cyclelops,

I am glad you brought this topic up. And I believe I am one of those people. You are right though, it gets involved! For years I could NOT understand why people could take all kinds of medications and I had issue after issue. And it is not like I didn't give the meds time. I just never, ever got past the SE's or rather, adapted to the medication. In any case, I CANNOT take the nerve meds (Neurontin, Depakote, Lyrica as an example) NOR the SSRI's. Suffice to say I was much worse while on them; extremely sick. I can handle the SHORT ACTING narcotics and the benzodiazepenes however. Also, Prednisone, Kenalog, Celestone; the last two as in injections.

Finally, a pharmacist mentioned CYP450 to me and basically explained to me it was the way I metabolized meds. Or, well, the way that I couldn't. He told me also it gets very, very involved. So, I have a family friend who is a Geneticist and she called me in regards to this subject. She told me that she, herself, is deficient in the CYP450 and always has to cut meds in half or take low doses. I kind of laughed when she said that because I have been cutting mine in half for years and stay with very low doses. But she did recommend asking my Neurologist to run a test to see where I stand on this CYP450. I haven't done so yet but really need to. I keep forgetting to ask.

In any case, I HAVE to keep the doses low. It doesn't obliterate all the pain; just takes the edge off. And I also have OA all over the place! My spine being the worst. I have also read something in regards to OA and arachidonic acid. I would have to go look it up again. But IF I recall correctly, it is the Cox 2's that inhibit production of it. I could be way off; just seems I read something about it.

I have issues with the Cox 2's as well with the exception of Limbrel which is really a botantical medical food. It DOES help with the OA pain since it ACTS LIKE a Cox 2 but it can also cause stomach upset. Some people swear by it while others don't.