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Nerve Pain and Anti depressants Nerve Pain and Anti depressants

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  #1  
Unread 05-10-2003, 08:18 PM
Nerve Pain and Anti depressants

Hi,
I was told part of my pain problem is now neuropathic. The doctor prescribed Desipramine which is an antidepressant in the same family as Elavil.

I was on 10 mg at bedtime for two weeks and recently went to 20mg this last week. I am unable to tell any difference in my pain but the meds make me really sleepy and I have nausea on the higher dose as well.

I would love if anyone could answer these questions:

1. How long does it take an antidepressant to work if it is going to help with pain? Also is the affect gradual of all of the sudden?

2. Do the side affects ever go away and how soon? I am having trouble with the nausea and fatigue of the higher dose.

Several years ago I was also told that I had nerve pain and prescribed Neurontin which I had a terrible time with even on a low dose. After several weeks I was also not able to tell any difference in my pain. Around that time I found out that it should work rather quickly if it is going to work at all - so at that point I stopped.
I found out later the severe pain I had was due to pelvic congestion and not nerve pain and that is why I didn't find any relief I guess with the Neurontin.

(In the past I have also tried Elavil, Prozac, Celexa (made me absolutely PYSCHO!) and the neurontin).

Thanks so much for any inputs.

SBlumen
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  #2  
Unread 05-10-2003, 09:32 PM
Nerve Pain and Anti depressants

First of all, I believe that the Elavil takes awhile to build up in your system and that pain relief would not be expected immediately. The side effects should also subside in a couple of weeks. If you don't have any relief after several weeks talk to your doctor again.

I have heard that a lot of people have trouble with Neurontin but you might want to try it again if the Elavil doesn't work. 300mg three times a day is the lowest therapeutic dose, at least that is what I've been told. But I usually titre new medication, especially if it has side effects that are difficult to deal with. I started by taking one 100mg capsule and built up from there. I started on Monday and today is the first day I've taken the full (minimum) therapeutic dose and I'm feeling fine. I haven't noticed any change in my pain yet, but I wouldn't expect that yet. I know that the dose will be increased if I don't experience relief in another week and the side effects are dose related, so we'll see what happens. My pain doctor emphasized that it takes a couple of weeks to get an effect and that the side effects will let up in time. The same is true for the anti-depressants. So hang in!!
  #3  
Unread 05-10-2003, 10:46 PM
Nerve Pain and Anti depressants

Joselle

Thank you so much for the information. I definately will not give up yet based on what you said. I am hoping it will work. The doctor wants me to get up to 25mg.

When I took Neurontin I quartered the 100mg tablets. Even at that very low dose my brain seemed like it had turned into porridge. I was a complete zombie and had trouble driving (after I missed a few stop signs I gave up my keys for a while). I do remember a women telling me she took 300mg for her pain and I was amazed that she could take that much when I was having such a hard time on such a small dose. I kept thinking that it was lucky I didn't have the illness that is the primary treatment of neurontin (is it epilepsy?). I wanted it to help so badly and for a while was very frustrated that I couldn't tolerate the one drug that might help relieve the pain I was having. Fortunately that didn't turn out to be the case at that time.

Well, here's hoping the antidpressant will work as I would be very reluctant to try Neurontin again due to my earlier experience. I am definately tolerating the desipramine much better than I did the Neurontin.

I hope the Neurontin helps your pain and you do not have any side affects. That is amazing you can take so much and feel fine and I take just a little and feel like mush-for-brains.

Many thanks again!! SBlumen
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  #4  
Unread 05-10-2003, 11:40 PM
Nerve Pain and Anti depressants

Hi there

You have to remember that the "anti-depressants" (actually a class of drug known as MAO inhibitor) and Neurontin are in the business of re-arranging the biochemistry of the nerves. What they are trying to do is to raise the threshhold where nerves are reacting to pain. The problem is, in doses that work on nerves which have been stimulated with pain for a long time (like, years, for most of us), the brain synapses (which are "normal") get off-balance.

Do ask your pharmacist about food interactions with the desipramine, as well as any possible drug interactions. The MAO inhibitors have a long half-life in the body, too, which is why they tell you to wait a couple of weeks for the effects and also to wean if you decide to discontinue them. Also, you should have periodic EKGs, as the medication can change the electrical activity of the heart. It's a very small risk, especially as this type of drug can work so well for neuropathic pain.

I do hope these drugs work for you, in the long run. Pelvic pain is extremely frustrating to treat, as it is multi-factorial -- it can be "mechanical" pain (as with adhesions and that tugging pain) and also nerve pain as so many of us have experienced. Add in the swelling that can often happen with pelvic congestion syndrome (and those of us with endo, it creates its own blood vessels, adding to THAT problem), and lymph node problems...that's why it's so difficult. The Neurontin and MAO inhibitors do work to alter the chemistry of the nerve pain, and hopefully raise the "pain threshhold" -- but they don't address either the mechanical issues of adhesions nor the swelling and inflammation that so many of us suffer from chronically.

