![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 36. This is the beginning of the thread.
Posted by ben on March 24, 2002, at 10:52:12
I do have a peripheral sensory neuropathy in my lower legs. I read of "treating" pain with TCAs (esp. amitryptiline, trimipramine, doxepine) and Antiepileptics (esp. Gabapentin, Carbamazepine and Oxcarbazepine). I am very sensitive to side effects (sedation, dizziness) so I have problems to bear "normal" doses considered to be helpful. Are there TCAs lacking the anticholinergic and antihistaminic side effects to treat neuropathic pain ? Other ADs like SSRIs doesnt seem to work for pain ?! Do you have experiences or considerations ? I am on Moclobemide (Aurorix) for several weeks (in diff. doses) and it doesnt seem to do any trick for my pain !
see this post too:
Posted by Ritch on March 24, 2002, at 14:48:42
In reply to How to treat neuropathic pain ? pleae help, posted by ben on March 24, 2002, at 10:52:12
> I do have a peripheral sensory neuropathy in my lower legs. I read of "treating" pain with TCAs (esp. amitryptiline, trimipramine, doxepine) and Antiepileptics (esp. Gabapentin, Carbamazepine and Oxcarbazepine). I am very sensitive to side effects (sedation, dizziness) so I have problems to bear "normal" doses considered to be helpful. Are there TCAs lacking the anticholinergic and antihistaminic side effects to treat neuropathic pain ? Other ADs like SSRIs doesnt seem to work for pain ?! Do you have experiences or considerations ? I am on Moclobemide (Aurorix) for several weeks (in diff. doses) and it doesnt seem to do any trick for my pain !
>
> see this post too:
>
> http://www.dr-bob.org/babble/20020322/msgs/99843.html
Hi Ben,You could switch the Elavil to nortriptyline instead. Nortrip. is the only TCA that I have been able to take during the daytime. You will get less dry mouth, and just a light sedation. I noticed that my vision was blurred only slightly. You might see about a gabepentin+nortriptyline combo. SSRI's tend to *increase* arthralgia type pain, especially in my ankles, knees, lower back.
good luck,
Mitch
Posted by TSA West on March 25, 2002, at 2:08:51
In reply to How to treat neuropathic pain ? pleae help, posted by ben on March 24, 2002, at 10:52:12
Hello Sir,
All you need to know about pain management with tricylics and their friends:
I've heard many times from people that amitriptyline produces a hangover on the next day or causes people to feel "brain-dead" as some have put it (ie, dysphoric). You might counter it by dividing the 25-mg tablet in half with a razor blade or commercial tablet cutter. If this still proves to be too much after trying it for several nights, you should switch to doxepin, which has a profile that is very similar to that of amitriptyline. However, doxepin has less anticholinergic and other undesirable side effects. Also, doxepin comes in a liquid form. I would say start with doxepin at a 10-mg dosage and, if need be, decrease it to only one half of one of these capsules as well.
People who divide tablets or capsules often complain of the terrible taste of Tricyclics and a numb mouth and tongue from the potent anesthetic action of many Tricyclics. This can be avoided by wrapping the half tablet in a small ball of bread and swallow the ball and medication whole. :)
If doxepin doesn't work or is effective or if it produces intolerable side-effects, another milder Tricyclic (eg, nortriptyline or desipramine). For vascular headaches, a Dr. Diamond recommended the use of trazodone (Desyrel), a nontricyclic Antidepressant with strong sedating properties but with minimal anticholinergic, which may be used when regular tricyclic agents are not tolerated. A 50- to 100-mg dose of trazodone hydrochloride to be taken at bedtime, with a maximum 200- to 250-mg dose...
Your servant and soldier,
TSA Wwwwwwwwwwwwwwww E Sssssssssssss T---------
Posted by Zo on March 26, 2002, at 4:40:54
In reply to How to treat neuropathic pain ? pleae help, posted by ben on March 24, 2002, at 10:52:12
Neurontin is a *great* help, but you have to start small, be very very patient, and ramp up SLOOOOWLY, to get to a therapuetic dose that does not put you in a coma. I did it, for FM pain--which it seems to have cured, hasn't come back in a year. But you have to be willing to go thru some fog for the first month. . .which does lift. . .
