should be able to either give you an easier exercise (if it's because you were doing an exercise that was too advanced for you) or a different one (if the exercise was one that flared up one of your triggers like touch or cold).

Remember too that any equipment you use at therapy can get cold...anything metal or plastic or whatever...depending on the temperature of the therapist's studio. That doesn't mean you can't use some of it...but you might need to do something to offset that...like wear socks (if you can tolerate them) to protect you from the cold. I often have to wear gloves to do certain things (always wear them at work) because touching metal or plastic (especially in the summer when there is air conditioning on everywhere) will cause a flare up in my hands/arms. The gloves themselves hurt to wear...but they allow me to do so much more that it is usually worth it. At home I only wear them for things like taking stuff out of the fridge/freezer...we keep the temperature pretty warm in my house so it's not necessary as much as when I go out and have no control over that temperature.

I didn't think the ultrasound helped a lot at first, but what I have noticed (especially since using one at home) is that it seems to extend the relief period I get from other treatments. For example...if I use the ultrasound after my hot bath with Epsom salts in the morning I get longer relief than I do with just the hot bath with Epsom salts. It also seemed to me when I was using it at physical therapy that using the ultrasound at the beginning of therapy with stim/heat at the end was the best mix for me leaving in less pain.

None of these things have been successful in taking the pain completely away...but all the little helps for the pain add up to a tolerable day.

I can't help you with the Effexor...I haven't ever been on that one and I have (at this point) dropped all meds except clonidine patches and lidocaine cream. I had some bad interactions between meds that really made me sit down and think about whether the risks and long term effects of the meds were worth it to me for the small relief (and it was always small) that the meds gave me. I ended up deciding that it wasn't worth it. If the side effects of a particular med are not working for you then you should talk to your doctor about trying something new. There are lots of options out there.

When I was taking meds in the beginning, it was really about finding the right COMBO of meds. I took Lyrica, Meloxicam (anti-inflammatory), Tramadol (pain), and doxepin (anti-depressant...for pain). This was the best mix for me and it did help keep my pain level down to a 5-6 most of the time. Unfortunately there were some issues with work comp and I ended up running out of meds because they wouldn't approve a doctor's visit...and then my pain just got so out of control even that mix wouldn't help anymore. Tried lots of other things that didn't help much and then had the bad reaction that ended up with me off of everything except the clonidine patches and lidocaine cream.

If something isn't working for you...don't be afraid to ask your doctor to switch. I will also say that when I first started Lyrica that it made me VERY tired...but that passed after about a week as I adjusted to it.

Remember that we are all different. We can talk about our own experiences and what helps us out day to day and the best hope is that through that you can find a few things that work for you. I learned lots of little things to help with my pain on this forum...one from one person, a couple from another, etc. This also takes time.

Sorry for the long posts...everyone tells me I am very long winded. I just want to share as much as I can in the hopes that some of it at least might help you.