I do hope the Elavil/desipramine work for you -- I had a co-worker who suffered from chronic, disabling migraines, and Elavil was in the end the only thing that brought her relief. Do make sure you read the pharmacy-supplied information sheet, as it should address the interaction problem. If you have any questions, check with your pharmacist.

Here's hoping relief is in sight, finally...that nausea should subside (you do take it with food, don't you, and nothing acidic?). If you can stand it, give it two weeks, and journal each day. I've often found that I didn't notice change on a day-to-day basis...but by journalling I've come to realize that my pain levels (at the moment) have gone from the 5-6 range down to 2 and the occasional 3. Had I not been keeping track, I probably would not have realized it quite so soon...

Audrey
  #5  
Unread 05-11-2003, 10:35 AM
Sblumen.......

Hi and to you. I was recently taking elavil for RLS, I can tell you that the side effect of the med making you sleepy will wear off in time. For me it wore off pretty quickly and THAT is the main reason I was taking it so that I COULD sleep. It worked for about a week and then after that ...nothing. So hopefully this side effect will wear off prettty quickly for you.

I was also tried on a course of neurontin for nerve pain......a very short course as I could NOT take it either. I was told to start out with one 300mg tablet a day and then two the next day and three the next. I never got past the one a day. Like you it made my brain feel like mush, I couldnt think straight and I was seeing tracers. I tried again the next day taking just the one dose and there was just NO WAY I could take the stuff. I called my doc and he said not to take anymore. He said ALOT of people are unable to take neurontin. For those who can take it seems to work great.

I'm not sure what my doc is planning on trying next but I will let you know. I hope this new med works for you and the side effects go away soon. I'll be thinking of you and looking for an undated post.

Dawn
  #6  
Unread 05-11-2003, 12:22 PM
Nerve Pain and Anti depressants

I've been told that I have nerve damage. There are many different meds that can be tried. I didn't fair to well on Elavil. I called it the devil drug as it turned me into a not very nice person.

I've been on Neurontin several times. The first time I had a horrible reaction. Nausea, dizziness, numbness, etc. I know with some of these meds these symptoms can dissipate over time, but they were intolerable at the time. The second time I took it I had none of the above symptoms but it didn't do very much for my pain. The doctor did indicate that it could be a long process, gradually building up the dose to where it would help. We opted to try something else at the time.

I've taken a med called Gabatril that did help a bit. I did have some symptoms for the first few weeks but they eventually went away.

We are all different and can have different reactions to different meds. If you feel the Elavil isn't helping, give the doctor a call and see what he/she suggests. Perhaps trying a different med will work out better for you.

  #7  
Unread 05-11-2003, 02:03 PM
Anyone notice this "side affect"?

Thanks very much to all the kind ladies who replied to my post. I am definately feeling encouraged... and also not so alone that others have trouble with drugs too.

I am wondering if anyone has noticed this "side affect".

I am usually quite a shy and reserved person. For example, I would sit in Sunday school class and have lots of thoughts to contribute to discussion but would very rarely share what was going on in my head. BUT, I have noticed that since I have been taking the Desipramine (antidepressant) I have become quite the jabber mouth and seem to have lost my inhibition about speaking out in large groups and also speaking to people I don't know very well and even complete strangers. My husband actually said something to me about it today without any prompting from me.
He had observed that I had talked more today in SUnday school than I had the entire preceeding year put together. I also started up conversations with complete strangers while I was standing in line at the Bagel store for lunch.

Anyway, my DH said I hadn't embarrassed myself yet and he was enjoying the new "free speaker". I will have to watch it I guess.
Hee-hee.

Sblumen
  #8  
Unread 05-11-2003, 07:53 PM
Nerve Pain and Anti depressants

I have been on Elavil for about 6 yrs..1st for Migraines & now for FMS & Chonic Pain syndrome, for me it helps It does take several weeks to build up in your system before you start getting some relief..if you do.

I have Post-Herpatic Neuralgia from Shingles in my arm, I have now developed Reflex Sympathetic Dystrophy, from the Nerve Damage. I take Neurontin w/ some success. The side effects can take some getting used to tho...here is some info I found on the use of Anti-Depressants for Nerve damage/Pain:

  Quote:
Source - from within the nervous system itself. The pain may originate from the peripheral nervous system (the nerves between the tissues and the spinal cord), or from the central nervous system (the nerves between the spinal cord and the brain).
Causes - may be due to any one of the following processes
Nerve Degeneration - multiple sclerosis, stroke, brain haemorrhage, oxygen starvation
Nerve Pressure - trapped nerve
Nerve Inflammation - torn or slipped disc
Nerve Infection - shingles and other viral infections
Receptors activated - the nervous system does not have specific receptors for pain. Instead, when a nerve becomes injured by one of the processes named above, it becomes electrically unstable, firing off signals in a completely inappropriate, random, and disordered fashion.