Zo
Posted by ben on March 26, 2002, at 5:06:40
In reply to Re: How to treat neuropathic pain ? pleae help » ben, posted by Zo on March 26, 2002, at 4:40:54
> Neurontin is a *great* help, but you have to start small, be very very patient, and ramp up SLOOOOWLY, to get to a therapuetic dose that does not put you in a coma. I did it, for FM pain--which it seems to have cured, hasn't come back in a year. But you have to be willing to go thru some fog for the first month. . .which does lift. . .
>
> ZoHow much do you take ?
ben
Posted by JohnX2 on March 26, 2002, at 5:20:41
In reply to Re: How to treat neuropathic pain ? pleae help » ben, posted by Zo on March 26, 2002, at 4:40:54
Neurontin from what I hear is almost the gold standard for neuropathic pain? I used it to bat off tingling from tapering off a medication. I used 300 mg 3x a day (but tapered up to that).Hmm, I saw this abstract recently indicating that Wellbutrin may be useful for peripheral neuropathy???? I'm pretty sure it won't sedate you. Might make you dizzy. Never heard of this one besides this abstract however...
John
1: Neurology 2001 Nov 13;57(9):1583-8 Related Articles, Books, LinkOut
Double-blind, randomized trial of bupropion SR for the treatment of neuropathic pain.Semenchuk MR, Sherman S, Davis B.
Department of Neurology, University of Arizona, Tucson 85743, USA. Marilyn.R.Semenchuk@gsk.com
OBJECTIVE: To evaluate the effectiveness and safety of bupropion sustained-release (SR) for the treatment of neuropathic pain. METHOD: This single-center, outpatient, randomized, double-blind, placebo-controlled, crossover study consisted of two phases. Forty-one nondepressed patients with neuropathic pain spent 6 weeks in each phase in random order and received identical tablets of 150 mg bupropion SR or placebo. Patients were instructed to take one tablet once daily for 1 week followed by one tablet twice daily for 5 weeks. RESULTS: While the patients took bupropion SR, neuropathic pain relief was improved or much improved in 30 (73%) patients, and one of these patients became pain-free. The mean average pain score at baseline was 5.7, which remained unchanged at the end of week 6 with placebo, but decreased by 1.7 points to 4.0 (p < 0.001) during therapy with bupropion SR. Pain relief with bupropion SR was significant at week 2 (p < 0.05) and continued throughout weeks 3 through 6 (p < 0.001). A significant decrease in interference of pain on quality of life was observed while patients were receiving bupropion SR compared with placebo. Side effects experienced with bupropion SR were not dose-limiting and consisted primarily of dry mouth, insomnia, headache, gastrointestinal upset, tremor, constipation, and dizziness. CONCLUSION: This placebo-controlled crossover trial showed that bupropion SR (150-300 mg daily) was effective and well tolerated for the treatment of neuropathic pain.
Publication Types:
Clinical Trial
Randomized Controlled TrialPMID: 11706096 [PubMed - indexed for MEDLINE]
> Neurontin is a *great* help, but you have to start small, be very very patient, and ramp up SLOOOOWLY, to get to a therapuetic dose that does not put you in a coma. I did it, for FM pain--which it seems to have cured, hasn't come back in a year. But you have to be willing to go thru some fog for the first month. . .which does lift. . .
>
> Zo
Posted by Zo on March 26, 2002, at 17:02:09
In reply to Re: How to treat neuropathic pain ? pleae help, posted by ben on March 26, 2002, at 5:06:40
I stopped taking it about a year ago--and the FM pain has *not* come back.
I was on the Neurontin-L list, and boy, do the doses vary on this med! Essentially, you start small, and increase slowly. I think I got up to maybe 600mg--all at bed,despite what the literature says, that worked fine--and that took a month of fogginess, but there were people going up to the thousands til it hit their pain level.
