It is now six months since I started to get daily around-the-clock symptoms of PN and it is nearly five months since I developed extreme fatigue.

The fatigue is quite debilitating and I am beginning to wonder whether I have ME/CFS (Myalgic Encephalomyelitis/Chronic Fatigue Syndrome) and Fibromyalgia or CFIDS as some of you may know it as. So many of my symptoms are parallel, except for the Peripheral Neuropathy.

Does anyone know whether PN can ever be a component of ME/CFS/Fibromyalgia?

Also does anyone have any input on longterm sequelae to a persistent Mycoplasma infection?

Hmmm....I don't know if I'll be any help. Fatigue is by far my worst problem, but as I have both fibromyalgia and Sjogren's syndrome, I can't honestly say which is the culprit or if both ailments share the blame. I have addressed my sleep issues the best I can, and the fatigue persists no matter how well-rested I am, so maybe my problem is primarily autoimmune?

I do know people who have both fibromyalgia and PN with no concurrent autoimmune disease, but I am not sure how much research has been done on this. Systemic ailments seem to cause more bodily malfunctions than the medical commmunity is willing to accept.

So my answer is....maybe??

fanfaire

Hi Megan,

I am one of those people with both Fibro and PN. Evidently, the PN caused the Fibro, but really I am not sure the docs really know. I of course have the fatigue, but again is it the condition or the meds. Hard to know. Right now I am doing fairly well, but I am taking too much medicene for my liking. I take Neurontin, Cymbalta, Lyrica, Tramadol and 25 milligrams of Topamax at bedtime. Actually, I can't believe I can function, let alone work. I work full time and am active with my 13 yr old daughter. I exercise at least 4 times a week. I have gained 50 pounds though. I know frightening. It was the Lyrica, but unfortunately that medicene provided so much pain relief that I made the decision that I could live with being chubby. I was very skinny to begin with. Now though, my doc has added Topamax to see if it will conteract the weight gain. It supposedly can cause weight lose. If it works, he will take away the neurontin. Lets hope it does.

Anyhow, keep fighting and never feel like any question is too stupid to ask your doctors. That is why I am doing as well as I am. I keep asking and asking. I question everything. Don't give up. And yes, there are still days I just cry. This hit me at 42 yrs old - 2 and half yrs ago. The fight can be exhausting, but it is well worth it.

Laurie

'I take Neurontin, Cymbalta, Lyrica, Tramadol and 25 milligrams of Topamax at bedtime.'

Did the same physician prescribe all the meds?

Duloxetine is Cymbalta. Do not discontinue any drug without first consutling a physician. Every drug you are on requires weaning off of and only under a doctors care. I am assuming you are under the care of a neurologist?

The following is from Medscape (professional)-Drug Info

Severe Interaction: Tramadol/Selective Serotonin Reuptake Inhibitors; Duloxetine; Venlafaxine


This information is generalized and not intended as specific medical advice. Consult your healthcare professional before taking or discontinuing any drug or commencing any course of treatment.


MONOGRAPH TITLE: Tramadol/Selective Serotonin Reuptake Inhibitors;

Duloxetine; Venlafaxine


SEVERITY LEVEL: 2-Severe Interaction: Action is required to reduce the risk of severe adverse interaction.


MECHANISM OF ACTION: The concurrent administration of tramadol and a selective serotonin reuptake inhibitor or the serotonin/norepinephrine reuptake inhibitors duloxetine or venlafaxine may result in additive blockade of serotonin reuptake, resulting in central serotonergic hyperstimulation. The combination may also lower the seizure threshold.

The selective serotonin reuptake inhibitors and duloxetine may inhibit the metabolism of tramadol at CYP P-450-2D6, which may decrease its effectiveness by decreasing its transformation to its active metabolite.


CLINICAL EFFECTS: The concurrent administration may result in serotonin syndrome. Symptoms of serotonin syndrome may include irritability, altered consciousness, double vision, nausea, confusion, anxiety, hyperthermia, increased muscle tone, rigidity, myoclonus, rapid fluctuations in vital signs, and coma. Serotonin syndrome may result in death. Concurrent administration may also increase the risk of seizures and decrease the effectiveness of tramadol.


