BiggDirty01 said:
Went on courses of both Cymbalta and Lyrica (seperately) and had awful reactions to both, culminating in suicidal thoughts on cymbalta (never been suicidal before or since) and awful withdrawals from lyrica (an otherwise great medicine). Has anyone else had these issues with these 2 drugs?
I am asking because my PCP has put me on a special folic acid, along with ultram/percocet (for BT pain) and has referred me to a PM Doc. Does anyone know of (personally or otherwise) of people improving from neuropathy not taking lyrica or cymbalta.
I've heard over 90% of patients are on some form of these drugs (what happens to the 10% who cant tolerate it?)
If the lyrica works well with the only caveat being withdrawal, then why don't you pursue it? As long as you take it as prescribed, then it should not be an issue. Withdrawal is going to be a BITCH with just about anything that would work on the pain, and this brings me to your second question; generally for neuropathy when the first and second line treatments are ineffective, the third line is pursued further. This is opioid analgesics so generally you will be on pretty large amounts of these to manage the pain. This of course is dependent on the doctors and largely the area that you are living in. Some PM doctors will be willing to prescribe astronomical amounts of opioids while others will barely script hydrocodone.
Another option that you (surprisingly) didn't mention is tricyclic antidepressants. According to protocol, these are generally first line treatment for neuropathic issues. I would recommend amitryptiline or nortriptyline... the former is statistically SLIGHTLY more effective while the latter has less complications from side effects, but the difference in either category is pretty small.
For me personally, Lyrica has been the single most important medication in my pain regimen. My pain right now is almost completely neuropathic and my life changed dramatically when I started neurontin/gabapentin (virtually the same as lyrica/pregabalin). Nortriptyline helped but not enough to stave off massive acute exacerbations that regularly sent me to the ER. The lyrica stabilized the pain and really cut through the sharpest, most electric sensations (paresthesias, hyperesthesia and dysesthesia).
Currently Lyrica is the cornerstone of my regimen; lidocaine patches are a godsend when the pain is burning, tingling, electric and the worst of it is limited to an area the patches can cover; celebrex prevents the stiffness and muscle spasm (I found this after trying over half a dozen benzos and muscle relaxants that were more sedating than therapeutic); hydrocodone 10/325 are my only opioid and BT medication. I also use marijuana as an adjunct that is opioid sparing, muscle relaxing, sleep inducing and mood enhancing. I used to have tremendous anxiety and depression due to the chronic pain (especially since I was 19 at the onset) and the marijuana let me take a break from this and smile and laugh. I think the cannabis really allowed me to change my perspective on all of it and now I live in daily pain but have minimal related depression and anxiety. Perspective on the pain may be the most important aspect of pain management; at first I thought pharmacology was key and scoffed at alternative opinions, but I've since learned how important the mind is in all of this.
Sorry for the long post but I REALLY want to share my experiences and offer anything that I can to help you and any other pain patients. Overall, I think tricyclic antidepressants should be tried and/or Lyrica should be utilized if withdrawal is the only set back. Opioids have their place but can be ineffective for neuropathic pain and can cause large complications (not physiologically usually, but with addiction. In people that do not have addiction issues previously, iatrogenic addiction is exceedingly rare, but if it is present prior to treatment, then it is all too common). Lidocaine patches, NSAIDs and medicinal marijuana are also avenues that I recommend pursuing. Best of luck and please, feel free to ask any questions or PM me for anything... whether medical help, emotional support or absolutely anything. Its important to know that you have support, even if its only through text.
