Cymbalta
 

I would like to hear some opinions about Cymbalta. I saw my neuro on Tuesday and he suggested Cymbalta at night to relieve my nighttime pain. He wants to me wait until my bloodtests come back (I was just tested for Sojerns and Celiac) He has been calling my neuropathy diabetic but now he feels it is caused by something else. I think what I find hard about taking Cymbalta is the side effects. I have been reading about things I don't want to deal with...high blood pressure -mine is finally controlled - blurred vision -I have enough problems there and also I am concerned it is an antidepressant and I am not depressed. Yet it is the middle of the night and I can't sleep because f the pain. Help!

Dorothy

If you'd like to know more about Cymbalta from people that are actually taking it you might try the Cymbalta group at Yahoo:

http://groups.yahoo.com/group/cymbalta

I moderate the Celexa and Lexapro groups there. The two largest, main, ones. I joined the Cymbalta group because my doc was thinking about putting me on Cymbalta at one point. What I've see so far is there is doesn't seem to an in between. It either works fairly well for you or it doesn't. Period. The 'doesn't' part includes intolerable side effects.

Cymbalta is widely used for all kinds of pain now. PN among them. I think some of the sides depends on the dose. *If* you experience sides that is. There are a number of people that have none at all after the first two weeks.

Look at it this way, if it's not helping in 2 or 3 weeks you can always try something else.

I'm sorry you're having trouble sleeping. That's when my pain is always the worst. I'm one of those people that cannot tolerate sleep deprivation at *any* level.

Hi. I'm on cymalta and was on it before for a few weeks but trying it again. I'm only on 30 because when I increase to 60 I felt dizzy and weird like the other meds. I had a hard time with lyrica and neurontin. Elavil was not great either. I have not noticed any change yet but only back on it for a week and very low dose. No side effects though I don't think. As I have so many weird things going on already. Sorry not much help. I have had before this the worst of sleep issues and it has just gotten worse like over the past 3 nights maybe 4 hours. So I'm not the best judge with the sleep meds. My docs are confused with that as I'm so sensitive to meds yet the ones that cause sleep do nothing. I don't know if its possible to be on a more sleep med and the another pain med if you don't want to take cymbalta? Like when I was on trazedone it helped the best with sleep. Did you discuss your fears with your doc? Also remember side effects like you know are different for everyone and they practically list every possible. Good luck.

What time of day are you taking the Cymbalta? If you're taking it at night and having increased trouble sleeping try taking it in the morning instead. That often helps that situation and it's the same, if it makes you groggy during the day and you're taking it in the morning switch to taking it at night about an hour or so before bed.

Oh thanks. No I have had the same sleeping issues before this med. Sleep meds don't make me sleep. In the hospital they gave me so much and I still was awake and everyone else was sound asleep. Not sure why. My old psych said I was on enough sleeping meds for a horse yet other meds I can barely handle at a low dose.Thank you though.

That brings to mind a lady I used to work for: Oddly enough, coffee had the exact opposite effect on her that it should have. She'd drink a cup of coffee and it would make her very sleepy. That might be the type of thing that's going on with you. What happens when you ingest a stimulant like caffeine?

Daniella:

Sounds like your brain chemistry is mis-firing. Like the kids who have ADHD, and they give them the stimulant Ritalin and it calms them down.

I bet you could down a fifth of vodka and go dancing.

Sleep meds have no effect on you at all!!!

How do you get to sleep???

Melody

I'm a nut I know but at least I admit it. I'm telling you I have seen so many psychiatrists and no one can figure it out. As for caffeine well I'm addicted to it and may I thought had something to do with sleep but then in the hospital I had to be off of it for 2 months. Lets talk hangovers it was the worst. I was given meds for that. Anyhow even after 2 months of no caffeine no sleep. No meds really helped with my anxiety/depression. For me it was more just self talk and therapy. I do know that when I was so underweight for 12 years it did effect my brain. When I got nurished I do see how my thinking is clearer. So maybe the sleep will come too.Makes for long days. All my friends sleep like 10 hours and can fall asleep anywhere. They joke with me that I'm like the mother of the group. If I ever get better in pain I need to be more young.
Dorothy what did you decide on the med?

