Hi APJH, Welcome.

IMO, if the gabapentin is not helping the pain, and causing those kinds of side effects, there doesn't seem to be any upside to continuing it, so ask your doctor to wean you off of it (abrubt cessation is not recommended).
http://en.wikipedia.org/wiki/Gabapentin#Withdrawal

Before trying Cymbalta, you might ask your doctor to indulge you and try:
100 mg. Stabilized R-Lipoic Acid (1/day)
500 mg. Acetyl L Carnitine (2/day, 12 hrs. apart)
100 mg. Pantothenic Acid (1/day)

You can take these with the B-12, which should be on an empty stomach.

Cymbalta may help your pain symptoms, but AFAIK, has little/no value in arresting/reversing neuropathy, and has a higher side effects profile.
http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0000274/

The above combination of OTC supplements may help your pain symptoms (with higher safety and lower side effect profiles) and may help nerve damage as well. If you don't see any results within 30-60 days, you probably won't.

Please feel free to google/check out any/all of this, and more information can be found in the PN Tips, Resources, Supplements & Other Treatments Sub-Forum and in the "Sticky" threads at the top of this forum.

Exercise is important; there's a recent thread on that (and more in the archives). I have similar mobility limitations/cane, but Tai Chi is working for me.

Doc

Thanks so much for your response. I'm going to print out the list of meds you provided and take it to my doc next week. Let's see what he says.

As for exercise, I may go back to swimming, which I used to do for years. It's the most low-impact exercise and won't exacerbate my symptoms or worsen the pain (I hope). I just need to get my heart rate up again!

Thanks and all the best to you.
APJH

Think about this:

When starting a new regimen for PN, it can be best to go slowly.

Now you know you are low in B12, so give this a while to work.
It might just fix everything, and you won't need much else.

Adding in RX drugs and a list of supplements may then cloud the issue. It is best to add in one thing at time, and wait a month or so to see if it works. RX drugs do not heal, they only block perception of symptoms.
The other supplements (including the B12) can lead to real healing.

Mrs.D, does the effectiveness of supplements is impede when taken along side the prescribed medicines?

Thanks

I don't believe so. But I do think that if there are improvements when you are taking many things, it will be difficult to pin down what is doing what.

In this thread the original poster has a diagnosis of low B12.
That should be attended to first, to see if improvements occur with supplementing it.

For Idiopathic patients with no B12 deficiency then typically they are on some RX medications when they come here. And many times are not getting the relief expected. So adding in some supplements, may help and turn things around. It is easier to
spot these improvements, because they were stalled using what the doctors gave. Each case is somewhat unique, therefore.

People with terrible dietary habits or gluten intolerance, may be low in many things as well (magnesium, antioxidants, B1). And people with mito damage, may need the combos (CoQ-10 +Acetyl carnitine + lipoic acid) for improving mitochondrial functions.

These are examples, of why I tend to ask lots of questions...because the answers may point to a different approach for that poster.

I like when you (or doctors) ask more questions. This helps us reveal some details which we think may be insignificant to our condition. Also, when you ask questions, this means that you are really interested to help.

Thank you for your concern to all of us.

Are you saying I should quit taking the gabapentin and just try the B12 by itself? Or just that I should hold off on switching to Cymbalta or another painkiller? (I've been taking B12 for 5 days now, but I will ask my doc if I can increase from 1000mcg to 5000mcg.)

Thanks!
APJH

If you start the B12 and Cymbalta together, and start to feel better, you won't subjectively know which is doing the job.

But if you are so uncomfortable, and miserable not starting the Cymbalta is only prolonging that.

It will take a month or more on B12 to see if there is any difference.

But I certainly wouldn't add in other supplements with either of these two things, yet.

You are already on gabapentin, and know how much that is working, right? (or not)

Not everyone who comes here has a definite low B12 test result already in hand.
All I am suggesting is that the low B12 when corrected may help alot.

Cymbalta does not work for everyone...and it remains the only antidepressant with potential toxic liver reactions. So considerations about that need to be considered. (benefit vs. risk).

If your gabapentin is working for you, you don't need to change it at this time. But this drug also is not reliable, and new studies show only about 30% of patients find it works for them.

Hi again. Gabapentin really has not worked for me, even after increasing the dose from 300mg to 1200mg. I don't want to take more because of how drowsy and foggy it makes me--it's hard to work while taking it.

So, I've decided to start Cymbalta 30mg, along with B12, while weaning off the gabapentin (down to 600mg now).

We'll see how this goes.

Thanks for your input and be well!
APJH

By all means. Just don't be surprised if he scoffs (he may or may not), but he shouldn't have any objections to your trying them. My own experience went something like this:

I got retested and a second opinion at a major medical center (which creatures do tend to be on the conservative side). The PN specialist there, who's supposed to be the best guy in the area, told me there was nothing to do, and gave me a prescription for gabapentin. Having done some homework in advance, I asked him about R-Lipoic Acid & Acetyl L Carnitine (I didn't learn of Pantothenic Acid until later) and his response was, "Well, I've heard they're doing something with that in Europe, but we don't have any studies supporting it here. If the gabapentin doesn't work, I might mention those others to a patient if they want to [try them]." (That's actually pretty close to his exact words.) I don't know if it was just him, or that he's a cog in the AMA/Med school machine, but his response sounded pretty lame to me; Europe isn't exactly Lower Slobbovia. I did manage to talk him into writing the prescription for a lower dose (again, from homework and previous experience).

Some of the more progressive doctors are on board, or getting on board, with these supplements; the more stodgy conservative Citadel dwellers aren't - they're quite frankly behind the times. I have no idea where your doctor may be on this; I hope he's one of the savvy ones. My current doctor is much more open-minded/progressive, and we have a great rapport/relationship.

Links to studies and other information supporting use of these supplements can be found in the PN Tips, Resources, Supplements & Other Treatments Sub-Forum, in the "Sticky" threads at the top of this forum, or by searching Google and/or WIKIPEDIA.

I have the same philosophy as MrsD's in that:
I tried B12 first (and I'm still taking it to keep my nerves fed), and after a month I began the R-Lipoic Acid (which worked very well for me). A month later I tried Acetyl l Carnitine, and after learning of it a few months after that, I added the Pantothenic Acid (B5) and had further improvement.

I mentioned the three of them together, and have no reservations about recommending trying them together, because there is so much evidence that they work in conjunction. Seperate or together is up to you.

By use of just supplements, lifestyle changes, and to a lesser extent diet, I've halted the progression of my PN and actually gotten some improvement.
http://neurotalk.psychcentral.com/post880426-220.html

Doc