Hi,

I'm new here and very thankful to have stumbled upon this forum.

I'm here for my husband as I research for solutions and information about drugs. He has had a very long history of issues over his life so it's been hard to try and narrow down a cause and treatment. This is his history:

At 5 he had hepatitis A with jaundice and was hospitalized. At 10 to 11 he experienced debilitating pains on his right side that would cause him to drop in pain. Shortly after that he got terrible itching in his legs to the point where he would scratch till he bled.

No doctor at the time (80's) could find a cause or cure. Eventually it subdued and wasn't as bad. Then in his 30's he starting having anxiety issues in public places so he was put on Paxil - originally at 60 mg he then dropped down to 30 and 20 mg after we found out about that medication.

in 2003 he ended up having a herniated disc. He was in excrutiaing pain and they had him on Demerol, Ms Contin and eventually a pain patch they give to dieing cancer patients. It took 2 years of fighting (Canadian healthcare) to have MRI's, see a useless neurologist and eventually get to a neuro surgeon. He was operated on but after the surgery came out with the same numbing and pins and needles in his right foot that he had before. Apparently they couldn't get everything out.

2 years after this he started having problems sleeping with a restless feeling, creepy crawly feeling in his legs. Through all this he was still on Paxil so we thought Paxil could have been the cause of this since we learned it alters brain chemistry. He also had attempted 3 times to come off paxil abruptly which no one knew at the time was a bad thing and he couldn't sleep and had horrible itching and severe anger and mood swings which went away within hours of going back on Paxil. He was still diagnosed with Restless Leg Syndrome and the doctor kept him on Paxil to treat it. They tried Mirapex but even the lighted dose made him sleep 18 hours a day.

He eventually decided he wanted to be off paxil as he was still having issues with the restless legs and it was disrupting his sleep. He has been off paxil now for 6-7 weeks and has constant nerve pain in his legs, back and occasionally arms. He seems to have all the symptoms of Neuropathy - Nerve pain, poking feeling, tickling feeling, terrible itching, still some restlessness, creepy crawly feelings. He can't sleep. He's been given sleeping pills and pain medication, and now is on ms contin 15 mg which is doing nothing. He's going to double the ms contin to see if that helps.

We're waiting to see a neurologist but after researching I'm seeing this as definitely neuropathy and could be caused by his liver issues as a child and he has low cholesterol both good and bad and very odd triglycerides. He's also been a vegetarian for 10 years so the lack of amino acids could be at play.

I've got him on several supplements for niacin, b6, b12 and recently amino acids but it's not helping.

So after reading about all the other treatment options Nurontin, Lyrica, Cymbalta etc. I'm wondering ....

1. Paxil did help. The itching and nerve pain did not exist till he dropped to 10mg and worsened when he came off it. It made him sleepy, foggy and he didn't like that but compared to some of the issues I've read maybe the evil we know is better than the evil we don't know?

2. Would Cymbalta or another SNRI be similar to Paxil but not cause the foggy sleepy side effect?

3. Would Lyrica or one of the siezure based medications be better than Paxil?

4. Would staying on an opiate - ms contin at a dose that treats the pain be better?

Anyone had anything similar in experience to this or been on any of these medications feel one option is better than another? I know each person is different and will react differently to medication but I'm just trying to be prepared for our appointment (God only knows how long it will be) so if he offers a drug treatment we can refuse it if we feel it may not be good.

Thanks for reading my very long post .. I just felt it would be better to have the whole history.

Welcome to NeuroTalk.

It is quite possible it is the Paxil. Long term use of SSRIs affects dopamine and reduces it so there can be muscular effects.

Then there is the discontinuation syndrome on top of that when anyone discontinues an SSRI after long term use.

If he is looking to help correct this problem, there is an antidepressant, called Wellbutrin, which may increase dopamine.
(generic name is bupropion). It is not considered an SSRI.

