[jess18]

Ok. I went for the first time to see a Pain Managment Dr, and this guy is the Director of the PM place. They have my records, he has seen the test and diagnosis of Pudendal Neuralgia. So, the nurse was more thorough, and he comes in, listens to me about my health matters, then ups the dosage of Neurontin from 1800 to 2400mg, and writes a script for Ultram for breakthrough pain.. and leaves. Just not a great first impression but since I have never been to one, is this the general way that PM centers are? Just there to write scripts right?
so I currently take an SSRI and Tricyclic and realize that there is an interaction where you can get Seratonin Syndrome if they are taken with Ultram. So I call them, and tell the nurse that I am not comfortable taking Ultram because of that, and she says to take 500mg of TYlenol!!!!
Hello.. that does not help with my nerve pain.. my break through pain..I was kinda ******. So should I not go back there and just see if my PCP or Neuro dc will prescribe something else? I didn't really care for how this dr was.

[nide44]

.........realize that there is an interaction where you can get Seratonin Syndrome if they are taken with Ultram........

I do believe that this has to do with dosages.
I'd PM Mrs D (unless she answers this first), and ask her about it.
She has prior knowledge of this particular interaction, I believe.
I think that taking them together, in this case, might be OK.
Your experience with the pain Doc is typical, altho not in the majority.
They pride themselves on the ability to Dx pain types and Rx for them- on the fly. The proper Rx is their goal.
They'll keep trying until they either get it right, give up on you,
or you give up on them.
But with follow-up visits. A call to the nurse, if there is a medication question, will always gt the same answer. Tylenol. Its a blow-off. You have to talk to the doc, face-to-face. They're used to having to see patients on a monthly basis, to renew Rx's that can only be done with a visit. No call-ins allowed, for many of their Rx's.

[mrsD]

But I think we've already discussed this.

With the increase in Neurontin, comparison of the other two
drugs (Elavil + Lexapro) changes. The Elavil may be redundant, or not much of a benefit compared to use of Ultram.

It is worth trying Ultram (it may not work for Jess anyway), because for pain, it is less constipating and since this is her
weak spot, needs to be addressed. Elavil CAUSES constipation you know. Elavil in very low doses doesn't do much anyway for serotonin levels.

Also another alternative is to use magnesium instead of the Lexapro. Magnesium will help spasms, and tight muscles as well as have a minor laxative action.

So alternatives involve changing the other two meds which provide little in the way of relief.

And the bottom line is that both Elavil and Lexapro are low dose and less of a risk than if they were high dose.

Stopping Elavil should not be much of a problem. Stopping the Lexapro may cause withdrawal symptoms. At low doses it is less likely, but length of time on it also enter into any discontinuance symptoms.

I think this experience is rather typical. Many pain doctors appear to be cold...that is all they hear all day long.

And I would also add, that you should LOOK like you are in pain when you go there. Putting on make up, and dressing up for the visit, makes it look like you are not suffering so much.
TOO casual, or unwashed may also put doctors off as looking like a drug seeker. So something inbetween should suffice.

Let's hope the PT works, and this all will be short lived anyway.
Using the magnesium may really help, so I would try it.
I have a magnesium thread on Vitamin forum on page 1.

[jess18]

Thank you Bob and Mrsd. I thought about it Bob, and realize what you say about the Drs. Also Mrs d, I know what you mean even about how you look too.. so I basically wake up and shower and dont wear makeup and wear casual clothes... I know you have to think about these things.
I went to my Neuro today too, he is great. He did say Ultram would be fine for me with the dosages of Lexapro and Elavil I am on. I am considering going off ( weaning ) the Lexapro, since it is just 5mg, but it was initially prescribed for GI/nerve gut issues and I have been doing well with GI problems since on the drug, so I am unsure. Magnesium may be a possibility. I still have some constipation issues and I try to drink more water and take stool softeners and such. Thanks for the info on elavil not affecting Seratonin much in low dosages. If I go to 25mg of Elavil, is this still considered a very low dosage? The Elavil and Neurontin are working presently, but I do have times...
I do not think I will visit the PM center again, I am dealing with my Neuro, My PCP doc and PT and will be calling around the major hospitals like Duke, Wake Forrest, UNC to see if there is a specialist in Pudendal Neuralgia, not easy to find in Charlotte.
Thanks for your feedback

[mrsD]

When you get to 50mg, that is when it becomes a bigger gun.
(that is a typical antidepressant dose beginning.)

That is all subjective tho...because people vary. In the old days,
when TCAs were all we had, antidepressant doses were
100-150mg. There was an occasional 300mg/day but that was pretty rare. (I know one patient who died on that dose-she was a diabetic in poor condition). The 10 and 25 were rarely used.
Now it is the reverse.

[jsrail]

I think Pain Management is really just "cost management" for the insurance companies. Kinda goes with the whole "its in your head" mentality you get from many docs who only know how to order a test, but little beyond reading someone else's test analysis. Yes, I'm a real cynic. :-)