[supermarky]

will Elavil be able to help again? my experience was that I took it awhile (when the situation was far worse, side effect of HIV drugs) the drug did what it could and no more then I stopped taking it and the benefit was more or less permanent

had a ridiculous overgenerous painkiller regimen going for a couple of years , detoxing finally left me with very bothersome resurgence of PN (in feet)

it's been since 10/31 I've had any oxycontin, since 11/24 I had any subutex (after about 2 weeks on it). so there's a chance that... maybe... I just need to wait longer for things to be as they once were...? but this is getting to be a ridiculously long wait if that's the case...

what annoys me very much is that I asked for Elavil from the guy treating me at the detox (for subutex) facility and he insisted it's "a bad drug" despite my insistance that it worked for me after only a small spell of usage. but nooooooo I have to try lyrica (ineffective, and I don't wanna get fat thank you), cymbalta (appears to be giving me pretty dreadful GI side effects unless I'm going around eating rotten food and not knowing it and my feet are killing me. just started it today, had it for 2 days running on the 28th and 29th but was afraid to take it with trazadone which I was going to be given for sleep so went off.)

I know neurontin has always been a do nothing drug for me.

I was thrilled to see an archived post from MrsB extolling Elavil over Cymbalta... just hope it can do what it did for me before again! I know my own physician would give it to me but I'm not supposed to see him till the 28th. I'll just have to call to come in sooner...

anyway here's another vote for elavil, but am wondering if it can do the same trick after the stupid stunt I pulled of going on opiates for long term...

[supermarky]

should have mentioned that the original course of elavil was in 1996

[Susanne C.]

Why did you go on the opiates if your pain was being controlled? I am on opiate therapy and I know it is for the long haul, likely the rest of my life, but I have hereditary neuropathy and this, together with gabapentin, works for me. They are relatively safe drugs with few side effects, and allow me to function at a much higher level than I would be able to otherwise.

Why did you give up the elavil if it was working? Couldn't it have been combined with an opiate if you were going though a bad time? If it wasn't working, it can't hurt to try it again, things change, but no one here can really tell you whether it will or it won't. We are all more or less living science fair projects, experimenting on ourselves.

[mrsD]

Welcome to NeuroTalk:

I am sorry, however, it is under such painful circumstances.

I wonder about your PN symptoms. I suspect they were always there and just masked by your opiate therapy.

What happens with opiates over time, is that the glial cells which are the supporting cells in the brain, have been found to be active participants in the pain cycle. Over time they create inflammatory molecules that stimulate pain cells to make more receptors. Each day more involvement of the glial cells in the pain cycle is discovered.

So in essence when you discontinue a long course of pain therapy, you end up with MORE receptors than you started with.
This is thought to create more intense pain than you had before.

If you Google "glial cells pain" you'll find many complex biochemical medical papers in recent years. There are a few posts here about it even if you search "glial" on the index page.

[supermarky]

Thanks Mrs. D I've taken a look but am not so much interested in the science as I am in getting some relief.

(BTW re your Galileo quote and the photo: it took me quite awhile to figure out that the "negative spaces" were in fact 2 cats! lol I had assumed given your scientific bent firstoff that the pic was some sort of cell cultures. then I Read the caption... and found myself trying to construe a couple of dogs swathed in xmas lights, or what, until suddenly the correct interpretation of the visuals - that the "negative spaces" of the image were actually 2 cats - snapped into place in my brain as happens.)

Anyway to proceed with both replies to responses (thank you very much):

I gave up Elavil cause it ceased to have a progressively helpful effect and I was satisfied with things as they were, able to live with what discomfort remained, didn't think taking more Elavil would help matters any further. When I asked for it recently at this detox facility I was told, "it's a bad drug. heart. bad drug." so maybe it's not the best idea to be on it really long term? I don't know...

I began taking opiates for other pain problems (back and burgeoning rotator cuff situation. I'm planning on surgery for the latter which is the principle problem) and let's face it - because I loved the little buggers, and so got "carried away" as many people do, and certainly ... the resurgence of the neuropathic pain had more than a little to do with the ever increasing frequency of ever larger doses, to the point of absurdity and most definitely chemical dependency.

