I have got to get off the gabapentin or at least reduce it and add something in the mix. I have had 2 pain free days! Yeah! However, this is at the sacrifice of losing my thoughts. I went to a meeting last night where I had to explain legal issues -- I realized I am not competent to practice. It's not just the pain, it is in effect the drugs interfering with my ability to think quickly and speak what NEEDS TO BE SAID right the first time.
Being uninsured, there is NO way I can afford Cymbalta! However, my mom was recently prescribed Effexor for other issues. I noticed it is in the same family as Cymbalta. That's also what the doctor told her.
Anyone on it? I was on it BRIEFLY when I first began to have depression issues but it made me completely hyper. I could not slow down. However, this was years ago, and I have other issues that I am willing to give it another try!
I feel like I need a mixture of things.. and going into my appointment tomorrow, I feel like I need to have some education so I don't make some stupid decisions.
I do know that I am going to be truthful and ask the surgeon to consider if he could not operate or treat his patients, what would he do? What course would he take?
The bottom line is I have to find a way to function so I can get back to work. Get back to studying for the next state's bar exam......
Hi Lisa, I currently take Effexor and have been on it since July of this year. It was originally prescribed to me for depression and anxiety but in the process we found that it worked for pain. I was up to 150 mg at one point for awhile then for a couple of weeks at 112.5 mg and had no pain at ALL. Then I had to back down to 75 mg because it was causing mania and anxiety. My neuro then prescribed topamax( I was getting migraines when I backed off the effexor probly just coincidence I have a history of them) to take care of the rest of the pain. Everything was going fine until January 4th when I had the trigger at the dentist and I now have pain on my left side,(bilateral) and I am now taking Trileptal 1200mg daily along with the others as well as norco 5/325 as needed every 6 hours for pain.
Lisa: If Gabapentin (Neurontin) is causing severe side effects, the other two meds commonly tried first are Carbamazepine (Tegretol) and Oxcarbamazepine (Trileptal). If you don't get the desired combination of pain relief and clarity of mind on one of these three, then the second tier of meds might involve a mixture of one of the top three (at lower dose) plus a muscle relaxant like Baclofen or a low dose tranquilizer (Valium). Cymbalta is an SSNRI commonly prescribed for anxiety disorder or major depression. A more commonly prescribed alternative for trigeminal pain might be one of the 10 or 12 tricyclic antidepressants (Amitriptyline, Nortriptyline, others). And finally there are the opiates. When you talk with the folks at OHSU, it might be worth while asking how these meds might be applied in the type of pain you have, or whether there are reasons for preferring one over another.
Thanks Red... I definitely talked meds with this doctor. He added Trileptal to the gabapentin. He said because I am having some periods of short remission that the gabapentin is doing something. He wants me to add the lower dose of the Trileptal and if I have no pain for 3 to 4 weeks, then lower the gabapentin slowly by 300 mg every 4 days.
He also thought the way that I increased my dose was incorrect and my body just has not had time to adjust correctly.
I did try Tegretol and I was a walking zombie..... UGH!
Tegretol made me a zombie as well...I am now on Gabapantin.. Amitripyline and when the pain is so severe I crack open a file of intravenous pain meds...add them to water...and in about 20 mins the pain subsides...I have no ida what this medication is as I live in Spain and France so I dont understand it....but it works anyway....
I am contemplating MVD....but the comments and research Iv done ist very positive....so I am booked in for it on the 20th Feb...but that was when I was in hospital for ATN when no meds could control it...I would have done anything to get rid of the pain...but I just have the niggling/aching upper jaw now...so I am thinking that Brain surgery is not the way forward at the moment...we shall see...
Red, my Neurologist mentioned to me in an email today that he wants to consider Effexor or Cymbalta as a new method of treatment for my TN2 when I visit in mid-January. Gabapentin, Tegretol, Neurontin have all been tried in the past with intense side effects as a result and no aid to my TN2 or persistent unilateral headache pain that is ever present. Should I be cautious of him wanting to move up to Effexor or Cymbalta without trying other things? I am presently on Indocin and Baclofen daily, but they do not seem to help anymore. ~Fred
Richard A. "Red" Lawhern said:
Lisa: If Gabapentin (Neurontin) is causing severe side effects, the other two meds commonly tried first are Carbamazepine (Tegretol) and Oxcarbamazepine (Trileptal). If you don't get the desired combination of pain relief and clarity of mind on one of these three, then the second tier of meds might involve a mixture of one of the top three (at lower dose) plus a muscle relaxant like Baclofen or a low dose tranquilizer (Valium). Cymbalta is an SSNRI commonly prescribed for anxiety disorder or major depression. A more commonly prescribed alternative for trigeminal pain might be one of the 10 or 12 tricyclic antidepressants (Amitriptyline, Nortriptyline, others). And finally there are the opiates. When you talk with the folks at OHSU, it might be worth while asking how these meds might be applied in the type of pain you have, or whether there are reasons for preferring one over another.
Fred, both Effexor and Cymbalta are used by some practitioners in Atypical TN. They help some people -- not all. Both require gradual tapering up to reach an effective range. Both cause side effects in some people. So the rule is try it and observe side effects carefully. Other alternatives exist in the class of Tri Cyclic Antidepressants, as well. I'm not surprised that Indocin hasn't helped your TN pain much. It's primarily used against migraine, which is not the same disorder at all.
Thanks Red. I have a companion unilateral headache (24/7/365) that has accompanied my TN2 since the beginning. Honestly, the headache started about a month before the first TN flare hit me. The Indocin keeps the headache on a leash, or had done so as long as I took low doses. It never made it go away, but kept it from spiking quite so hard which helped avoid TN flares incited by the headache. My Neurologist has given me no reason to distrust his judgement. So I will try whichever one he wants me too. I do somewhat hate to start something that is so hard to come off of (like Cymbalta) since nothing else that typically works for people with TN has helped me. All have failed to slow this thing down and some gave me wild side effects. It has been two years now since I first came here looking for answers and support about my Atypical TN (TN2) and nothing we have tried has really helped. I have had a burning flare around my right eye day in and out for better than a year now...it never goes away. I unfortunately had a terrible excuse for insurance last year that would not pay for anything related to my TN2 as they deemed Neurology a mental health science and my plan did not cover mental health services. Then, they jacked my policy up so high due to excessive claims that they refused to pay anything on that I lost them last September. I am thankfully getting a really wonderful plan starting Jan. 1st thanks to the Affordable Care Act ($49/month premium on a policy that would otherwise cost $502 per month for my family). Will finally be able to pursue this again and hopefully not just live with it in all its raw fury. Of course, I am now having TN-like nerve pain from head to toe with exception to my trunk and the left side of my face (my TN2 is on the right). I have something else going on beyond Trigeminal Neuralgia. One Doctor thinks it's MS, one thinks it's Fibro, but I've not had insurance that would allow me to pursue getting on a path to diagnosis for it until now. ~Fred
Richard A. "Red" Lawhern said:
Fred, both Effexor and Cymbalta are used by some practitioners in Atypical TN. They help some people -- not all. Both require gradual tapering up to reach an effective range. Both cause side effects in some people. So the rule is try it and observe side effects carefully. Other alternatives exist in the class of Tri Cyclic Antidepressants, as well. I'm not surprised that Indocin hasn't helped your TN pain much. It's primarily used against migraine, which is not the same disorder at all.
Lisa,Hit your doctor for free samples.Believe me,they have a closet full of stuff.I have two bags of Cymbalta he gave to me to try.I think it was a couple months worth.I took one pill and hated the feeling it gave me.Never took it again.Hate these drugs!
