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chronic pain, insomnia - advice?

Posted by Elizabeth on April 23, 1999, at 23:30:01

My depression seems to be under control at present with Parnate, but I'm still having sleep troubles. This is a big problem for me, because if I can't sleep, it's hard to think clearly, and I have a *lot* of school work I need to catch up on.

I think there are several things contributing to my sleep problems:

1. An inherited tendency to erratic sleep patterns - I learned only recently that my dad has just the same problem I do, namely middle and terminal insomnia resulting in an inability to keep to any regular schedule (basically I - and he - can't sleep more than 4 hours at a time or so). I've had episodes of REM sleep behavior disorder that weren't clearly related to medication, which suggests that there's something going on beyond just insomnia. My psychopharmacologist thinks a sleep study would be in order, but I wonder how useful that would be (especially with the effects of the MAOI confounding the results).

2. I have chronic pain in my back, neck, and shoulders that can make it very hard to get to sleep in the first place.

3. The antidepressant I take (Parnate) tends to exacerbate the middle and terminal insomnia. It's very activating, and it causes major changes in sleep architecture as well.

I'm wondering how I can go about dealing with this stuff. With the kind of work I want to do, I really need my attention, concentration, and alertness to be better than they have been.

BTW I've been to internists for the pain - they don't have a clue. :-P I've also done physical therapy which was ineffective and tried things like regular exercise (walking, swimming) and changing sleeping surfaces.

I've tried a couple of drugs; Fioricet is the one that's worked best. Other ones I've tried:
- acetaminophen (that's paracetamol for you Euro-types): no effect
- benzos (Valium, etc.): seem to work (though inconsistently - as does Ambien (interestingly enough)
- NSAIDs (ibuprofen, naproxen, topical salycilates, Cataflam): didn't help
- Neurontin: didn't help
- opioids: have nasty side effects (although I do have buprenorphine as a PRN); tramadol doesn't seem to work very well
- antidepressants: phenelzine may have helped (though I should note I was also taking Ambien consistently throughout the time I was on Nardil), and I think that Effexor XR might have had some effect; I haven't been able to tolerate tricyclics, and Parnate doesn't seem to do the trick

Carbamazepine and primidone have also been suggested; does anyone have experience using either of these for pain, or have any other suggestions?

Any thoughts appreciated. (See also my latest posting under the fibromyalgia thread.) Thanks.





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