Zo
Posted by ben on March 27, 2002, at 7:34:18
In reply to Re: How to treat neuropathic pain ? pleae help » ben, posted by Zo on March 26, 2002, at 17:02:09
> I stopped taking it about a year ago--and the FM pain has *not* come back.
>
> I was on the Neurontin-L list, and boy, do the doses vary on this med! Essentially, you start small, and increase slowly. I think I got up to maybe 600mg--all at bed,despite what the literature says, that worked fine--and that took a month of fogginess, but there were people going up to the thousands til it hit their pain level.
>
> ZoThanks
My pdoc thinks Neurontin would knock me out because I am very sensitive to meds ! A year ago tried 7.5 mg Remeron at night (for depression) and that was knocking me out for the next day. Zyprexa at only 2.5 mg the same
story. Lamictal was also making me tired and dizzy at only 10 mg/day. Pdoc thinks about Trileptal (Oxcarbazepine) as an option ?!
Posted by Lia Mason on March 27, 2002, at 23:54:00
In reply to How to treat neuropathic pain ? pleae help, posted by ben on March 24, 2002, at 10:52:12
Hi,
For what it's worth, I'm trying tricyclics for chronic pain and am having some luck with imipramine. Started with Neurontin and a small dose made me dangerously dopey and dizzy. Spent 3 months on Nortriptyline and couldn't stand it (though it did help). Too tired and dizzy upon standing. I'm at imipramine 70 and doing well. Pain not gone but much better. I'm trying to work to 100.
L
Posted by ben on March 28, 2002, at 2:30:51
In reply to Re: How to treat neuropathic pain ? pleae help, posted by Lia Mason on March 27, 2002, at 23:54:00
> Hi,
>
> For what it's worth, I'm trying tricyclics for chronic pain and am having some luck with imipramine. Started with Neurontin and a small dose made me dangerously dopey and dizzy. Spent 3 months on Nortriptyline and couldn't stand it (though it did help). Too tired and dizzy upon standing. I'm at imipramine 70 and doing well. Pain not gone but much better. I'm trying to work to 100.
>
> L
Did you have a try with Trazodone / Nefazodone or Venlafaxine. I read it could be an option too treating pain.ben
Posted by Lia Mason on March 28, 2002, at 10:20:25
In reply to Re: How to treat neuropathic pain ? pleae help, posted by ben on March 28, 2002, at 2:30:51
Actually... Venlafaxine (Effexor) was highly recommended by my doc for my pain situation. I am on it for depression at 75 and that's about as high as I'm willing to go cuz of side effects. My understanding is you have to go higher for pain relief. (You know how effexor works, right? You have to get to a certain dose to get the dual neurotransmitter action) My doc told me that one of her patients who failed every treatment achieved relief at effexor 180.
L
Posted by Tye on March 30, 2002, at 13:45:19
In reply to How to treat neuropathic pain ? pleae help, posted by ben on March 24, 2002, at 10:52:12
> I do have a peripheral sensory neuropathy in my lower legs. I read of "treating" pain with TCAs (esp. amitryptiline, trimipramine, doxepine) and Antiepileptics (esp. Gabapentin, Carbamazepine and Oxcarbazepine). I am very sensitive to side effects (sedation, dizziness) so I have problems to bear "normal" doses considered to be helpful. Are there TCAs lacking the anticholinergic and antihistaminic side effects to treat neuropathic pain ? Other ADs like SSRIs doesnt seem to work for pain ?! Do you have experiences or considerations ? I am on Moclobemide (Aurorix) for several weeks (in diff. doses) and it doesnt seem to do any trick for my pain !
>
> see this post too:
>
> http://www.dr-bob.org/babble/20020322/msgs/99843.htmlHey,
I think desipramine is your answer. Excellent for neuropathy, low side effect profile. Try 10 to 25 mg in the morning.
