Is or has anyone with ATN combined Gabapentin (neurontin) low dose, Lyrica (low dose) and Amitryptiline (probably spelled wrong) to see if this combo reduces pain without the sever side effects of high doses of any one of them? I am seeing a new neurologist in 2 weeks and want to ask him about trying this cocktail in low doses to see if that helps my pain. In the last 2 weeks, my pain has escalated and is now waking me up during the night - even though I am taking doxepin and Xanax at night to sleep. I used to feel that, at the least, sleep would get me out of pain. Now, even that is being taken away by pain.
I have heard of two in combination but not three... However, I don't see why this should be an issue except if taken all together, you likely will want to sleep for a long while. They are all from different drug classes, taken to treat different issues.
Have you run these drugs through a drug interaction program like at www.drugs.com?
No, I haven't researched if there is any interaction yet. If these are taken in low doses and at different intervals during the day, I was hoping they would enable me to be work and still reduce the pain. I am so hypersensitive to drugs and side effects, so thinking of trying "low dosages" of meds would be best. Taking Lyrica in the AM, Neurontin at dinner and Amitryptilene at bedtime might be the combo that would work.
Lyrica and Neurontin are so similar to each other that I don't know if they're prescribed together too often. Maybe though. You can definitely add either of those two to amitriptyline. Let us know what your doctor says!
I have taken 300mg 3xdaily of gabapentin with the max dose of Lyrica before. I had severe side effects from the gabepentin so I was taken off of it quite fast. I became very agitated and verbally aggressive, just mean. Changes in mood and behavior is one of the side effects of gabapentin. I did remain on the Lyrica for 2 years without any problems. I have never taken the amitryptilene. Good luck.
LaLa
I tried this combined dose of meds to see if they worked..sadly they didnt and I had alergic reaction to Lyrica...so needed antihistame injections to take away the swelling of the tongue and to help me breathe....I sometimes wonder if there is actually anything anyone can do about this disease...I too wake up in the night with the pain...and am sick and tired of being on lots of medication...and I dont think MVD treats Atypical TN...
@Carol,
MVD does not typically work for ATN. It is a 50% chance of working for you. I had MVD in the hopes of a slim chance that it would help me. It worked for a whopping 2 months but it was 2 months well worth it.
LaLa
How on earth are you able to function on all those meds? Personally I can handle Gabapentin, but it is lights out with Lyrica.
I nearly road down a luggage conveyor at an airport after taking Amitryptiline.
Granted we are all different, but if I use drugs it is generally because I'm left with no other choice. I'm coming down from taking a mixture of drug cocktails last week when I got so desperate I checked myself into the ER. Today is the first morning I've felt like I've woken to a clear head, I just hope I can get the work I need done while this remission period lasts!
I just pray you have a reliable support group watching over you, I am by myself so I really have to be careful.
Best of luck to you,
John
Thank you La La....I must admit I didnt think it would work for ATN either....soooo...just I will just keep taking the meds and hope one day they come up with something that can cure or at least relieve the symptoms of ATN.....we can live in hope eh !! xx
La La said:
@Carol,
MVD does not typically work for ATN. It is a 50% chance of working for you. I had MVD in the hopes of a slim chance that it would help me. It worked for a whopping 2 months but it was 2 months well worth it.
LaLa
My Mom suffers with ATN and the combo of 300 mg of Lyrica (100mg, 3 X's daily) and 25 mg of Amitryptilene at bedtime did the trick and got her out of her daily pain. Lyrica by itself didn't work. Hope this info helps. Wishing you the best as you look for the right meds. Carole Artino
I cannot take Lyrica...I had quite a bad reaction to it...My tongue swelled and I had difficultly breathing....luckily I was in hospital at the time....and the Nuerologist then gave me antihistermine injections and obviously stopped the Lytica...so its back to the Gabapantine and Amitryptilene....which so far is working again now....fingers crossed it will continue....but thanks you for sharing this xx
D. McGinnis, Replies to your combo of meds question shows that combinations are often used and are highly dependent on the individual reactions to the meds. I have been placed on multiple meds from all three groups by various pain specialists. Here are some meds references used in this new concomitant or combo drug approach. As the previous messages have said, side effects are different for everyone as well as the benefits. Hope these are helpful in watching for interactions and side effects and also for looking for alternatives. It seems there is a huge amount of research called concomitant medications or multiple meds to replace opiods. Here are some of the better summaries. But, as you already know, we each have to find what works for us. A good tool is to ask a friend or family member to review these (they are written for patients) because you need a cross check on your decisions on improving your meds and their results. Besides, there are so many choices that you need to narrow your focus.