Characteristics - These signals are then interpreted by the brain as pain, and can be associated with signs of nerve malfunction such as hypersensitivity (touch, vibration, hot and cold), tingling, numbness, and weakness. There is often referred pain to an area where that nerve would normally supply e.g. sciatica from a slipped disc irritating the L5 spinal nerve produces pain down the leg to the outside shin and big toe i.e. the normal territory in the leg supplied by the L5 spinal nerve. Nerve pain is often described as lancinating, shooting, burning, and hypersensitive.
Useful Medications - only partially sensitive to paracetamol, NSAIDs, opioids. More sensitive to Anti-depressants, Anti-convulsants, Anti-arrhythmics, and NMDA Antagonists. Topical Capsaicin
<---I also use this may be helpful
Sympathetic Pain:

Source - due to possible over-activity sympathetic nervous system, and central / peripheral nervous system mechanisms. The sympathetic nervous system controls blood flow to tissues such as skin and muscle, sweating by the skin, and the speed and responsiveness of the peripheral nervous system.
Causes - occurs more commonly after fractures and soft tissue injuries of the arms and legs, and these injuries may lead to Complex Regional Pain Syndrome. CRPS was previously known as Reflex Sympathetic Dystrophy.
Receptors activated - like nerve pain there are no specific pain receptors. The same nerve processes as mentioned above may operate in CRPS.
Characteristics - presents as extreme hypersensitivity in the skin around the injury and also peripherally in the limb, and is associated with abnormalities of sweating and temperature control in the area. The limb is usually so painful, that the sufferer refuses to use it, causing secondary problems after a period of time with muscle wasting, joint contractures, and osteoporosis of the bones. It is possible that the syndrome is initiated by trauma to small peripheral nerves close to the injury.
Useful medications - many of the features of sympathetic pain are similar to those of nerve pain, and therefore nerve pain medications may be useful (Anti-depressants, Anti-convulsants, and Anti-arrhythmics). Drugs which lower blood pressure by causing vasodilatation (nifedipine) may also be useful when used in combination. Treatment should include appropriate multi-modal medications, sympathetic nerve blocks, and intensive rehabilitation combining occupational and physiotherapy.

http://www.coventrypainclinic.org.uk...-paintypes.htm
http://www.coventrypainclinic.org.uk...edirectory.htm
http://health.discovery.com/centers/...nerve_crp.html
http://www.myopoint.com/network/phys...ge_source.html

Pain Medicine and Palliative Care Division: http://www.painconnection.org/MyEduc...epression2.asp

Femoral nerve damage following surgery: http://www.medhelp.org/forums/neuro/archive/16463.html

http://www.pudendal.de/

Scar articles, support groups, and resources: http://www.medhelp.org/HealthTopics/Scar.html

Nerve damage at time of hysterectomy:
http://forums.obgyn.net/forums/women...0006/1993.html

Nerve damage after surgery:
http://neuro-www.mgh.harvard.edu/for...rvedamage.html

http://www.gwpharm.com/news_pres_13_jun_02_int.html
http://www.perspectivesinnursing.org/v1n2/Smith.html

Pelvic Surgery or Trauma:
http://www.newshe.com/factsheets/Pel...r_Trauma.shtml

Is nerve damage permanent?
http://www.medhelp.org/forums/neuro/archive/12786.html

CPP~Symptom checklist:
http://www.obgyn.net/cpp/_carter/image3.htm

Pain in pelvis/lower abdomen:
http://www.wdxcyber.com/what.htm#pelvicmn

Questions You Should Ask About Pain & Pain Treatment:
http://www.ortho-mcneil.com/painb/index.html

Pain Assessment & Management in the New Millennium:
http://www.bellaonline.com/articles/art288.asp

http://www11.medica.de/cipp/md_medic...a_s_t/oid,5371

http://womenshealth.about.com/msubadhesions.htm

Neuropathy infrequent after pelvic surgery: http://www.orgyn.com/news/2002/week_..._infrequen.asp

http://www.neuropathy.org/

http://doctorsforpain.com/patient/treatments.html

http://health.discovery.com/centers/...pain/pain.html

Nerve pain Q & A:
http://health.discovery.com/centers/...rve/nerve.html

Good Luck..I hope you can get some recieve some releif from your new meds Pls keep us posted...(((hugs)))
  #9  
Unread 05-12-2003, 06:36 PM
Nerve Pain and Anti Depressants

Hi Everyone,

I just saw my Dr today and she prescribed Ultram. Has anyone tried that for pain? I tried elavil years ago for migranes, but it caused me to gain so much weight that I am afraid to try it again. Has anyone else had weight gain side effect?

Thanks,
Debbie
  #10  
Unread 05-12-2003, 08:17 PM
Nerve Pain and Anti depressants

I will be very interested to hear what you think of Ultram. I am not able to take Ultram.

The pain clinic I went to several years ago didn't know what to do with me so they sent me home with a lunch bag full of Ultram samples and told me that Ultram would be better for me to take than the Vicodin I was taking at the time. I took one pill... when it started to take affect I felt drunk... then about 2 hours later I was so sick I was vomiting and my head felt terrible.

I will never touch the stuff again.

I hope it works for you but be careful the first time you take it.

Sblumen
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