Tye
Posted by ben on April 2, 2002, at 11:58:27
In reply to Re: How to treat neuropathic pain ? pleae help, posted by Lia Mason on March 28, 2002, at 10:20:25
> Actually... Venlafaxine (Effexor) was highly recommended by my doc for my pain situation. I am on it for depression at 75 and that's about as high as I'm willing to go cuz of side effects. My understanding is you have to go higher for pain relief. (You know how effexor works, right? You have to get to a certain dose to get the dual neurotransmitter action) My doc told me that one of her patients who failed every treatment achieved relief at effexor 180.
>
> LI took Efexor two years ago 150mg/day for depression. I couldnt tolerate more because of sweating, weight gain, headaches and memory probs ! A second try ?!
ben
Posted by Elizabeth on April 4, 2002, at 4:55:52
In reply to Re: Trileptal, posted by ben on March 27, 2002, at 7:34:18
Hi Ben. Trileptal is closely related to Tegretol *(carbamazepine) which is considered a gold standard for neuropathic pain. FWIW, I take Trileptal (for seizure prophylaxis) and haven't noticed any side effects. But I'm not a "med-sensitive" person. Still it generally has few side effects compared to Tegretol.
BTW, about the Remeron -- that tends to be very sedating in *low* doses, but this side effect decreases as you increase the dose. A lot of pdocs will start people out at 30 or even 45 mg because people tolerate that range better than 7.5-15. Zyprexa is generally really sedating, and it also lasts a very long time.
-elizabeth
Posted by ben on April 4, 2002, at 12:50:55
In reply to Re: Trileptal » ben, posted by Elizabeth on April 4, 2002, at 4:55:52
> Hi Ben. Trileptal is closely related to Tegretol *(carbamazepine) which is considered a gold standard for neuropathic pain. FWIW, I take Trileptal (for seizure prophylaxis) and haven't noticed any side effects. But I'm not a "med-sensitive" person. Still it generally has few side effects compared to Tegretol.
>
> BTW, about the Remeron -- that tends to be very sedating in *low* doses, but this side effect decreases as you increase the dose. A lot of pdocs will start people out at 30 or even 45 mg because people tolerate that range better than 7.5-15. Zyprexa is generally really sedating, and it also lasts a very long time.
>
> -elizabethMany thanks Elizabeth
I read a lot about the lesser sedation on higher doses of Remeron (Mirtazapine). I think its more theoretical (increasing Noradrenaline) because my pdoc started to patients on 30 mg at night and they were knocked out for two days ! I know that not all do agree with this but thats why we react all different.
For me Reboxetine (Edronax) was more stimulating than Methylphenidate (Ritalin) but pooped out as an adjunct to SSRIs very quickly.
How much Trileptal is considered to treat pain and often do you have to take it ? Could it be a good mood stabilizer for unipolars ?
Posted by Elizabeth on April 5, 2002, at 11:32:00
In reply to Re: Elizabeth - Remeron...., posted by ben on April 4, 2002, at 12:50:55
> I read a lot about the lesser sedation on higher doses of Remeron (Mirtazapine). I think its more theoretical (increasing Noradrenaline) because my pdoc started to patients on 30 mg at night and they were knocked out for two days ! I know that not all do agree with this but thats why we react all different.
We sure do. It is true that a lot of people (not everyone) find that the sedation decreases as they increase the dose, so it's not just theoretical. That doesn't mean that everyone will experience this. Also, 30 mg is a middle-range dose of Remeron, and it's quite possible that someone who finds 30 to be oversedating will be less sedated on 45 (for example).
> How much Trileptal is considered to treat pain and often do you have to take it ?
Unlike Tegretol, this relatively new drug isn't labelled for any pain syndromes. For epilepsy, I think the recommended daily dose range for adults is 1200-2400 mg; the dose is probably similar for pain. It's taken in two divided doses per day.
> Could it be a good mood stabilizer for unipolars ?
I'm not sure what you mean by "mood stabilizer for unipolars." Can you say more about this?
