Hi all, I've been on a combination of Gabapentin and Cymbalta for my PN for a few years now. It has worked fairly well up until recently. However, for the past few weeks I been experiencing pain way beyond what I had been accoustomed to. In the past, when pain levels have increased, my neurologist has tinkered with the Gabapentin and Cymbalta dosages until some combination seemed to work. My question is, have any of you become immune to a certain degree from your medications and switched outright to a different treatment? Or is it worth continuing with what worked in the past until the right combination is found? Thanks for any input!

Marty

You've found a great place to discuss this!
Actually, that's quite a loaded question you've asked, but certainly a good one.
I wouldn't even know where to begin to be honest......there's so many factors involved. The question regarding our bodies building up a tolerance to our meds......in my case YES, especially the strong pain meds (opioids)...which calls for higher doses, which eventually leads to more side effects (depleted hormones, increased liver enzymes....) so, in my case I felt as tho I had literally been thru the gammet of medicinal options, so I opted for a more invasive procedure and had a dorsal column stimulator implanted.

Since you've been taking your current meds for several years, and in just a short time have noticed a substantial spike in your pain level, I would probably look into other factors outside of the medication issue in the attempt at finding the underlying issue before making any drastic changes in medication. Make sure you follow Doc's orders if you DO change meds....tapering will be an important factor (which I'm sure you already know)...

There are so many very knowledged folks here who can point you in a direction of perhaps targeting some underlying issues.......
Meanwhile, take a look at the 'stickies' at the top of this page......it's FULL of valuable information..... It really is worth it to do the 'detective work' involved, rather than just hoping for the right medicine. It's a huge undertaking and a process of elimination.....but there really is no possible way to compare one's PN battle with another's.

Hopefully others will be along and share suggestions and experiences.

Do stick around......you'll find we do have one thing in common --- the desire for a better quality of life.....
So much to learn, but we do stick together

Best Wishes
Rae

You certainly have found a great place for info. I changed the type of meds a couple of times before I finally found the right combination. Each of us is different, and you will need to experiment.

Another idea is to check the two threads on Vitamin D deficiency, posted in this forum. You will find mrsD has some great information in both threads. Many of us PNers have discovered Vitamin D deficiencies, and are experiencing improvement in our pain levels with Vitamin D supplements.

http://neurotalk.psychcentral.com/sh...hlight=vitamin

http://neurotalk.psychcentral.com/sh...hlight=vitamin

I also found some good, easy-to-read information about Vitamin D at pain-topics.org:

http://pain-topics.org/clinical_concepts/vitamind.php

I look forward to seeing you around.

[QUOTE=MartyD19;648240] My question is, have any of you become immune to a certain degree from your medications and switched outright to a different treatment? Or is it worth continuing with what worked in the past until the right combination is found? Thanks for any input!

*** I think the gabapentin worked about 6 months for me; I'm now on Lyrica -- the most expensive PN drug, of course. I was on morphine CR and titrated up to a plateau of 60 mg/day. I understand I can increase that dosage for a while before having to switch, but it's been working for 4 months now, so I'm hopeful.

Cowboy

a poster here Brian who has been able to a large degree to reverse his PN caused by pre diabetes with tight sugar control and his pain with the use of magnets, has posted that at times he had to titrate down his medication for a period of time and then titrate back up, working with his doctor, because he would become too tolerant of high doses and titrating down and back up again allowed him to keep using the same medication. It would regain its effect that way. If you do a search of his name you might find the posts.

Ditto that, except it worked more like four or five months. I'm on Lyrica now with Cymbalta. Is it working? Eh, hard to say. I also have CRPS and it's tough for me to differentiate sometimes which is causing which pain. I mean, the pain itself is very different, but it seems like one makes the other flare up.

I don't know, if you asked me a few weeks ago, I'd have told you that I thought my pain was reasonably under control. Now? Not so much. I unfortunately think it's something I'm just going to have to live with. My worst problem with it is the lack of sleep. I'm a light sleeper and when I'm hurting so bad, I either can't fall asleep, or I wake up when I try to move (if the sheets even touch my leg wrong, it will awaken me).

It stinks, I won't lie. My PN, however, was caused by trauma, not by diabetes, and from what I've heard, it's rather different, so your mileage may vary depending on the cause of your PN.

For me I was doing better for a time too on my meds and now not so much. I am not sure if it is the meds not working as well or if it just my body in not as of a good place. I wonder though what dose your on of these meds if you may need a higer one or if you could see about adding another med in?

First off, it's that time of the year. I have increased pain in the fall and the spring. I'm not sure what it is about those two seasons that cause this but there it is and I believe many other people here can tell you the same thing.

When I was on Gabapentin I had to have my dose upped about 3 months after starting it. That took me up to 600mgs once a day. That was enough to make me suicidal. So my experience with that drug is limited.

I take Tramadol, usually only 50mg tab per day when I know my pain is at it's worst. Time of day seems to matter for me. There are times in the spring and fall when I need to take two a day. Usually one just a short time before bed and the other in mid to late afternoon. It was a miracle drug for me.

Had a doctors appt yesterday. She switched me from 37.5 mgs of Effexor XR to 30mg Cymbalta. So I'll see how that does. Also gave me Elavil for sleep. Elavil is known to help with pain as well but I can see what my doc meant when she told that at the dose the Elavil would need to be at for PN relief I'd me a zonked out mess. But for sleep 25mgs does me just fine. Best night of sleep I've had in a very long time last night.

Oh! I also have Mirapex as needed. I take it about 2 or 3 times a month and boy it's a lifesaver. My doc wouldn't give me Lyrica because it's related to Gabapentin.

The poop-out issue is what keeps me using these drugs at the lowest doses I can and only when I need it. Of course your pain may be much worse than mine is and need constant help. Mine is manageable most of the time. When I was first diagnosed it was very bad. But it's gotten better taking the supplements that are recommended here. Not all of them mind you cause some of them are very expensive and I simply can't afford them. The B12 I take and things like that.