So now, Mrs. D, you've explained the background, but will Elavil help me at this point? Eek. Maybe I shouldn't ask! I definitely want to try. I'm giving the Cymbalta a try cause I've got it here and won't be able to get switched to Elavil for several days anyway, I anticipate. I'll give it at least 5 days but I think it doesn't agree with me. In fact... my situation is a bit confused. I'm still in this 2 week post subutex detox period. I was on subutex for only 2 weeks on doses beginning at 2 mg (generic) increasing to 4/day. At that point I became concerned and did some research and learned how dangerous the stuff is and so...soon returned to the detox facility I went to to get off oxycontin and told them: I want off subutex now. (They didn't appreciate my preaching against the long term use of suboxone and subutex to the other patients, but I was on a mission for others as well as for myself.) So I am still very weak then I went and caught the worst cold I have had in many years. The cold is almost gone. I'm a mess. But I'm sure time will cure most of what's going on, maybe the neuropathy too, considering the baseline? I mean will those glial cells ... go away?

Certainly the neuropathy, one way or another, seems to be ... subs?iding a bit... in fact it's at this threshold at which it's ... just barely intolerable, but at least it doesn't keep me awake at night anymore. Perhaps the situation with the brain modification will .... come into balance again on its own in the absence of opiates, or will they just stay there?

Also, wonder what you think of this thread and its relation to the glial phenomenon:

[oh turns out I am too much of a newbie to post links it had to do with something called DXM which I think might be related to (eek) ketamine as a kind of "miracle drug" for opiate abuse fallout.]

[mrsD]

You cannot use dextromethorphan if you are using Cymbalta or Elavil. (or any other antidepressant that affects Serotonin).

Dextromethorphan is the isomer of levomethorphan which is a CII narcotic-opiate.
http://en.wikipedia.org/wiki/Levomethorphan

It has been used in some pain states, but has mixed effects. Not everyone finds it useful.

Elavil is the only antidepressant that has recently been shown to have effects on nerve growth factors.

5 days of Cymbalta is not long enough for much effect. The effects of Cymbalta are central in the brain, not the periphery.
Cymbalta and other mixed antidepressants affect perception of pain in the brain.

My cats are both black. It is difficult to get photos of black cats in low light, which is needed for the lights to show up when lit.
I cropped the photo as artfully as I could, but it is not sterling, I agree. I liked Weezie's paw on the yellow bulb...that is why I chose that photo.

The glial cells do not go away. They are the framework of your nervous system. It used to be thought that was all they did, but now we know much more about them. I have not seen papers discussing loss of receptors after opiod tolerance issues. I assume they do not go away, or if they do it would be a slow attrition.

I think at this point you need to address what gave you the PN in the first place. If it is triggered by some environmental thing, you may remove it and improve. I see from your first post you use anti-retroviral drugs? There are specific treatments for PN for patients who do so. One is acetyl carnitine. Some of the websites for patients using these drugs have extensive recommendations for the PN that may develop.
Have you been to a good podiatrist? Had an thorough exam for mechanical issues in the feet?

[supermarky]

very interesting!

I am not really interested in the ketamine route myself, plan to "get normal" by simply renouncing opiates and waiting. cause I'm through with that kind of life, and I don't anticipate any relapses. I've also at various times renounce amphetamines and alcohol without going back.

would it be ok to do the elavil and the cymbalta at the same time?

honestly I feel that the situation is probably improving on its own...little by little it was quite a bit worse a few days ago than it is now. but then... I've been taking one thing or another, lyrica once or twice a day, now cymbalta.

I have been to a podiatrist, needed a kind of laser surgery on both big toes for this "crixivan" related ... ingrown toenail phenomenon. I ended up with a bad relationship with that MD he was a narcissistic creep, not the kind of doctor I like to deal with. lol But that's a great idea and I'll look into this / these supplements as well. I can live with light neuropathy and I'm almost at the point where it's tolerable so I think the prognosis is good. It's just that... ugh... right now... it's really annoying!!!

oh I was given inserts to wear because the shape of my foot had evidently changed due to pn, but... the inserts rarely fit into my shoes so I never got into the habit perhaps I should scope out some of my larger footwear and start using them for awhile at least.

[mrsD]

No it is not safe to take both Elavil and Cymbalta. You risk serotonin syndrome if you do. This is a serious thing and can end you up in a hospital or worse. In fact you cannot take DM either with either drug.

[Brue]

I take the maximum dosage of cymbalta every day. Apparently there's an innumerable list of drugs it's supposed to have an interaction with. One is tramadol, which I also take - I've survived numerous warnings from my pharmicist about the danger of taking those two, but I haven't noticed anything out of the ordinary. Cymbalta helps my mood, no doubt, but as far as the PN goes, I can't really tell if it does anything at all. And there's no generic option for it, so I'm thinking of moving onto something else if it only helps my mood.
Mrs. D is right - you definitely should not take Elavil and Cymbalta at the same time - NEVER take two anti-depressants at the same time. Especially the seratonin reuptakers, etc. Any number of things can happen, and none of them good.