-elizabeth
Posted by ben on April 6, 2002, at 9:41:50
In reply to Re: Remeron.... » ben, posted by Elizabeth on April 5, 2002, at 11:32:00
> We sure do. It is true that a lot of people (not everyone) find that the sedation decreases as they increase the dose, so it's not just theoretical. That doesn't mean that everyone will experience this. Also, 30 mg is a middle-range dose of Remeron, and it's quite possible that someone who finds 30 to be oversedating will be less sedated on 45 (for example).Yes, but only try and error will show this. We know a lot about drugs in vitro (or of rats -> in vivo) but very less in vivo !
> > How much Trileptal is considered to treat pain and often do you have to take it ?
>
> Unlike Tegretol, this relatively new drug isn't labelled for any pain syndromes. For epilepsy, I think the recommended daily dose range for adults is 1200-2400 mg; the dose is probably similar for pain. It's taken in two divided doses per day.Wow, thats pretty much - do you take such doses ? I think this would knock me out ? Okay, try and error !
> I'm not sure what you mean by "mood stabilizer for unipolars." Can you say more about this?
Carbamazepine, Valproate, Lamotrigine....are
used as an adjunct in unipolar depression for
diminishing recurrence of episodes and as an augmentation strategy . I thought Oxcarbazepine might be used as a new alternative (?) - very few data available yet on that theme ! Or do you have other infos about that ?ben
Posted by Elizabeth on April 7, 2002, at 18:45:34
In reply to Re: Remeron.... » Elizabeth, posted by ben on April 6, 2002, at 9:41:50
> > It is true that a lot of people (not everyone) find that the sedation decreases as they increase the dose, so it's not just theoretical. That doesn't mean that everyone will experience this. Also, 30 mg is a middle-range dose of Remeron, and it's quite possible that someone who finds 30 to be oversedating will be less sedated on 45 (for example).
>
> Yes, but only try and error will show this. We know a lot about drugs in vitro (or of rats -> in vivo) but very less in vivo !I'm not talking about lab experiments, in rats or in isolated brain tissue; I'm talking about the observed effects of dose increases in live human beings. Again, that doesn't mean that everyone will experience this! But it's a far cry from being "just theoretical."
> Wow, thats pretty much - do you take such doses ? I think this would knock me out ? Okay, try and error !
I take 1200 mg/day (600 AM and 600 PM). It doesn't "knock me out." In fact, I don't notice any side effects; no sedation, dizziness, etc. It's a less potent anticonvulsant than Tegretol (that is, it requires higher doses to achieve the same effect), but it has fewer side effects, not more. It might seem reasonable that less potent drugs would be "dirtier" than more potent ones, but as it turns out, this isn't necessarily true.
> > I'm not sure what you mean by "mood stabilizer for unipolars." Can you say more about this?
>
> Carbamazepine, Valproate, Lamotrigine....are
> used as an adjunct in unipolar depression for
> diminishing recurrence of episodes and as an augmentation strategy.Oh, that. There's nothing specific about Trileptal, but it is being used in bipolar disorders. My guess is that it's probably about as effective as Tegretol for relapse prevention, either way.
-elizabeth
Posted by kpo2002 on May 4, 2002, at 16:35:42
In reply to Re: How to treat neuropathic pain ? pleae help, posted by ben on April 2, 2002, at 11:58:27
It has taken me 4 1/2 years to come up with this combination of drugs to treat neuropathic pain.
37.5 mg. Effexor and 2 1/2 mg. Dexedrine, morning
600 mg. Neurontin 4 x a day
60 to 75 mg. Remeron at bedtime 15 to 45 mg. Restoril at bedtime AND 60 tablets 5 mg. Methadone a month -- to use in any manner that I like. My advice is to keep trying one antidepressant after another. Plus you need to mix and match!
Posted by DonnaM on May 8, 2002, at 12:25:22
In reply to How to treat neuropathic pain ? pleae help, posted by ben on March 24, 2002, at 10:52:12
I have fibromyalgia and found that Doxepin helped extremely well with my back pain as well as sleep at the dose of 30 mg(10 mg>>30 mg over a week). THe first few days were difficult with anti-cholinergic (sp?) side effects but after a couple of months they were totally gone. The problem for me was increased depression and weight gain on it. Depakote (Epival)with Zoloft also helped quite a bit with back pain and also headaches with no sidee effects. Eventually I felt unmotivated on it.