I haven't decided anything yet. I appreciate the replies and the information. I work full time and it is important that I sleep. I get up at 5 Am and leave about 5:45. Usually, I don't get home until 6PM so my days are long and and I don't get the opportunity to nap during the day. You would think I would be sleepy but I am tired beyond sleepiness. I had been taking Quinine for leg cramps and now the FDA said they cannot be prescribed for leg cramps anymore so the cramping wakes me up. My neuro thought the Cymbalta might be able to lessen the pain and cramping. I am going to call my PCP next week and talk about it. My nuero will put the results of my bloodwork into his note (which he copies to me) and then I will decide. The last thing I need is somethingthat will make me worse. And in truth the thought of an antidepressant when I am not depressed scares me.

Dorothy

I myself, have never been a sleeper. From when I was a child. Guess it's something about my nervous system. The slightest thing will wake me up.
If I'm taking a nap, I always tell Alan, don't you dare come into the bedroom and turn off the tv, I'll wake up". What does he do? Because he can't stand anything being on if I'm asleep (now how silly is this??), he'll try and tiptoe into the room and close the tv. Each and every time, I turn over and say "thank you very much, you just woke me up"

I have (this is my term for it), over sensitive hearing. I do have some kind of high pitch hearing loss. I found that out years ago, when I went for a hearing test. I guess it comes from years of listening to my cassette player at full volume and all those concerts at the Fillmore East when I was 22 years old. I saw Santana, John Simon, Tom Jones perform. I saw everybody. I jumped up on chairs. But all that loud stuff affected some part of my hearing.

So while I do measure at having some degree of hearing loss, I also have this ability to hear stuff that no one else will hear. I can hear the people upstairs play music and I go to Alan: "doesn't that drive you crazy, and he goes "what???" oh that little music?? that drives you crazy?"

I can hear the old people downstairs when they play the italian music. I hear absoutely everything. If the people next door are fighting, or the people who live upstairs from the people next door, I can hear them turn on the music so they can fight and they think no one can hear them. I once heard bodies being thrown across the room. And this is another building over from my house.

I once went outside and asked their neighbor who lives on the other side of them (not near me), I asked him "did you hear the fight last night?" and he said: "you can hear them, you don't even live next door to them". I said "yeah, I hear everything". It can real annoying when your nervous system allows your brain to register unwanted sounds.

I used to have to sleep with ear plugs because of Alan's snoring. He lost weight and does not snore anymore, but I swear I almost killed him once. I need complete quiet to sleep. But now, since I take Alprazolam at 11 p.m. it doesn't matter. I go to sleep and get up at 8 a.m. and feel just fine.

I also don't like to hear the screech of tires, or, if Alan and I are in Dunkin Donuts and people sit down at another table, and they pull out the chairs and make that awful screeching sounds. Goes right through my head.

I believe I have some sort of sensory stuff going on. It's not enough to drive me bonkers, but since I know it gets to me, there's nothing I can do. I can't stop the people upstairs from moving their kitchen table and chairs so they can wash the floor, but boy, when they move the kitchen table and chairs, the screeching is horrible. So I just learned to live with it. I conditioned my responsiveness to not let it drive me nuts.

And this is a person who used to live at discos in the 70's. Makes no sense whatsoever. I can go to a wedding and dance all night. But if I go to the movies with Alan, I have to put stuff in my ears because the sound is SOOO loud.

I also listen to the tv with headphones, so I tune out the rest of the world. I try and not do this from time to time. If I know that no one outside is in the backyard, then I put my tv on regular. But if there's people in the backyard, they will hear my tv and I don't want anybody knocking on the window saying "melody, turn down the tv". So I got in the habit of using headphones. I'm an odd little duck aren't I?

I also don't jack up the sound. I know better. But we live in a world of cars, blaring horns, teens playing music right next door to me, etc.

I will never forget the time when Anthony, the little juvenile delinquent who lives next door, was playing his stereo at night. It was 1 a.m. Alan was at work as a night time security guard.

So there I was, walking in my backyard, wondering where on earth is this loud music coming from. I wasn't the only one. The people downstairs came out of their house and we all looked at Anthony's backyard and into his bedroom window (which was open), and there, at 1 a.m. in the morning, was Anthony listening to his stereo at full blast.

The people downstairs started yelling in italian and grabbed the water hose and were about to shove the hose into his open window. Thank god I stopped them. They were going crazy. I just yelled at him. He stopped. He closed the window.

