[groucho]

I'm not getting any answers whether anyone's tried both Nortriptylene and Gabapentin. I'd be interested if anyone has just tried Nortriptylene for peripheral neuropathy in their feet, their results, and doseage. I've got the numbness, pins and needles, burning pain, and a friend and I both have a very uncomfortable "folded sock" syndrome behind our toes.

[mrsD]

Many people who have come here, and some who are still here,
have used one or both of those medications for their PN.

High doses of nortriptyline (or amitriptyline) are not usually necessary. And there is some new evidence that the --triptylines enhance peripheral nerve growth factors.

I tried amitriptyline last year briefly, but it made my blood sugar go up some. It didn't do much to my nighttime pain, but I didn't stay on it because of the blood sugar changes. I don't think they have that effect on everyone though.

I never took gabapentin. If it had been available back when I was severe, I probably would have tried it at least. But my pain issues are not severe anymore, so I have no desire to do it now.
There are meta study evaluations for gabapentin now available on the PubMed that claim only about 30% of pain patients respond to gabapentin. So keep that in mind.

This post discusses gabapentin and Lyrica (which are related and very similar)
http://neurotalk.psychcentral.com/post829091-8.html

[groucho]

Originally Posted by mrsD

High doses of nortriptyline (or amitriptyline) are not usually necessary. And there is some new evidence that the --triptylines enhance peripheral nerve growth factors.

I tried amitriptyline last year briefly, but it made my blood sugar go up some. It didn't do much to my nighttime pain, but I didn't stay on it because of the blood sugar changes.
There are meta study evaluations for gabapentin now available on the PubMed that claim only about 30% of pain patients respond to gabapentin. So keep that in mind.

Luckily, I am not diabetic. I am presently on Gabapentin, but am not satisfied with the results, and am weaning back down. The Neurologist told me he'd give me the Nortryptelene if I wasn't happy (or a combination of both) My friend (out of state) seems to be happy with the help he's getting from the Nortrypt, but maybe he's just easier to please. LOL. I Googled your statement regarding these meds helping to regrow nerves, but I found nothing on it.

[mrsD]

Here is the link to the article:
http://psychcentral.com/news/2009/06...tors/6761.html

Some others:
http://www.ncbi.nlm.nih.gov/pubmed/19748184

This is Ye's full article:
http://www.ncbi.nlm.nih.gov/pubmed/19549602

[groucho]

Thanks, mrsD. I'm going to email that first link with less technical talk, to my out of state friend. I think he'll be happy to know that in the long run, the Nortryptelene may be of more actual benefit that just cutting his pain.

[Nervous1]

Originally Posted by groucho

I'm not getting any answers whether anyone's tried both Nortriptylene and Gabapentin. I'd be interested if anyone has just tried Nortriptylene for peripheral neuropathy in their feet, their results, and doseage. I've got the numbness, pins and needles, burning pain, and a friend and I both have a very uncomfortable "folded sock" syndrome behind our toes.

Hi groucho,

I recently started taking nortriptyline about three days ago, it seems to be helping with my pain. It is to soon to tell what the complete benefit will be, because it can take up to 2 weeks for the drug to reach it's maximum effectiveness.
It is also worth mentioning that I am taking the following:
B12 Methyl 5000mcg
Benfotiamine 150mg twice daily
R Lipoic Acid 600mg / split into 200mg 3 times daily

I noticed less burning and pain in my feet when I increased the dose of R Lipoic Acid, so it may be a combination of the two now helping with my foot issues.

I take 25mg of nortriptyline at night before bed and let the effects taper off during the day.
This is helping me some for now, but I am sure it will need modification in the future.

[groucho]

Originally Posted by Nervous1

Hi groucho,

I recently started taking nortriptyline about three days ago, it seems to be helping with my pain. It is to soon to tell what the complete benefit will be, because it can take up to 2 weeks for the drug to reach it's maximum effectiveness.
It is also worth mentioning that I am taking the following:
B12 Methyl 5000mcg
Benfotiamine 150mg twice daily
R Lipoic Acid 600mg / split into 200mg 3 times daily

I noticed less burning and pain in my feet when I increased the dose of R Lipoic Acid, so it may be a combination of the two now helping with my foot issues.

I take 25mg of nortriptyline at night before bed and let the effects taper off during the day.
This is helping me some for now, but I am sure it will need modification in the future.