> I do have a peripheral sensory neuropathy in my lower legs. I read of "treating" pain with TCAs (esp. amitryptiline, trimipramine, doxepine) and Antiepileptics (esp. Gabapentin, Carbamazepine and Oxcarbazepine). I am very sensitive to side effects (sedation, dizziness) so I have problems to bear "normal" doses considered to be helpful. Are there TCAs lacking the anticholinergic and antihistaminic side effects to treat neuropathic pain ? Other ADs like SSRIs doesnt seem to work for pain ?! Do you have experiences or considerations ? I am on Moclobemide (Aurorix) for several weeks (in diff. doses) and it doesnt seem to do any trick for my pain !
>
> see this post too:
>
> http://www.dr-bob.org/babble/20020322/msgs/99843.html
Posted by ben on May 8, 2002, at 13:48:17
In reply to Re: How to treat neuropathic pain ? please help » ben, posted by kpo2002 on May 4, 2002, at 16:35:42
> It has taken me 4 1/2 years to come up with this combination of drugs to treat neuropathic pain.
> 37.5 mg. Effexor and 2 1/2 mg. Dexedrine, morning
> 600 mg. Neurontin 4 x a day
> 60 to 75 mg. Remeron at bedtime 15 to 45 mg. Restoril at bedtime AND 60 tablets 5 mg. Methadone a month -- to use in any manner that I like. My advice is to keep trying one antidepressant after another. Plus you need to mix and match!
HiWhats the cause for your neuropathic pain ?
Why do you take such a low dose of Effexor besides relative high doses of oder drugs ?
I tried Remron and it knocked me out at only 7.5 mg at bed (I know that sedation could lessen at higher doses but not for all). Neurontin at 2400 mg/d - do you tolerate this ? It causes al ot of dizziness and sedation. I am sure it lasted a long time getting a trial mit methadone ?! Which doc would prescribe it for
such pain ? Did you tried other drugs like:-Tegretol
-Trileptal-Elavil and other TCAs
-SSRIs-Oxycodon
-Tramadol
Posted by ben on May 8, 2002, at 13:52:24
In reply to Re: How to treat neuropathic pain ? pleae help, posted by DonnaM on May 8, 2002, at 12:25:22
> I have fibromyalgia and found that Doxepin helped extremely well with my back pain as well as sleep at the dose of 30 mg(10 mg>>30 mg over a week). THe first few days were difficult with anti-cholinergic (sp?) side effects but after a couple of months they were totally gone. The problem for me was increased depression and weight gain on it. Depakote (Epival)with Zoloft also helped quite a bit with back pain and also headaches with no sidee effects. Eventually I felt unmotivated on it.
Hi
Do you have fibro or/and neuropathic pain ?
TCAs like Doxepine, Amitryptiline etc. knock me out ! Did you tried Tegretol, Trileptal or Neurontin ?
Thanks
>
> > I do have a peripheral sensory neuropathy in my lower legs. I read of "treating" pain with TCAs (esp. amitryptiline, trimipramine, doxepine) and Antiepileptics (esp. Gabapentin, Carbamazepine and Oxcarbazepine). I am very sensitive to side effects (sedation, dizziness) so I have problems to bear "normal" doses considered to be helpful. Are there TCAs lacking the anticholinergic and antihistaminic side effects to treat neuropathic pain ? Other ADs like SSRIs doesnt seem to work for pain ?! Do you have experiences or considerations ? I am on Moclobemide (Aurorix) for several weeks (in diff. doses) and it doesnt seem to do any trick for my pain !
