Posted by bulldog2 on April 18, 2010, at 11:59:32
In reply to Re: ultram, really... » ed_uk2010, posted by floatingbridge on April 18, 2010, at 10:52:45
> Hi Ed,
>
> Your list is really quite helpful--seeing it all lined up--like the first time I looked at the STAR chart for depression.
>
> In answer: I have no experience in the second category--celebrex and the like. Maybe that's a possibility.
>
> I have taken 4,000 daily of tylenol and on seperate days of ibuprofen. Neither provided noticeable relief--and alarmed my pdoc. He thinks that is above standard U.S. dose recommendations. (Well, my grandmother was from the UK.)
>
> My pdoc expressed concern over muscle relaxant--that they could have cognitive effects. (We've worked long and hard to get my mood levels up and stable....)
>
> After your posts, I feel better prepared for my phyiatrist visit next week. Knowing the treatment protocol helps immensely. I'll do some reading about other nsaids.
>
> I mention the psych meds such as cymbalta because I seem to need one, but I suspect difficulty tolerating most snri's which are the ones usually given patients with chronic pain--however, there is renewed interest in effexor and pain treatment. I tolerated that years ago....
>
> Thanks again! And a good day to you.Hi Floating
The tylenol dose has been lowered to 2000 mg in the states because some were getting liver failure on the 4000 mg.
While celebrex is safer on the stomach it has been implicated in sudden heart attacks because it does thicken the blood.
The tcas have been rated as the best ad's for pain relief. Amitriptyline and clomipramine maybe being the best. I am on 25 mg of clomipramine at this moment for only several days and can't say that has helped my pain. However that is a low dose and maybe I will get better results on 50 mg. But I have gotten a nice ad response at this low dose! So this may be a very good ad or very powerful. It is a bit sedating but your stimulant may very well counter that.
There are some studies that tcas seem to potentiate the action of the opiates which is a good thing if you go the way of the opiates.Of course one has to be able to tolerate the tcas.
So tylenol might be to weak for your chronic pain and the nsaids to toxic to the liver, and kidneys for chronic use.
So you have the ads for chronic pain of which the tricyclics seem to have the best pain relieving attributes. Some however don't get enough pain relief from them and combine them with a time released opiate. There are some good time released morphine products.
You have savella which is new but is more for the pain of fibromyalgia. Some do get pain relief from cymbalta but that seems as hard to get off of as the opiates for some.
You haven't mentioned the anti convulsants which are good for neuropathic pain but not as good for arthritic type pain. Again some combine it with an opiate.
Of course my p-doc is trying to kill two birds with one stone. So he is prone to the opiates and he strongly monitors dosage. He has found that benzo withdrawal is far worse than opiate withdrawal. Opiates are on a par with stims in that there are tolerance and withdrawal issues.
You are going to a phyiatrist next week. Did you mean psychiatrist or do you mean some other type of doctor.
It is up to you and your p-doc which way you go. I think you mentioned he was okay with the tramadol so at least he/she has an open mind.
I think opiates by themselves are not complate ads or at least not for me. But they are nice adjuncts.
This is my feeling on using tramadol as your ad and bumping pristiq. I think you would get more out of a strong and standard ad such as effexor or any you can tolerate and adding in a time released opiate to the ad. That is if you go the way of an opiate. A strong ad plus a time released opiate would give you a better pain and ad combo than the tramadol.
By the way I saw studies where they combined effexor and tramadol. That was interesting.
poster:bulldog2
thread:943398
URL: http://www.dr-bob.org/babble/20100416/msgs/943843.html