Hi Nervous1,
I've been taking 900mg of Alpha Lipoic Acid for several months now (3-300mg gel caps that I found easier on the stomach). I cut the pain very slightly and about eliminated the so called stocking-glove feeling. I also was taking Befotiamine, for about 3 months with no noticeable effect, and have switched to daily thiamin (B1) tablets. Recently added 50mg B6, 1000mcg (cheap) B12, and 1600mg folic acid. The latter 2 were in the normal range, but my homocystiene level was high. My Neuro recommended the folic acid for this reason to raise my methylmalonic acid (likely due to low folate).

Do you have the "folded sock syndrome" where it feels like there is something behind your toes near the ball of the foot, that you are stepping on, all the time? If so, has the Nortryptilene done anything yet for that. The gabapentin barely touched it for me, but did reduce pins & needles and burning. The numbness isn't very great and pretty much just in my (larger) toes, and is not too noticeable when I first get out of bed in the AM.

[mrsD]

I have bolded a very confused statement.

MMA is supposed to be low. When higher it indicates that B12 is not working in the body.
http://labtestsonline.org/understand...s/mma/tab/test What I do think you should do is
take your folate as the methylated active form. If you cannot methylate your B12 and folic acid to their active useful forms, that may be your problem. Folate is give in micrograms not milligrams. 800mcg is the typical dose, OTC.

If your doctor really said that... folate to raise MMA then that says to me he/she does not understand this chemistry. Doctors tend to think low test results are indicative of a problem. Just like high ones also. Doctors commonly worry about high B12, because of this misunderstanding too. If your MMA is in a lower range that is GOOD. And taking folate will not change it.

A test you might want to explore is the DNA test to see if you are genetically not methylating properly. This tests for MTHFR problems.
http://labtestsonline.org/understand...mthfr/tab/test
Having this genetic mutation, can lead to elevated homocysteine levels.

Originally Posted by groucho

Hi Nervous1,
I've been taking 900mg of Alpha Lipoic Acid for several months now (3-300mg gel caps that I found easier on the stomach). I cut the pain very slightly and about eliminated the so called stocking-glove feeling. I also was taking Befotiamine, for about 3 months with no noticeable effect, and have switched to daily thiamin (B1) tablets. Recently added 50mg B6, 1000mcg (cheap) B12, and 1600mg folic acid. The latter 2 were in the normal range, but my homocystiene level was high. My Neuro recommended the folic acid for this reason to raise my methylmalonic acid (likely due to low folate).

Do you have the "folded sock syndrome" where it feels like there is something behind your toes near the ball of the foot, that you are stepping on, all the time? If so, has the Nortryptilene done anything yet for that. The gabapentin barely touched it for me, but did reduce pins & needles and burning. The numbness isn't very great and pretty much just in my (larger) toes, and is not too noticeable when I first get out of bed in the AM.

[groucho]

mrsD,

You're on the ball. I didn't look at he folic acid bottle lable, and it is 800mcg. According to my lab tests both my B12 and Folate levels are in the normal range, but the folate is at the top of the scale for normal. Report reads: Homocysteine levels may be increased in both folate and B12 deficiencies. A methylmalonic acid level can differentiate the disorders since it is increased in B12 deficiency but not in folate deficiency. My methylmalonic acid is well below the normal range (at least 30% below end of the normal scale). I would assume my folate is low, and perhaps the Dr did too. My tests do not appear to be indicative of B12 deficiency.

[mrsD]

The active form of folate is Metafolin, by Solgar OTC. It is called methylfolate. Folic acid is not active, and there is some concern that it may compete with methylfolate at the blood brain barrier.

This is not definitive yet, but some complex research papers are now suggesting to not use folic acid, but to use the methyl form for this reason. It is not common to be low in folic acid testing.
Our foods are highly fortified today in the US with it.

People with genetic errors in methylating inactive forms of the B12 and folic acid, develop elevated homocysteine. The blood tests for both in serum do not separate out the inactive and active forms. So it is best to take the activated forms since you are paying money already. Best to pay the same $$ and get the most useful. When you have a neurological problem, that suggests a problem metabolically as well. The doctors just haven't caught up with that concept yet.

methylcobalamin == active B12
methylFolate== active folic acid (called MetaFolin).