PREDISPOSING FACTORS: Predisposing factors include a history of seizures or epilepsy, a recognized risk for seizures (head trauma, metabolic disorders, alcohol, drug withdrawal, or infections of the central nervous system), or a genetic defect in CYP P-450-2D6.


PATIENT MANAGEMENT: If concurrent therapy is warranted, patients should be closely monitored for signs and symptoms of serotonin syndrome, seizure activity, and decreased tramadol effectiveness. Tramadol may need to be discontinued.

The manufacturer of duloxetine states that concurrent use of tramadol is not recommended.(1)


DISCUSSION: There are several case reports of serotonin syndrome occurring following the addition of tramadol to a stable selective serotonin reuptake inhibitor regimen. The syndrome developed between 12 hours to 3 weeks after the initiation of tramadol therapy. The patients recovered after tramadol was discontinued.(2-12) One patient also developed mania.(2) Another patient developed nightmares and hallucinations after taking concurrent tramadol and paroxetine for 56 days.(13)

A review of the 124 reports of seizures following tramadol therapy received by the FDA through July 31, 1996 revealed that 20 patients were receiving concurrent therapy with an selective serotonin reuptake inhibitor. (14)

The manufacturer of tramadol states that the risk of seizure is increased in patients receiving concurrent therapy with selective serotonin reuptake inhibitors.(15)

In a study in 16 healthy subjects, paroxetine (20 mg daily) decreased the formation of tramadol's active metabolite and tramadol effectiveness.(16)

There is one case report of serotonin syndrome with concurrent tramadol and venlafaxine.(17)


REFERENCES:

1.Personal communication: Cymbalta (duloxetine HCl) concomitant opoid analgesic use. Eli Lilly and Company June, 2006.

2.Gonzalez-Pinto A, Imaz H, De Heredia JL, Gutierrez M, Mico JA. Mania and tramadol-fluoxetine combination. Am J Psychiatry 2001 Jun;158(6):964-5.

3.Mahlberg R, Kunz D, Sasse J, Kirchheiner J. Serotonin syndrome with tramadol and citalopram. Am J Psychiatry 2004 Jun;161(6):1129.

4.Mittino D, Mula M, Monaco F. Serotonin syndrome associated with tramadol-sertraline coadministration. Clin Neuropharmacol 2004 May-Jun; 27(3):150-1.

5.Mason BJ, Blackburn KH. Possible serotonin syndrome associated with tramadol and sertraline coadministration. Ann Pharmacother 1997 Feb; 31(2):175-7.

6.Sauget D, Franco PS, Amaniou M, Mazere J, Dantoine T. Possible serotonergic syndrome caused by combination of tramadol and sertraline in an elderly woman. Therapie 2002 May-Jun;57(3):309-10.

7.Lange-Asschenfeldt C, Weigmann H, Hiemke C, Mann K. Serotonin syndrome as a result of fluoxetine in a patient with tramadol abuse: plasma level-correlated symptomatology. J Clin Psychopharmacol 2002 Aug; 22(4):440-1.

8.Kesavan S, Sobala GM. Serotonin syndrome with fluoxetine plus tramadol. J R Soc Med 1999 Sep;92(9):474-5.

9.Egberts AC, ter Borgh J, Brodie-Meijer CC. Serotonin syndrome attributed to tramadol addition to paroxetine therapy. Int Clin Psychopharmacol 1997 May;12(3):181-2.

10.Lantz MS, Buchalter EN, Giambanco V. Serotonin syndrome following the administration of tramadol with paroxetine. Int J Geriatr Psychiatry 1998 May;13(5):343-5.

11.John AP, Koloth R. Severe serotonin toxicity and manic switch induced by combined use of tramadol and paroxetine. Aust N Z J Psychiatry 2007 Feb; 41(2):192-3.

12.Llinares-Tello F, Escriva-Moscardo S, Martinez-Pastor F, Martinez-Mascaraque P. Possible serotoninergic syndrome associated with coadministration of paroxetine and tramadol. Med Clin (Barc) 2007 Mar 24; 128(11):438.

