Medications & Medication Combos
 

Hi,

My husband has Poly Neuropathy, diagnosed 3 years ago, but suffering for probably 5 or 6 years before getting the diagnosis.

He's on 150mg of amitriptyline, which is a very high dose from what we're told and he's suffering greater side effects and it's not treating all his symptoms. We're finding it's progressed from his feet up to his knees, causing muscle weakness and now reaching his hands with pains, stabbing feeling and overall weakness in both the legs and hands.

He previously tried Lyrica with no relief as well as Gabpentine which he reached a daily dose of 2000 which only made him prone to severe mood swings and did much to provide any relief to his pains.

Our Neurologist last suggested coming off Amitriptylne for Cymbalta but that he would have to come off completely the one for the other, which was impossible as anything less than 100 mg of Amitritylne and he couldn't bear the pain.

What I'm wondering is if he can stay on Amitriptyline and add in another drug - like he did with Gabapentin - and if anyone here has a combination of drugs that help. Ideally I'd like to see him lower his Amitriptyline with the help of a 2nd drug so that he has lower side effects of 2 drugs instead of insane side effects from one that still isn't providing the relief he needs.

Thanks

Are his doctors open to prescribing real pain medications such as opiates? Generally with neuropathy pain, assuming that no underlying treatable cause had been found, they will start with Gabapentin, add an anti-depressant at low dose, and then add an opiate if necessary. High dose anti-depressants are by no means primary pain medications.

I have a long standing hereditary neuropathy with muscle wasting and severe pain. The pain is well controlled by 600 mg. x 3 of Gabapentin and 30 mg. x3 of MS Contin ( time release morphine) daily. I also take Baclofen for muscle spasms. I have been on this dosage for some time, but we did work up to it slowly, over several years. I do not have appreciable side effects from this combination beyond constipation and some afternoon drowsiness which may be from muscle fatigue or menopause as much as the morphine.

Pain management is a big challenge for neuropathy sufferers. Sometimes even strong pain meds do not touch neuropathic pain but in my opinion it is worth a try. I have never heard of simply increasing the dosage of an antidepressant as the solitary treatment.

Neurologists are often not comfortable providing pain management. They do not see the patient often enough for one thing. Could his PCP provide this?