[debbiehub]

Has anyone tried Savella. My PM Doc said it is the new cymbalta..Nothing agrees with my stomach but I will give it a go this weekend...

[Mycah]

I have not tried Savella. My PM NP suggested Savella this week when I told her I was seeing a psych doctor soon. I like that it's supposed to help with pain and brain fog.

Good luck with it and let us know how it goes.

[fmichael]

Hello there. Looking at the FDA approved prescribing information sheet for Savella, it's hard to tell it apart from Cymbalta. http://www.frx.com/pi/Savella_pi.pdf they are both Serotonin–norepinephrine reuptake inhibitors (SNRIs), for which there is a decent Wikipedia article @ http://en.wikipedia.org/wiki/Seroton...take_inhibitor

In particular, in the prescribing insert page, check out Paragraph 5.4 and the warning that SNRIs can increase heart rate and patients heart rates should be check before they go on the drug and periodically thereafter. Based on mt experience 10 years ago at UCLA, where an adult ADHD clinic put me on a related SSRI end the first time abyine checked my heart tate was when I presented in the ER with tachycardia (that went away as soon as the med was out of my system) I would guess that these warnings are there to protect the manfacturer, knowing full-well that too few doctors will follow it in practice.

I have tried SNRIs as well, but they just make my spasms worse. Perhaps other people find them useful. I would just note that while Savella has been approved for fibromyalgia, amd the supporting studies are referenced in Paragraph 14 of the Savella's prescribing information sheet - and set in a particular pdf format that makes it impossible to copy - there is apparently at least some suggestion in the literature that these studies may not be generalizable to other brain conditions. See, Serotonin-norepinephrine reuptake inhibitors for pain control: premise and promise, Marks DM, Shah MJ, Patkar AA, Masand PS, Park GY, Pae CU, Curr Neuropharmacol. 2009 Dec;7(4):331-6.

Department of Psychiatry and Behavioral Science, Duke University Medical Center, Durham, NC, USA.

Abstract
The precise mechanisms of pain perception and transmission in the central nervous system have not been fully elucidated. However, extensive data support a role for the monoamine neurotransmitters, serotonin and norepinephrine, in the modulation of pain. Experiments with animal models of pain indicate that noradrenergic interventions, and to a lesser extent serotonergic interventions, reduce pain-related behavior. This is supported by data from clinical trials in humans in which antidepressants have been shown to reduce pain and functional impairment in central and neuropathic pain conditions. These effects are particularly well-studied in trials with serotonin-norepinephrine reuptake inhibitors (SNRIs), which have provided a useful tool in the clinician's arsenal, particularly considering the limitations of other classes of pain medications such as opioids, anti-inflammatories, and anticonvulsants (i.e., limited efficacy, safety and tolerability issues). Moreover, painful physical symptoms are frequently comorbid with major psychiatric disorders such as major depressive disorder and anxiety disorders. This paper reviewed and summarized the rationale and potential role of SNRIs for the control of pain including clinical and preclinical background. Currently evidence does not definitely support a role of the SNRIs, while limited data propose a putative promise of SNRIs in the treatment of pain related disorders including fibromyalgia and depressed patients with multiple somatic complaints. More researches are warranted to generalize currently available preliminary evidences.

PMID: 20514212 [PubMed - in process]PMCID: PMC2811866

http://www.ncbi.nlm.nih.gov/pubmed/20514212

I will post if I can get a copy of the article.

Then too, even if Savella is 30% effective on fibrimyalgia pain, and assuming that carries over to CRPS, I am not aware of any claim that Savella - or any other SNRI - modifies the loss of executive function found in Fibromyalgia, which, along with selective memory issues is part and parcel of CRPS:

Fibromyalgia is a pain syndrome that is thought to be related to CRPS. Recent functional imaging research with patients suffering from fibromyalgia reveals an altered network of neural structures involving dorsolateral and orbitomedial frontal areas, the anterior cingulate, and, in some studies, the parahippocampal gyrus (Burgmer et al., 2009; Kuchinad et al., 2007 ; Schmidt-Wilcke et al., 2007). Luerding, Weigand, Bogdahn, and Schmidt-Wilcke (2008)also studied a group of patients with fi bromyalgia by using MRI voxel-based morphometry (VMB) and found an association between poor performance on the digits backwards test and a decrease in frontal lobe activity. Derailed or altered functioning in a network of anatomic structures, as described above, would be consistent with the executive, naming, and episodic memory defi cits seen in the current research.

Neuropsychological deficits associated with Complex Regional Pain Syndrome, Libon DJ, Schwartzman RJ, Eppig J, et al, J Int Neuropsychol Soc. 2010 May;16(3):566-73, E-pub 2010 Mar 19 at *6, FREE FULL TEXT @ http://www.rsds.org/2/library/articl...ychol_2010.pdf

Quite frankly, as far as "brain fog" is concerned, I frankly don't see any applicability of SNRIs where it's not simply a matter of chemical imbalances in the brain, but actual "cortical reorganization" as well as a loss of certain cotical gray tissue. See, The Brain in Chronic CRPS Pain: Abnormal Gray-White Matter Interactions in Emotional and Autonomic Regions, Geha PY, Baliki MN, Harden RN, Bauer WR, Parrish TB, Apkarian AV, Neuron. 2008;60:570-581FREE FULL TEXT @ http://www.rsds.org/2/library/articl...aliki_etal.pdf AND Libon et al (2010) (above).