Some people coming off SSRIs also try the amino acid tryptophan to help the body make more serotonin. Serotonin synthesis is actually reduced by SSRIs since they promote reuse of exisiting serotonin in the synapse of the nerves. So production of "new" is reduced. Going off SSRI then results in low serotonin activity until the body catches up and restarts production. You cannot use tryptophan if using another SSRI or SNRI drug substituted for the Paxil. So discuss this carefully with your doctor.

Itching comes with opiate therapy. Adding that for pain, may make the itching worse. Itching does not occur for everyone however. The antihistamine Atarax (hydroxyzine) is typically used for itching that is severe and all over the body.

Because of the liver involvement, Cymbalta is OUT... This drug causes liver damage and not indicated for anyone with liver issues. Some doctors don't know this yet, so be aware.

Restless legs sometimes responds to improving magnesium levels in the body. These may be low-- and this is common in US.

This is my magnesium information thread:
http://neurotalk.psychcentral.com/thread1138.html

With the history of liver disease, you will always have to be monitored carefully by a doctor, have testing done, and discuss any supplements you decide to try.

There are other forums on the web that are devoted to Paxil.
(angry patients etc.) just Google that.

Hi sweetcell,

You didn't mention burning, which seems to be a very common symptom of neuropathy (but not a deal-killer).

If it is neuropathy, opioids like ms contin are not generally the first-line or preferred medication, and as mrsD mentioned, they can cause itching. Increasing the ms contin could exacerbate that symptom (as well as cause constipation). Neuropathic pain is more often addressed with certain antidepressants and anticonvulsants you'll see mentioned here and elsewhere (and since you're in Canada where they're legally prescribed, cannabis derivatives like Sativex).
http://en.wikipedia.org/wiki/Neuropathic_pain

If he decides on trying one of the anticonvulsants, most patients here (USA) begin with gabapentin (Neurontin) because it's much cheaper than Lyrica, and well tolerated by many. (Sorry, I don't know about Canada's prescription coverage.) Some folks prefer one over the other (result-wise) and others have been known to alternate every few years as their systems build tolerance to one or the other.

For some patients, a combination of an antidepressant or anticonvulsant along with an opioid works better at lower dosages of both.

Please also check out the resources and links in the Peripheral Neuropathy forum here.
http://neurotalk.psychcentral.com/forum20.html

Doc

I would deal with these multiple problems one at a time.

The Paxil issue, and the withdrawal symptoms, seems pretty severe to me. Take care of that, and then move on to any PN that remains.

In the meantime, our SubForum at PN has many resources.

http://neurotalk.psychcentral.com/forum119.html

B12 levels, and Vit D also are big players in PN and chronic pain.
So get tested for those and fix if necessary. All the information you need for that is on the PN forums.

Thanks for the feedback.

I have him on a range of supplements including B12, B6, Niacin, Vitamin D, Amino Acids, Magnesium and a protein shake. He's been on those for quite some time before he came off Paxil.

I agree with the Cymbalta if it is that bad for the liver. Paxil also came with a liver warning however it seems that it's not as severe as what i have seen for Cymbalta.

I agree there seem to be multiple sources, however I would have thought the Paxil withdrawl would be over and not necessarily a cause for the pain. Then it leaves it to whether the nerve issues are Liver related mixed with some back related issues, vitamin deficiencies etc.

I'll do some more digging. Thanks for the valuable input!

Niacin causes flushing in many people...and some with skin
problems...sensory neuropathies react very negatively to it.

There is a non-flush version which would bypass that effect.

Also NAC can cause itching and rashes in some people. (If you are using that amino acid).

And check to make sure the magnesium is NOT OXIDE form. This is basically useless and only used now as a laxative.
Some restless leg symptoms come from low iron, but that is not common in males. More common in female patients.

B12 needs to be taken on an empty stomach for best results.
Methyl version is much more useful since it is activated already.
(some people cannot methylate folate and cyano B12).

These are just some details, if you haven't seen them already...