ACPA Consumer Guide to Chronic Pain Medication & Treatment, 2011 Edition
American Chronic Pain Association
2. http://www.jci.org/articles/view/43195
The discovery and development of analgesics: new mechanisms, new modalities
3. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2844007/?tool=pubmed
Recommendations for the Pharmacological Management of Neuropathic Pain: An Overview and Literature Update, 2010
For people who prefer summaries the tables of this article are at:
Table 1: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2844007/table/T1/
Table 2: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2844007/table/T2/
Table 3: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2844007/table/T3/
Also published again by NIH as: http://www.ncbi.nlm.nih.gov/pubmed/20194146
You can download the full PDF file document from www.nice.org.uk/guidance/CG96
Or the patient’s Quick Guide Reference with the “Neuropathic Pain” title.
A summary of the NIH guideline is published by the International Association for the Study of Pain in their November 2010 online newsletter entitled “Pharmacological Management of Neuropathic Pain” at www.iasp-pain.org
The Mayo Clinic version of these recommendations is Mayo Clin Proc. • March 2010 85(3)(suppl):S3-S14 • doi:10.4065/mcp.2009.0649 • www.mayoclinicproceedings.comM
4. http://www.medscape.com/viewarticle/730671_print
Treatment of Neuropathic Pain (how to implement recommendations of reference 11.)
5 http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001751/
Trigeminal neuralgia (short version by NIH of references 11. And 12.)
6. htp://www.stoppain.org/pain_medicine/content/chronicpain/trigeminal.asp
Who gets trigeminal neuralgia? (article shows that hospitals other than Mayo are developing TN treatment programs with info on the internet)
7. http://www.ncbi.nlm.nih.gov/pubmed/17038030
EFNS guidelines on pharmacological treatment of neuropathic pain
(European guidelines in 2006 agree with NIH 2010 guidelines and recommended research areas)
8. https://secure.pharmacytimes.com/lessons/200509-02.asp
Neuropathic Pain Diagnosis, Treatment, and the Pharmacist's Role in Patient Care
9. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3002644/
Treatment options in trigeminal neuralgia (NIH study reviews current meds results as well as surgical intervention results)
10. http:// www.painknowledge.org/painresources/productindications.aspx
Pain Medications Product Info (effects and side effects written for patients)
11. http://www.uofapain.med.ualberta.ca/Palliativeconversiontable.htm
CONVERSION BETWEEN OPIOID ANALGESICS , 4/30/2007 (helpful in finding different meds and doses to replace current meds)
D McGinnis, Your description is already nearly good enough. Here are some thoughts to refine it.
Pain scale use at the pain management doctor’s office:
Your name is called and the nurse weighs you on the way to a patient room where he/she takes your vitals (blood pressure and temperature), reviews your prescriptions then asks your current pain level. If you hesitate or alternatively, begin a lengthy description you will be stopped and asked to look at the wall chart and pick a number that will be written next to your vital signs for the doctor who checks this sheet before starting your interview (obviously, choose your worst pain location at the time for your answer because they only want a single number and not a conversation which is the doctor’s job called taking your clinical pain history). The typical wall chart from one of many pharmaceutical company sales reps follows the Visual Analog Scale (VAS) for pain because it is accepted worldwide, works in all languages for children and adults and acknowledges that the number is only an initial indicator for the patient to begin his description while giving the doctor an indication of patient coherence at the time. The key for the patient is prior preparation using the proven pain diary and patient forms required by doctors at initial interview. Similar to the recommendations in the TNA Knowledge Base forms recommended to prepare to see your Physician.
(Pharmaceutical Company wall chart):
Level = 0, Description= no pain
Level = 1-3, Description= Mild-nagging and annoying but little
interference to Daily Living Activities (DLA)
Level = 4-6, Description= Moderate interference to DLA
Level = 7-10, Description= Severe- disabling, unable to perform DLA
Name your usually dominant pain point or starting pain point and the next three most frequent pain points and assign a number using the wall chart scale. As pain levels increase the pain usually spreads and hopefully you can distinguish between the primary (most frequent and highest pain) and secondary which arise only at the higher pain levels such as 7 or higher.
Now, use one sentence or phrase for those four pain locations to tell the activities you are unable to perform to put these numbers in context for the doctor. Then you can tell about the secondary pains that also start as the primary pain levels are high ( 7 or above).
The doctor already knows you have tried all the over the counter meds and they do not allow you to do DLA or you would not be in to see him. The numbers don’t mean a lot without context on how the pain affects your life. The sentence or phrase for the four pain locations provides the context. People have different pain tolerances due to different nervous systems as you already know and you are telling him/her what it means to you. Use real examples such as “had to leave work four hours early on – number of days” or “I spent all nine company holidays, ten vacation days, 8 sick days and every other weekend in bed” due to pain.