13.Devulder J, De Laat M, Dumoulin K, Renson A, Rolly G. Nightmares and hallucinations after long-term intake of tramadol combined with antidepressants. Acta Clin Belg 1996;51(3):184-6.

14.Kahn LH, Alderfer RJ, Graham DJ. Seizures reported with tramadol. JAMA 1997 Nov 26;278(20):1661.

15.Ultram (tramadol) US prescribing information. Ortho-McNeil Pharmaceutical Inc. May, 2004.

16.Laugesen S, Enggaard TP, Pedersen RS, Sindrup SH, Brosen K. Paroxetine, a cytochrome P450 2D6 inhibitor, diminishes the stereoselective O-demethylation and reduces the hypoalgesic effect of tramadol. Clin Pharmacol Ther 2005 Apr;77(4):312-23.

17.Venlafaxine + tramadol: serotonin syndrome. Prescrire Int 2004 Apr; 13(70):57.

Hi - FYI - I am taking topamax and have lost 25 lbs. It happened slowly at first then very rapid as the dose increased. I started at 25mg twice/day and now I take 75 mg twice/day. My doctor could not increase my dose because I could not stop loosing weight.

Good luck with everything! Staying active is probably the best way to go for health.

Megan,just curious but how did you get this type of infection? What's being done for it? Anti-biotics?

Hope you're feeling better!
Buttons

Serotonin syndrome happens to some people much easier than doctors expect. I experienced it when a supposedly reputable shrink switched me from Paxil to Prozac abruptly without telling me that Paxil is long-acting and Prozac is short-acting. Apparently, there was a period of time the Paxil was still in my system along with the Prozac I had just started, which had the same effect as a double dose, and it seriously messed me up.

I'm no doctor, so you should probably check this out with one, but it is my opinion that using one anti-seizure med (Topamax) to counteract the effects of another (Lyrica) is a bad idea. I've been on Topamax and Lyrica and Neurontin, but only one at a time, never concurrently. Each medication had undesirable side effects, and incidentally, the Topamax did not cause me to lose a single pound.

Hope I'm not hijacking the thread, but I was really alarmed by the list of medications listed by Laurie and felt I should say something. I'm relieved cyclelops jumped on this with some data. I just want everyone to be safe with their meds because sometimes doctors drop the ball.

fanfaire

I seen it happen many times as a nurse,and i've seen Drs. who had
Drug problems. Thanks again C. you came through.and yes nurses have
been know to tell on Drs. Sue

To Laurie43 - Thanks! How long after getting the PN did you get the Fibro?

I have just posted a message on the Fibro board mentioning that I am not on any conventional PN medications yet, as I wanted to get as many tests done to see if we could elicit the cause first. I am taking some other supportive supplements though which you can read about on the CFS/Fibro board, if interested.

Fanfaire - I agree with you that the fatigue is crippling. Pain, burning, muscle fatigue and aches all over etc. are certainly far from pleasant but the fatigue effects everything!

Buttons. Your question re. Mycoplasma. I don't know where I picked it up. Can it come from garden mulch? Just prior to developing the dreadful cough we had been spreading bark mulch on our garden to minimise water evaporation due to our drought and I have wondered whether it could come from damp or mouldy mulch......Anyway I developed a terrible cough in Nov '05 and after a couple of weeks I went to the doc and he tested me for Mycoplasma Pneumoniae as he said that a couple of his other patients had it and it tends to come in clusters. Sure enough - positive result.

Had the appropriate antibiotics (extra long course of Doxycyclin) but the cough persisted for the next ten months. The I had a massive asthma attack and was in hospital for nine days in August 2006. I had five A/B's going at one time, three IV's and two oral, as well as, oxygen, humidifiers, nebulisers and all the asthma drugs. Eventually the attack settled and it took me about three months to get better. Then this year the PN and fatigue started.

In my recent research I have come across many references to Mycoplasma as suspect in causing quite a few sequelae - Fibromyalgia/CFS being one of them. So in looking at the time lines I have been interested in any possible connection between Myco and PN etc.

My research is ongoing and I may never know for sure!