I wish I sometimes lived in the country like my friend does. She goes in her backyard and there are deer, and little animals. Now I don't like that stuff about animals coming to the back door, but I sure would like to be surrounded by quiet.

Melody

That makes much sense. What you said about maybe the sleep issues will clear up. I believe you may be correct.

You may simply be one of those people that meds they give you for specific treatments work in ways unexpected from what they should be doing. If this is the case than maybe herbal types and supplements and vitamins might be the way for you to go.

The B-12 is good for depression and anxiety. One of the symptoms of a deficiency is depression and/or anxiety. Being mal-nourished as you were I'm betting you are lacking or low in many nutritional areas and a pox on the tests they run for this. They simply are not accurate or adequate.

Dorothy, are you using magnesium?
 

and Calcium in the proper ratios?

Cymbalta has some usefulness in chronic pain states where the brain overfires and gives faulty responses. As in RSD and fibromyalgia. Cymbalta has some usefulness and it works centrally.

However, having SSRI actions (along with some norepi reuptake), is not a good idea for cramping. People using SSRIs can develop muscle tension and cramps.
This is due to the fact that SSRI drugs reduce dopamine over time. Dopamine agonists are typically used for cramping, and RLS symptoms like you describe.
These drugs are typically Sinemet or Requip or Mirapex. However, they too have side effects and people often don't like them.

The best thing to try is a good absorbable magnesium. Support that with high potassium containing foods, and good absorbable calcium, and leg spasms should improve.

I don't recall what other drugs you are on, but sometimes you get cramping/spasms as a result of nutrient depletions that other drugs cause.
For example: diuretics for blood pressure.

If you try Cymbalta--be advised that it is VERY difficult to come off of. This would be in the 6mos+ time frame. Even the sales reps who sell it and use it ...discuss this negative attribute (at www.cafepharma.com Eli Lilly board). It is similar to Effexor, and that too is hard to come off of, and requires a slow taper and time.

Yes, as you point out they say the same thing about Effexor. I just came off Effexor (About 3 years on it). It was nothing like any of the horror stories I've heard. I was only ever on 75 mg so that may have something to do with it. It took me a total of about 3 months to come completely off Effexor. Took me 6 months to come off of 40mg of Celexa. The withdrawals I *did* experience were the same for both drugs, oddly enough. The worst symptom I had and it was more annoying than anything was this odd feeling behind my eyes. Like when you have a fever and you move your eyes. I never did have any brain zaps or anything like that. No nausea... What I'm trying to say is these drugs effect each of us very differently. Which one of the SSRI's (dual inhibitors included) works well for me may not work for anyone else the same way. Weaning off can be an individual process as well. There is no "one-size-fits-all" when it comes to these kinds of drugs. Period.

My NP is probably one of only a few of the GP type docs that I know of that is familiar with what the withdrawal time frame really is for SSRI's. So many people have told me their docs think they can just stop taking it in a few weeks. 3 at most. Many of them have told their patients they can simply stop taking it.

I agree: Try the mag first. Try anything else that has a hope of working before going to any kind of drug that 'plays' with your brain chemicals.

I experienced the first and only suicidal depression I have ever had late last fall or there abouts. And it was due to medication I was given for PN. It seemed to be a bad reaction between the Gabapentin and the Effexor Gabapentin did a big number on me. It just occurred to me while writing this post that my determination to not be on these kinds of drugs anymore is because of that suicidal depression. Now I *know* what the worst feels like for me. And nothing I had ever experienced prior to that was as bad. Well, perhaps the anxiety...that felt pretty bad. :p But I don't think I'll be needing any kind of AD anymore.

Someone correct me if I'm wrong but I think a lot of us find this board because we're pro-active when it comes to our own care. I don't know about anyone else but I *know* that doctors are just human and make mistakes and they certainly do not have all the answers. When my neuro told me no known cause I was a bit confused. How could something that causes such damage and discomfort have no known cause? Granted, there are some Dx's of PN that don't have any cause that is found easily. But I also believe that eventually they will find all the causes. And that treatments will involve more than simply throwing meds at the symptoms. That's what many people are dealing with right now, only treating the symptoms not the underlying causes.

Mrs D.