Basically, you need to choose a few words to concisely tell your pain level so the doctor can understand. The pain level number doesn’t mean anything without context (as short as possible). All of us have favorite examples and here are a couple of mine. After months of exams and interviews by ENT’s (otolaryngologists) with no recommendations, I mentioned that I had just forfeited $2000 deposit on an Alaskan week long fishing trip to a remote cabin via pontoon airplane because my pain was too great to board the aircraft. Within 15 minutes I was scheduled for sinus surgery. To his credit we had already established that lidocaine on a cotton swab at a specific point in my nostril eliminated my constant burning pain.
You don’t always get what you intend. I told an east coast ENT that my pain was too great and allergy medicines were not sufficient. I considered my only options as moving to the desert if he could not help me. He called my bluff and said I had three choices – continue the allergy medicines, stop the medications or relocate. He suggested Alaska might also be better with my allergies. This was before I was diagnosed with TN, had multiple dentists declare no teeth related problems or learned about pain management specialists who are continuing to develop their diagnostic and treatment procedures at a rapid pace. Even family doctors are beginning to learn about pain management and will often refer you to a specialist or a neurologist.
Anyhow, I recommend you use the wall chart descriptors above to choose your own descriptive words for each pain level number in terms that have real context. Your short descriptors will come naturally if you keep a pain diary after recording the same words repeatedly. Here are some examples of levels where interference to DLA:
My level 6 = can drive my car but don’t want to.
My level 7 = pain too distracting to drive my car any long distance but I make short trips to the store or pharmacy; avoid walking a block to the community mail boxes; cannot read more than a few pages in a book or a short magazine article due to distraction.
My level 8 = bedtime often after taking breakthrough pain med. Important to state how long these episodes last, e.g., may be seconds or minutes or hours depending on your type of pain.
To make things worse, pain locations may be multiple and moving . This is not as tough because you can list a pain level for each location. Use anatomy terms from Wikipedia to select your pain locations because you have probably already looked up the anatomy terms where it hurts. Teeth are a common ailment so list the teeth that hurt once then you can refer to the area after listing the involved teeth if needed. There are excellent teeth charts on the internet for this. Remember, doctors are only human. Think about how you would listen to a stranger describe their pain to you. A simple example that you have probably encountered is a friend with back pain who just wants to remain motionless. I am sure you have heard it is best to write in down in one page or less to hand to the doctor in case you are in pain and have difficulty conversing.
I hope this helps and you may already be keeping a pain journal or diary and can assign numbers to your pain locations and the journal or diary allows you to determine how long a dose of meds lasts so you can choose the best meds for your condition. There are many good meds because this is not a new problem. But, you are the one who determines the efficacy of each of the meds the doctor asks you to try as he asks for your reports on each medicine to find the ones that have fewest side effects and the lowest effective dose. This is already lengthy so I will post a separate reply to provide internet references on the most popular pain scales and pain logging or diary tools to track your pain. Here are a few that will be in the longer list:
- “Making the Most of Your Consultation with a Healthcare Provider” (one and a half page list of info to prepare for your doctor) at TNA Home page in the Knowledge Base links on the right side of the page.
*** 1. Randall Chronic Pain Scale
http://www.rsdhope.org/ShowPage.asp?page_id=116
2. Pain Management Guide
http://www.webmd.com/pain-management/guide/nerve-blocks
3. WebMD Medical Reference on February 10, 2009
Quality Of Life Scale, A Measure Of Function For People With Pain
*** 4. Gentile, D. A., Woodhouse, J., Lynch, P. J., Maier, J. A., & McJunkin, T.L., (November, 2010) Reliability and Validity of the Global Pain Scale with Chronic Pain Sufferers. Presented at the 2010 meeting of ASRA, Phoenix, AZ http://www.ncbi.nlm.nih.gov/pubmed/21267043
***5. The Measurement of Pain in Patients with Trigeminal Neuralgia
www.cns.org/publications/clinical/57/pdf/Chapter19.pdf
Paper and pen works fine to log your meds and pain levels and times or you can use apps on smart devices from:
6. http://appshopper.com/healthcare-fitness/my-pain-diary
My Pain Diary, iOS iPhone
7. The pain diary app known as MyPainDiary (item 6. Above) for the Apple devices has been adapted for Android and is available at Android Market https://market.android.com then search on "pain diary" to view Manage My Pain (Pro and Lite versions) or free Lite version at http://appaggie.com/manage-my-pain-lite/ . User comments are shown below the descriptions.