> >
> > see this post too:
> >
> > http://www.dr-bob.org/babble/20020322/msgs/99843.html
Posted by Lia Mason on May 9, 2002, at 11:45:43
In reply to Re: How to treat neuropathic pain ? pleae help, posted by DonnaM on May 8, 2002, at 12:25:22
Hi Donna--
Have you tried guaifenesin for fibromyalgia? It's the subject of a book by a guy named (last name) St. Amand called (I think) "What Your Doctor May Not Know About Fibromyalgia". I ask because I have vulvodynia (chronic vaginal pain) and my doc is pushing guaifenesin.
Any help appreciated.
Lia
Posted by Lia Mason on May 9, 2002, at 11:48:39
In reply to Re: How to treat neuropathic pain ? please help » ben, posted by kpo2002 on May 4, 2002, at 16:35:42
I had a strange experience. I take 150 imipramine for pain and was doing very well. I had 37.5 effexor on board, too, and my doc said at such a low dose it can't be doing anything why not cut it. So I did and the pain came back. Now what's peculiar about this is that I was on more effexor a few months ago and it did nothing for my pain. So... my doc's theory is that the combo of imipramine and effexor is the key. Go figure.
Lia
Posted by kpo2002 on May 13, 2002, at 16:14:49
In reply to Re: How to treat neuropathic pain ? pleae help, posted by ben on April 2, 2002, at 11:58:27
There is no answer as to why what medications work for neuropathic pain. It is all trial and error--benefits versus undesirable side effects. Today I didn't take methadone but I did take 1/4 of a concerta. But I took methadone yesterday, 2 doses, so some of it is still in effect. I have taken a lot of drugs including TCAs, they didn't provide any pain relief and they made me feel like shit. It is not worth my time telling you all of the drugs that I took if they didn't give me any pain relief. Yes, I took Ultram (tramadol) for 2 years. I was allergic to it but I was forced to take it because it got me out of blinding pain. I had been in blinding pain for a year and a half, so it was a welcome relief. As I increased the Remeron and got a few doctors to give me a few oxycontin or percocets, I weaned myself from the Ultram. I still suffer with the allergies given to me by Ultram. Occasional hayfever, itchy eyes, runny nose, sinus headaches, and cannot were any earrings except real gold, and cannot wear any makeup without itchy eyes and runny nose. Also mixing Ultram with Trazedone produced Seratonin Syndrome which was awful. Coudn't sleep or eat for 4 days, horrible headache, nausea, vertigo, tinnitus. Just horrible. Then I had two chronic pain people blessing me with a few methadones from time to time, and I knew that it was the best. My son had to be sent to a county shelter before I got methadone. I suffered horribly for 3 1/2 years and when I took my son to a doctor's appt. I pleaded desperately to him, "If I don't get some painkillers soon my son is going to be sent to a foster home." He gave me 2 months supply of Fentanyl patches, 50 mcg. but I didn't use them the way you are supposed to. I figured if I hadn't gotten addicted yet, then why should I? Remeron had gotten me out of the french-fryer. I finally figured out that the only way that I could use the patches was to put it on at bedtime and take it off upon awakening (approx 12 hours.)I got the best pain relief (and almost always complete pain relief) from the Patches, but I was high as a kite, plus it is a pain in the ass pulling those patches off and trying to get them to stick again. I have saved some patches for special occasions, like vacation (snorkelling/ice skating) or big housecleaning or a much needed vacation from the pain. As for the dexedrine and concerta, every other boy on the block is diagnosed with ADD/ADHD. If you read the fine print on the Adderall drug info you will see one line that says that it increases the action of narcotic analgesics. You must keep trying pill after pill. Narcotics will not work alone. Antipsychotics work but have horrible side effects. I have a theory that Cogentin would work against Neuropathic pain, because it has only one use in pharmacology, and that is to undo the horrible side effects of antipsychotic drugs, and I figure if it's action is to undo unwanted random neurological actions then why would'nt it undo random pain impulses? As for the Neurontin - I had to start with 30 mg. (dumping out the capsules) It took me about 10 months to get up to 1,200 mg. 4 x day. The increases were equivalent to being shot out of a cannon into a brick wall. Increases should be made at bedtime so that you sleep through it all. Even with all of these drugs I am still in a lot of pain, but I am able to stay vertical for whole entire