I am taking magnesium...400 mg of magnesium oxide, and calcium 600 mg 2x /day. I take atenolol for my bp and also diovan (which does have 25mg of hctz) Of course I take the b vitamins and 2800 mg/day of neuronton. I take alpha lipoic acd also.

Sometimes I thing I read something and someone says it is good and works well so I try and and now I have found myself taking 24 pillsa a day. Beforethis began 7 years ago I only took one pill a day. it just amazes me.

Dorothy

Check out the latest on the news regarding SSRI's of which Cymbalata is one.
SSRI's are associated with bone loss in the elderly...they did not define elderly. Now I assume they used a control group not on SSRIs and one taking SSRIs and did bone density tests. I don't know for sure what variables they controlled for or what they defined as elderly. Post menopause usually gets us females tossed in that group.

I have always had my concerns regarding SSRIs, predominantly because they are the most prescribed drug. They are generally the first prescribed drug even before any test is done....what is wrong with that picture?

Prior to SSRI's hitting the market, drugs for depression were more dangerous and less often prescribed. You had to see a therapist for 8 weeks first....now we have a new use for those old drugs...pain control (tricyclic antidepressants)...Those are highly anticholinergic and if you look up what an anticholinergic does, you will see what a lot of folks have as symptoms of disease or side effects.

SSRI's combined with tricyclic antidepressants are a recipe for disaster. I refer you to the Cytochrome P450 chart online. SSRI's impede the metabolism (efficacy and excretion) of many other drugs.

If Cymbalta works for you fine. If it doesn't you'll know. For myself, I tried it and after 3 pills I thought I would die....that solved my indecision. Other people love it.

By the way, Daniella, I don't sleep either, and I have what are called 'paradoxical reactions' to medication. I have had episodes of 'anesthesia awareness'. I had a C-section when they thought I was out...I wasn't. The worst was getting intubated...sometime after that I konked out, but by then they had already cut...I had a lovely girl. She is in her 30's now. I had one other episode with general anesthesia...I crashed upon 're-entry'. My BP and P and temp plunged....simply described as shock. I can not be put to sleep with massive doses of choral hydrate. Benadryl keeps me up and ticking with bodywide RLS for days as does any anticholinergic or antidopaminergic. There are a few old standbys that I predictably react to...and that is it. Those are mostly the drugs that doctors are loathe to prescribe.

Good neurologists admit they don't know much about neurology, nor the drugs they prescribe. Mine aptly asks me what 'poison' I haven't tried yet, and we together decide what 'might' work...(haven't had a lot of luck.) Mind over matter seems to have been my best medicine, and lately, my mind doesn't matter..it isn't working all that well for me either. Eh, tomorrow is another day.

We are not all wired the same. It doesn't mean we are sick, because we react differently to meds, we are just wired differently.

You can be phenotyped to see if you have any genetic polymorphism in the identified families of the Cytochrome P450 system. Some people just can not tolerate some drug 'families'. Plus people with autonomic neuropathy have a tendency not to react predictably to drugs.

When new drugs come out, I prefer to let a few million other folks down them first, and see how they fare.:eek: Then again, I simply refused to eat Chinese fish when I saw them on the market too.;) Unfortunately most of us have enough melamine in us to be featured on HGTV, not to mention the raft of antibiotics we eat via animal products...Ah yes,
back in the old days we just had cholera and tetanus...it was so much simpler then.:eek:

oxide form doesn't work well, or at all basically.
 

Dorothy, Magnesium Oxide does not work....please read my mag thread on
the vitamin forum:
http://neurotalk.psychcentral.com/showthread.php?t=1138
There have been studies showing very poor absorption (around 8mg for the 400mg dose) of oxide form. I have alternate suggestions on that thread that work much better. In comparison 3 oz of unsalted almonds have 270 mg of Mag available to you naturally.

Cymbalta = evil
 

you know, more power to those that Cymbalta works for but I found it made my pain worse.

I was originally being treated for RLS which is how I ended up on it. Turns out it is a painful small fiber PN of unknown etiology at the moment (well, so that's what they think it is now, who knows what the deal will be in 2 years or so).

So my experience was that the pain was worse as well as the buzzing. I also got whole body jerks as a side effect whenever I was attempting to relax. They weren't constant like every minute but would come completely out of the blue. *If* the drug was working, this wouldn't have been a side effect that would have caused me to get off of it.

