Elavil or Nortriptyline?
 

I'm on Lyrica, 200 mg. per day. Every few weeks it quits working, so I have to increase. So now, my Dr. suggested adding an TCA like Elavil or Notriptyline to the mix. Anyone here used a TCA with Lyrica and if so, which one did or do you use?

I've heard that Cymbalta is great, but I don't tolerate that class of drugs well. So, first I'm gonna try a tricyclic.

Elavil has shown effects in inducing growth factors in the peripheral nervous system. The other TCAs have not shown this ability. So it would be preferred. But nortriptyline has fewer sedative side effects.

There is an article here on this forum about the new Elavil research. I don't have time to search for it now, since I am leaving in 10 degree weather to go the hospital for my lab work.

thanks Mrs. D. I'm going to have to make a decison now. I had planned on the nortriptyline due to less side effects. I've used Elavil in the past but the side effects were hard to deal with.....much to think about now.

I am actually on Cymbalta.......
 

I know you said you don't tolerate that class of drugs well, to be truthful, just FYI, I don't believe it has done anything for my nerve pain, as it has been lately advertised for. As far as for my depression......I think you can guess by my last few posts how it working for that!

Here's the article
 

Wow..........
 

Very impressive.........I think I am going to ask to change over to it.

Not only for symptomatic relief, but it sounds like it may do some repair work (if I am interpreting this correctly)

Thanks for the info.

I was on Elavil for 7 years for bladder pain. It worked very well. I took 50 mg. but it took me 5 months to work up to that dose. That is why I was considering trying the nortriptyline this time, less side effects. When I went off the Elavil 5 years ago to get pregnant, my bladder pain was significantly improved, might have been some repaired nerves? Who knows.

The doses typically used for PN are smaller than antidepressant ones. I would not expect much in the way of depression alleviation therefore.

Thanks for finding that article. I had to go out in this frigid weather, for medical tests at 7am (fasting). It was 6 degrees out!

They had told me that I wouldn't get an depression relief from the 50 mg. of Elavil I was on, but honestly, I can say, that the 7 years I was on Elavil were my happiest every. So for me, it did help. But I respond to mouse doses of all meds! Except Lyrica.

If treating depression & neuro pain.......
 

wouldn't it be reasonable to take a higher dose if one wanted to treat depression and neuro pain. I would assume it would work even better for neuro pain at a higher dose and also help depression. Is my thinking wrong?

Most doctors are afraid of high dose TCAs. This family of drugs can cause long QT syndrome, and affect the heart.

Low electrolytes (low potassium and low magnesium) can also bring this on when you are using a TCA.

more here:
http://www.azcert.org/

Any dose of TCA may do this, esp when mixed with other drugs on the lists. However, mostly it appears when people overdose (depression patients may take overdoses in suicide attempts), or when electrolytes get low from diarrhea/vomiting.

Recovering from an overdose of TCA is not easy, so doctors are afraid to use high doses.

50mg of Elavil is not a typical dose (or higher) for PN. Typically 10-25mg are the more common doses.

If a doctor goes higher, then he is seeking a bit of antidepressant action, as well.

You can be screened for long QT with an EKG.

I was prsecribed 10mg and felt it wasnt doing any good so the doc prescribed Imipramine and still I think I am taking it needlessly, I may try doing without. I am afraid to speak too soon but my Lidocaine Infusion seems to be giving really good results, the past three weeks have been lovely and I have just had another so am hoping this will last through Christmas.

Lidocaine infusions
 

Are dr.'s doing lidocaine infusions in the US?

Yes, but mostly we see that intervention on the RSD forum.

If you search "lidocaine" there you'll find those posts.

There is a poster there currently who gets these infusions regularly.

Mrs D, why are US medics not using Lidocaine Infusion for PN?

I really don't know. Medical habits...treatments, get very cultural. In US there is a liability term used called "standard of care". So most doctors have journals which explain this, and they all sort of band together and adhere to it to keep their insurance premiums down.

Daniella ( she also has RSD) here was offered a lidocaine infusion. And I have read on another board--at another site-- in the past, some chronic pain patients have tried it.

Some RSD doctors offer it here in US.

Lidocaine does affect the heart, and so there may be a liability constraint here.

Here is an article illustrating it:
http://www.ionchannels.org/showabstr...?pmid=10863041

and this:
http://www.medscape.com/viewarticle/409782_4
(you have to join --it is free-- to view medscape)

I really think it is a benefit vs risk decision. (both for the doctor and patient)

I've been on Elavil (50mg) and Gabapentin 600mg 2x for about 5 months. Pain relief, not really. Now my neuro is adding Carbamazepine, which I guess is another anti-seizure med like Gabapentin. Well, at least he's trying something...my last doc refused to prescribe anything at all for me.

I can't believe these Doctors who won't prescribe anything. I'm glad you found a new Dr. You are on a low dose of Gabapentin compared to some people. I hope your new med helps you.

Thanks rose. Yeah those kind of docs...and then there are so many laypeople who disparage medications too. They say, "you just want to take a pill to make it go away" to which I say "YES, that would be the best of all possible worlds, you %#&ing idiot!" I don't really say it. But I think it.

I was on 3600 mg/day of Gabapentin before. One of these days we're gonna find the right combo...I hope soon! This doctor does seem like he's trying. He ordered a new EMG for me and is going to perform the test himself..pretty fancy-schmancy, eh?

I have thought %#&ing things myself.....
 

I must confess.........like those people wouldn't want it to go away if they were in our (painful) shoes!!!!!!!!!!!