Dear Amy -

As you know, Nortriptyline is a "tricyclic antidepressant" which has some effect on neuropathic pain, but is not a pain killer itself. I can't believe your doctor doesn't have you on an analgesic as mild as Ultram (tramadol) http://www.nlm.nih.gov/medlineplus/d...s/a695011.html but it apparently reflects an iirrational bias in the U.S. medical community (particularly the Midwest, I say as a native of Rochester MN) against giving effective pain killers to young adults on the theory that they will all go off and become drug addicts: Tell that one to Nurse Jackie and Dr. House! (Seriously, I would bet the next mortgage check that there's no valid empirical evidence in support of that prejudice.)

So what to do? Off hand, I can think of a couple of things to ask your doctor about. One of which is Dextromethorphan. For starters, please check out my post of April 1st (#2) and the various threads and other sources mentioned in it on the thread rsd pain at http://neurotalk.psychcentral.com/sh...d.php?p=758115

The second thing to consider is something called Low Dose Naltrexone (LDN). Please check out the following two web pages of Nancy L Sajben MD, a board certified neurologist of La Jolla CA and pain specialist, that were brought to my attention by Ballerina:

LDN World Database – Low Dose Naltrexone
01/19/2011 — Nancy Sajben MD http://painsandiego.com/tag/low-dose-naltrexone/

AND

Pain and the Immune System – It’s Not Just About Neurons – Naltrexone
01/25/2011 — Nancy Sajben MD http://painsandiego.com/category/com...pain-syndrome/

And here are a couple of more items on the subject, courtesy of the RSDSA:

The Other Brain
The Leonard Lopate Show
Friday, January 22, 2010
Neuroscientist Douglas Field, explains how glia, which make up approximately 85 percent of the cells in the brain, work. In The Other Brain: From Dementia to Schizophrenia, How New Discoveries about the Brain Are Revolutionizing Medicine and Science, he explains recent discoveries in glia research and looks at what breakthroughs in brain science and medicine are likely to come. http://www.wnyc.org/shows/lopate/epi...egments/148700

AND

Younger J, Mackey S
Fibromyalgia Symptoms Are Reduced by Low-Dose Naltrexone
Pain Medicine. 2009;10:663-672
http://www.rsdsa.org/pdfsall/Younger...Naltrexone.pdf

Of the two therapies, it is my guess, based largely on Dr. Sajben's comments, that LDN requires more art and skill in its administration, than does Dextromethorphan.

Accordingly, if your physician refuses to put you on any opioids - and in the view of Dr. Sajben and others their use may actually be counterproductive* - and isn't currently using LDN with other patients, you might want to start with Dextromethorphan.

I hope this is useful.

Mike


*Although my physician now has me on Neudexta (dextromethorphan along with quinidine sulfate, to block the metabolism of the dextromethorphan) and thereby "potentiate" (give greater medical effect per mg.) of both my opioids and Namenda (mementine) and hopefully reduce some of the potentially negative side-effects of the opioids.