I did think it negatively impacted my sleep...night sweats, extra bad nightmares, seeming inability to get into deep sleep...

And yes, getting off of it was really crappy..I was awfully moody and the sleep got worse before it got better.

Unfortunately since these drugs effect us all so differently I think there's almost no choice but to at least try them because there's no definitive measure to determine whether or not it's going to work for you.

My new best friend is currently a low dose of lyrica 2x a day, works pretty good for me but I know others have had different experiences.

Cymbalta
 

just enhanced the side effects of Lyrica and Tramadol of which I had maxed out on, add to that Vidicon the drug HOUSE craves and is very additive. After 5 years of seeing all kinds of doctors and the testing involved I quit everything cold turkey. Was fortunate at the time of reading an article in the neuropathy association newsletter from a medical university on the west coast about using marijuana for pain control. No wonder the government keeps this stuff illegal it works. 75mg Lyrica x 2 with a half bowl of THC at night 1 hour before bed time makes for a good nites sleep. Yesterday I was back working in the yard repairing some bird feeders when my wife came out with a glass of lemonade gave me a hug and said "Welcome Back" . My pain levels have dropped to a 2 level since this transition and not being a mental and physical cripple is a born again experience. The best thing about going cold turkey was the diarrhea an empty colon is a happy colon. IMO being bound up all the time is a major source of depression. If you have any questions ask me and I'm not a drug pusher or dealer, just an old cat who won't tolerate putting up with pain

Hi D and S
 

Dorothy i agree with the Dr. wait until your blood tests come in . Sjoren's
can play all sort of tricks on the body. I have a terrible time with sleep-
ing problems,and nothing knocks me out.

Hi stagger good for you,i wish they made that legal everywhere. Sue

I use Cymbalyta
 

I take 40mg a day. No way does it touch my NP pain. But it works good for my depression. It works better than anything else I have been on in that aspect. I don't know what a dosage would be for it to work on my pain. Because there isn't a generic for it, it is pretty expensive. Luckly, my insurance pays for it.

Hi. Like I said I'm on Cymbalta and it just got increased to 60mg at dinner from 30. They said at cc that to work for pn the dose needs to be really high. I'm not sure how much that means though. I meant to ask and will on Thurs and will later tell you.

From what I know of Cymbalta it works well for some and not at all for others as far as pain goes. Of course that's the same old song and dance heard about SSRI's right from the beginning. It may take a higher dose to work for your pain. But there are more sides at higher doses usually.

What many people don't realize is that all the information in the prescribing info comes from short-term limited patient studies. I saw none that were based on a length of time greater than 6 months. After 6 months who knows what happens? Many people state (on various boards I've read) that the weight problems and other sides don't begin til right around or after the 6 month period. The drug companies are so intent on making money they don't want to take the time to do longer term studies before putting these drugs on the market. Scary isn't it?

Your right not just on meds but all different aspects of health care there is very long term follow ups. I think they look for just the basics and the move on to the next to save time but in the long run I think makes things longer. I was wondering if anyone knew the optimal dose for cymbalta for pain relief and is it always given all at once during the day. Like right now I'm up to 60 but at dinner and was wondering if it could be split up and then increased like neurontin?

I think that's something you need to discuss with your doctor. Being as these kinds of drugs work so differently for each person there is no optimal dose as far as that goes. It's a hit and miss situation. You may have to have your doctor just up the dose and see what happens.

I have to say this: Every time I see that someone is taking Neurontin I shudder. Neurontin, for me, made my pain worse the longer I was on it so the dose was increased. Oh, it worked fine at first. But after a few months the dose had to be increased. I was getting to the point of needing *another* increase when I stopped taking it. Most likely related to causing B12 deficiency. It also caused weight gain and bloating as well as suicidal depression for me. I'll never take it again.

I had bad reactions to neurontin too. I'm having such a hard time with meds. When I was on cymbalta 30 I was fine and took it at dinner. The first few days of the 60 I was fine but then I was so nausea last night I was on the floor in the bathroom. I didn't throw up though. I wonder if I could split it up and it would be easier on the systom. I will try though again though tonight before I ask.Jarrett what meds are you on now?

Daniella, have you ever taken a narcotic for your pain?