Hope I'm wrong.

Mike

[Mycah]

Mike, good to know about the tachycardia issue. I've also had the same ER trip for it and have been on Verapamil ever since.

Will be interested to see what medication, if any, psych recommends for me. I was on three different psych drugs (one at a time), including Pristiq, about nine months ago. One made me break out in hives and the other two made my skin burn more. At the time an RSD dx wasn't even in the picture.

Blunted emotional decision-making capabilities, that's me.

[fmichael]

Yup. My Dx stays in that range as well, with alternative diagnoses of Personality Change Due to (underlying medical condition: CRPS) (DSM iv 310.10) and Mood Disorder Due to Underlying . . . (296.83).

The best I can do to maintain alertness is a combination of the following:

Namenda (memantine HCL) (10 mg.) [3/day]
Razadyne (galantamine HBr) (16 mg) [1/day]
Provigil (200 mg) [3/day]
Wellbutrin SR (100 mg.) [2/day]

That said, I've been on Namenda and Razadyne - two drugs commonly taken to slow the spread of Alzheimer's disease - for years. I don't know if they did anything to slow the onset of the fog, which rolled perhaps 2 years ago, but haven't done anything to mitigate it since.

Most impotantly, when all I had was ADHD, a slightly smaller dose of Wellbutrin was sufficient to totally compensate for it, for about a month, and then I developed extreme out of the blue anxiety - enough to leave me close to cowering under my office desk - until 6 weeks of Clonazepam brought me back to normal. But now the Wellbutrin neither appears to (significantly) cut the fog, although with the Xanax I take to control shhoting pains, along with a small amount of Clonazepam for opioid induced aggitation (as the levels in my ststem go down), Wellbutrin at least is no longer bringing on anxiety.

But the lack of effectiveness of Wellbutrin now, as opposed to when there was only ADHD(I) to deal with, that is the most telling, at least with regard to the loss of executory function, e.g., organization.

And while Provigil works well for me in staying awake through Baclofen and opiods - as opposed to the newer Nuvigil that kicked my BP up by 40 pts. on both ends - it doesn't appear to do anything for either executory dysfunction or memory issues.

This is about what I know, hope it's useful.

Mike

[Mycah]

Was put on Cymbalta by my pain doctor end of June. Took it for 2.5 months and after having depression and constipation/diarrhea I had had enough. Come to find out it was helping with my pain. Too bad the side effects were debilitating.

So now I started the Savella titration pack last week. Tired of being a guinea pig.

debbiehub - how's it going on Savella for you?

[Reddawn600]

Originally Posted by debbiehub

Has anyone tried Savella. My PM Doc said it is the new cymbalta..Nothing agrees with my stomach but I will give it a go this weekend...

My PM put me on it early late last winter. At the time, I was having some full body aches and pains which we thought might be fibromyalgia.

Honestly, it took me a good month to get over severe headaches, nausea and dizziness from the Savella. I did do the titration pack but it was still very rough initially. I stayed on it for about 5 months as it was hard to tell whether it was really working or not but in the end I realized it wasn't as my pain was increasing since it was CRPS, not Fibromyalgia or MPS.

The side effects did all go away for me over time tho so if it works for you, you may want to stick it out a bit and see if you can tolerate it. I had previously tried Lyrica and Cymbalta but found some of the side effects (mostly sexual ones) to be intolerable.

Good luck with it,
Dawn

[Mycah]

Originally Posted by Reddawn600

Honestly, it took me a good month to get over severe headaches, nausea and dizziness from the Savella. I did do the titration pack but it was still very rough initially.

Very rough indeed. Yesterday I had the first 50 mg dose of the titration pack and my head felt like it was going to blow off. Blood pressure was up and pulse is still over 100. I have tachycardia so I'm done with this experiment. I'll take the pain, thank you very much.

[painfull]

I have an accupunturist that helps me mainly with nausea and headache from the side effects of my medication. He has worked wonders on the vomiting I was experiencing. You might try that.

[Swatgen27]

I have CRPS in both legs from hip to toe and about three months ago my Dr prescribed Savella. I had to tirate the dose and slowly worked up to 100millagrams once a day. I did experience the following side effects: increase in blood preasure, nausea and sweating episodes. The b.p and nausea subsided after a couple weeks and the sweating stopped roughly a month later. The Savella was prescribed to help with the muscle pain (Opiates do not help with the muscle pain and I could barely walk). The Savella worked great and I think it is one of the best medicines that I have tried (and I have tried cymbalta, gabapentin, flexoral, ect.) When my dose was increasing I was told to cut back the dose if I became to nausea's but to increase the dose slowly over a two week period. If the side effects are too strong then they recommended staying at 50mg a day but I was able to get to 100mg because I thought the side effects were worth the benefit. Hope this helps and let me know if you have any other questions.
Sarah