days, and I can think clearly, although I'm not my normal self. I can have days of immense pain relief by skipping days on the methadone, keeping the methadone doses low, and having about 4 days a month in which I take lot of methadone so that I can do all-day affairs. Only now, after adding the Effexor XR do I feel well enough to get on the internet and read and write. The Effexor XR 37.5 gave me immense pain relief for one month, then when the unusual side effects subsided so did much of the pain relief. I am still getting 20% of the original pain relief plus I am calmer. I lost 5 lbs. during the first month but gained it back in 2 weeks. I have lost my appetite for sweets. (Except Pepsi!) I have bi-femoral compression neuropathy, from being improperly positioned and/or left in the stirrups too long (two hours) during a vaginal hysterectomy at the VA hospital in Pittsburgh Pennsylvania, and the surgeon was Dr. Kathleen McIntyre Seltman from Magee Women's Hospital in Pittsburgh, Pennsylvania. I am in pain from my belly-button down, everything inside and out. I gained 40 lbs in 4 months after taking Remeron. I don't really like it, but it is a small price to pay to be able to walk and wear clothing. I hope that I have helped you and would like to warn everyone out there of this horrible injury. Men can get this injury too from prostate or hemmorhoid surgery. The way to prevent this injury is too have it written in the pre-surgical agreement that the legs have to be taken down for a few minutes and repositioned during surgery, or in the case of a hysterectomy the woman can opt to have the organs removed through an incision in the abdomen. Roxane 5 mg. Methadone seem to be stronger than Roxane 10 mg. and Methadose 10 mg. Sometime the binders in the drug can affect the action and the binders in the 5 mg. may be different. PLUS if you are paying for your drugs you would be interested to note that a month's worth of Duragesic Fentanyl patches is over $200.00 and the equivalent in Methadone is about $10.00. PLUS Methadone is not highly desired by junkies (if it were, there would be no heroin traffic as all of the junkies would be at the Methadone clinics)so it may be easier to get, but I don't know-it is still a narcotic. I recommend Methadone as it has great pain relieving qualities and few side effects, and if you are not addicted to it when you do take it subsequent doses are smaller than the first because of its long-lasting action. For instance, I get up, take 10 mg. Methadone, lay in bed for a while, get up get going, and decide that I didn't take enough, an hour and a half after the initial dose, take another 5 mg. An hour and a half later I'm doing OK but not great, I take another 5 mg. and I'm set for 4-6 hours and after the 6 hours I still have 50% of the pain relief for the rest of the day. Then the next day when I wake up I may only have to take two 5mg. doses to get comparable pain relief of the day before. At first I tried 1 day on and two days off, but after a few months I couldn't stand the pain anymore and now I'm usually two days on and 1 day off. Occasionally I go three days in a row, and occasionally I skip two days in a row. If I skip two days in a row, one of those days is likely to be augmented by 5-10 mg. of dexedrine. My other posting said that I took dexedrine every day but I don't, I just put that in to simplify my posting as I did not know when I'd feel well enough to write a more complete description. I sort of alternate drugs so that I don't become hopelessly addicted to narcotics but since I have been on Effexor I have not had to use alcohol once (yuck). Sometimes I have been able to double the effects of methadone just by having two drinks. However I don't really like the taste or effects of alcohol. Chronic pain patients who are friends of mine say that sooner or later I will become addicted to narcotics so why not just do it and get it over with and have a better life? I would love to do that if it guaranteed me a better life, but I am fearful that I will live another 60 years and become so tolerant after 30 years that they don't work and I will live another 30 years in hell. (No I won't,I'll kill myself first.) Plus I am just terrified of addiction itself because I have seen first-hand what narcotic addiction is like. Plus by staying sensitive to narcotics I can get pain-free hours or pain-free days, and I know that my methadone buddies get a lot of pain relief on a regular basis, but they never even have a pain-free moment.
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Dr. Bob is Robert Hsiung, MD,
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