Yes I was on vicadin but off of it for 2 weeks and tramadol. There is no narcotics or pain killer use at the cleveland clinic so I had to go off. I'm not a med person at all. I always get other side effects but at the same time need some relief when doing more. I have been prescribed too naproxen I think and motrin 600. I'm trying not to take any so just pushing to the limit where I don't need but sometimes even at rest I do. I just know with the anti depressent for pain relief it takes awhile, a combo of meds,or a super dose. I can't imagine with the troubles I seem to have with meds. They sure as hell don't make me feel less depressed. Now or even in the past when I used them for that. I felt worse in that department. I must be a real nut that they don't even help. Hey at least I admit it. Just kidding.

I am a big believer that everyone should find a doctor they like and then take his/her advice, not try to get medical treatment form a forum like this, but it is interesting to hear what other people take and think and discover. So I am not recommending what I say, just throwing my two cents worth in. I feel like with narcotics, they have been around a long time, and there is a huge amount of data on them and their side effects and what happens long term and the fact that people who take them for pain relief rarely get addicted. They are not perfect, but we do know all the parameters about them. Now I take Lyrica, but with this and the other, newer, drugs, we really have almost no body of knowledge about them: how they will affect our health long term, what they might be doing to us in the way of side effects, etc. So I really do not understand why so many doctors are so hesitant to prescribe stuff like the fentanyl patches (a narcotic -- which I also take). The new stuff may turn out to be much more harmful in the long run -- or even the short run. It really frustrates me that people in terrible, life changeing pain are made to take all these new drugs in lieu of narcotics when they haven't even been tried on the best narcotics, like fentanyl, to see how they tolerate them or respond to them. I think it makes sense to try narcotics before going on a bunch of new stuff, or trying a bunch of expensive, less effective stuff like biofeedback and relaxation crap that has never been documented to be effective for severe chronic pain. So that is my two cents.

Word, Dakota.

I am on the Lyrica at a low dose for about 3 months 2x a day and the pain is greatly controlled...don't usually get pain until my day is winding down...7 PM. Sometimes it's not enough on the pain/disruption of life scale for me to take anything but about 60% of the time I take 1 5-500 Vicodin and it does the job. Now, my Dr has indicated that she'd like me off of the narcotics but I don't get any euphoria from this dose, I don't have a dependence on it...I've gone 3+ days without taking one. So why should I switch to, say, tramadol? It's just something new in my regimen that may or may not be fitted in easily...Why upset the apple cart, if you will? I feel like I've had to try so many different things over the past two years that I've been seeking treatment that now that I'm almost on a level plane, I'd like to try and enjoy my life for awhile...keep things status quo..

Boy, I soooo agree with you. Have you expressed this to your doctor? I think you are right on.

I agree about talking to your doc. I jus came from a pain program where the only meds allowed were the anti depressents. We were educated on the why's and I see both sides. I did express cause I have never had the overuse issue that I feel it needs to be on ones needs. There came a point in the amount of physical therapy they had me through that mental coaching and writing about how I feel about the pain didn't cut it. I still have been off all the pain killers like vicadin,tramadol for a few weeks and though my pain is horrible I feel better in certain ways. They are thinking for me doing that epidural where meds are put in all day but I'm waiting to see of progress on my own. I do know the frustration your in but as a person who has high liver enzymes and I know those pain killers add to this I don't want to sub one issue for another so you may want to think of that too. Maybe getting a feel on the why from your doc and then weighing your options. You want to think long term too. Hang in there.

Tramadol is an opiate type drug. It works well for me. I take it several nights a week at this point. If I'm not mistaken Tramadol has been around for some time. It's prescription name is Ultracet. Oddly enough, I'm sensitive to all the other pain killers out there. They put to me to sleep and one dose can leave me groggy for two days. Tramadol has the opposite effect on me. It wires me. For me this is a *good* side effect! :D That's one of the things that has kept me off most of the other drugs out there used to treat both RLS and PN. I feel like I have no kind of life on the other drugs. To be fair I've not tried the newer ones and to be honest I'm not sure I want to. I always seem to get the worst of the sides of any drug prescribed for me. So for now I'm sticking with the Tramadol. It works and works well for me with minimal sides.

I do plan on discussing this w/ my doctor (see her on 7/30), see how she likes the 'more active' role I want to play with my treatment. She doesn't seem to specialize in small fiber PN but since I appear to be on the right path I don't know that I see the point in going to a PN specialist until or unless it really makes sense to begin that process of rebuilding a relationship with a new doctor. Hi, I'm new, give me some vicodin. Don't worry, I don't abuse it. Doesn't work so well...

My PCP recommended a rehab/physiatrist route months ago when I was in bad shape <read: cymbalta and requip and 24/7 pain> and taking 3 vikes a day and I was really agitated with the suggestion. Problem is untreated pain, not the 3 vikes. I have a good relationship with her and I know she was trying to be helpful but it's not like there was anything specific to rehab. I didn't have any surgery, complications, diabetes, comorbid condition, accident, etc. My legs just have always hurt--but it didn't used to be all day and every day. I'm not thinking that 'learning to live with the pain' by writing out my feelings is going to do a damn thing. I'd rather burn my eye balls out with white hot pokers.

Now, I truly don't mean to be harsh.--And daniella, what a crap fest that you've got additional complications that make the no pain meds road an almost forced path--One just tends to read more not-good stories about rehab/pain mgmt places than good ones. I know there's a protocol they must follow because some of the non-pain med things DO work for some people...yada, yada, yada.. But, in this societal environment where prescription meds are close to surpassing illegals as recreational drug of choice (it was on the CNN ticker a few days ago), I understand that everyone will get a higher level of scrutiny.

Jarrett, the last thing I want is being wired since I'm taking it at wind down time! I'm not saying I won't try the ultram either..I'd just prefer it to be on my own timetable if I can make it so!

Hurty, first if I'm confused about your statements I'm sorry. I think for me finding the right combo. I think the program I was in and though couldn't complete cause of how bad my pain was was helpful. In the way that it pushed me to do more through the pain and work through the mental and physical ups and downs. I think the part of writing my feelings has helped in some ways but like I said there was a time where doing that was not acceptable form of humane treatment in my case there. I had went from basically bedrest to being on my feet full days and in pt with swimming so on. There needs to be a combo and maybe if you keep an open mind and work with meds but also rehab it may work so you can have less meds. I know the mental part does not take away from the pain but working on coping can make it easier to deal with and to take the next steps. There was a post about coping here and I was confronted on my past thread how my coping was not good and still may times is not. I'm not sure what a pcp is but maybe it is time if you feel not being helped to go to the specialist. I know my last doc I saw really helped me realise how important though so painful to be on my legs and rehabilitate them. I still fear making them worse cause often feel it is but hopefully in the long run will make it better. I'm also in a different issue then some here to so get different advice I feel sometimes based on my age and also this is my only dx and is supposed to be treated similar to rsd. Ok take care and use your voice.
Jarrett I understand with you and I have the worst issues with meds. Its like switching one issue for another. Jarrett I was on tramadol which didn't help but my doc wanted that rather then the vicadin. Are you on slow release cause I heard that is better for long term. I was just put on doxipin has anyone used this and its in addition to cymbalta. I hate new meds and also why I fear the catheter.

daniella, just to clarify, I wasn't trying to indicate that pain clinics aren't good options and that they don't work for anyone (just in case my previous post was jumbly).

I'm glad it helped you out some <yay> but I'm also not clear on your story, if you will,...spinal impingement, degeneration, diabetes, surgery, car accident, etc.. I was just trying to relate that since I personally had no precipitating factor/disease that resulted in the pain, physical therapy and other standard injury recovery (and related) programs probably wouldn't fit in well.

pcp = primary care physician

:hug:

Actually the pain clinic was not good for me in the way intended but did show me I have to push more through the pain and I need to cope mentally better. I'm not sure how my pn started. It may have been because I overused it in exercise with the result of this or from years of eating disorder though healthy now with that. There is no real answer. I do know for me they have stressed since my treatment needs to be like rsd treatment though not it I need to do a lot of physical therapy. I fear that but have really been pushing and the program showed me that I have to. I didn't mean to offend you if I did. I really think everyone is different. I think for me I have such issues with meds and I am young which is a big factor with already high liver enzymes the meds are not the greatest for me. So for yourself are you worried about the long term issues with meds like vicadin? I know you said you were on Lyrica low dose but have they thought of increasing so maybe you would need vicadin less? I have no clue and am sorry not much more to offer. Up till this year I had never heard of this issue or these meds. I learned more about them at the clinic but really don't know how long a person should be able to stay on vicadin or similar without bad side effects. Take care.

There are some people who simply can not take any SSRIs, tricyclics or tetracyclics, so their options are limited.

Besides small fiber neuropathy, I also have herniated discs in my t spine that are inoperable and I had 3 spinal nerve root blocks I wish I had not had. To get to those discs they have to do open chest surgery and move over my internal organs and deflate my lungs and cut ribs, hardly a recipe to relive chronic pain. Besides that, I had spinal anesthesia for 3 c-sections back in the 70's, due to an episode of anesthesia awareness for an emergency c-section for my first child. Can you imagine waking up during that open chest surgery?? My current neuro feels my spine has had too many intrusions, so he isn't keen on any more pokes in the spine for me.

It is obvious that I have some polymorphism that makes me not tolerate drugs the way normal or average people do.

I just tried a second trial of Cymbalta and failed miserably getting so sick I was bedbound. I have reacted like this to almost every SSRI, and feel that I should be probed for a possible Carcinoid, or at least typed for a Cytochrome P450 polymorphism.

I have a very limited repetoire of tolerable drugs and unfortunately if I really want pain relief it has to be an opiate, and I seldom get a script, or have to ration it so judiciously that I still rate a 4 or 5 on the scale. Plus, opiates do not sedate me, they cause paradoxical excitation. Benadryl, chloral hydrate and other drugs that knock most people out, cause me to be up for days, not to mention the restless leg, arm and back I get.

Every intrusion into the spinal canal has potential for scarring and other issues as well. As far as exercise goes, yes it is good and it needs to be adapted to your condition...however, I was a sprint triathlete, and I hurt as bad when in shape as when out of shape....Movement is important to keep our bodies in working order. We were not meant to be sedentary. Moderation is key, but it still hurts to do.

I think every person needs to find their own balance, take as few meds as possible, keep their stress level manageable, exercise as tolerable, work to resolve emotional issues that come with disease and trauma, eat as healthy as possible. It is difficult to live with a condition, especially if idiopathic, that causes pain and disability, and doesn't have a treatment or cure, or predictable prognosis.

I am not fond of pain clinics, as you said, they only permit antidepressants, and that is very simplistic. Before antidepressants are administered, I believe the patient should be genotyped. That is just my opinion.

Antidepressants are the most prescribed drug. I just do not see them as the panacea they are made out to be. On the otherhand, narcotics need to be reserved for cases that have demonstrated clinical pathology, have not responded to other treatments, have no reasonable possibility of recovery via other modalities. No matter how sick or injured you are, narcotics are stigmatizing, and will affect how many medical providers view your case. It is the world we live in.

I'm using the regular generic Tramadol. I only take it when I need it. Which is usually a few nights a week.

I thought I'd answered this already. Guess not! Sorry about that. Other than my vitamins and supplements I take Tramadol and Atarax. Only when needed which is usually a few nights a week. In order to sleep when taking Tramadol I take 1 Atarax per every Tramadol. So I took two of the 37.5 Tramadols I take two 10 mg Atarax. That's pretty much it for my meds at this point. I've been off the Effexor XR for over a month now and about 4 months off the Gabapentin.

cyclelops -- I'm the same way with benadryl, nyquil, tylenol PM, etc. I get wired immediately! My hubby, OTOH, nyquil knocks him right out. It's not fair! I also didn't tolerate any SSRI's--and they didn't do anything for the pain either so it wasn't a hard choice when it was time to stop..and I've tried a few. As I've said before, I'd like to find one person who isn't depressed and is using cymbalta successfully just for nerve pain. I haven't really been able to find any. They must be so successful in their treatment that they aren't actively posting on PN boards!

daniella, you didn't offend at all, no worries. I think maybe I just don't know enough about pain clinics and their approach to treating folks with pain who aren't a) addicted b) drug seeking c) recovering from surgery or accident...

If that sounds confusing, I guess I mean I understand rehabbing from stroke, broken leg, etc. And I also understand that people sometimes have adverse recovery from these things where the pain level doesn't die down (is that the RSD? not sure). I completely understand the aspect of getting someone with an intolerable pain level to find and learn alternate ways to cope so that they may ultimately be able to live with less hard core pain meds and still have a life. I'll just go kicking and screaming down that path if and when I end up on it.