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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 3 of 3. This is the beginning of the thread.
Posted by cecilia on February 28, 2006, at 1:17:11
I have painful diabetic peripheral neuropathy. Neurontin does nothing. Tricyclics are the other thing you usually see recommended, but I've tried several tricyclics (for depression) and the only one I was able to get to a therapeutic dose on was nortriptyline and that had terrible side effects too, just not as bad as the others. I've read some places that only small doses of tricyclics are needed for neuropathy and and other places that you need to get up to the full dose to do any good. If the latter is true there's no point in bothering, but if a small dose would work it might be worth trying. Anyone know? Oh, I've tried Cymbalta too (for deprssion) couldn't tolerate it. I haven't tried Lyrica, but doubt that it would be that different from neurontin. Cecilia
Posted by Larry Hoover on February 28, 2006, at 8:24:20
In reply to Peripheral Neuropathy- Tricyclics, posted by cecilia on February 28, 2006, at 1:17:11
> I have painful diabetic peripheral neuropathy.
I am sorry to hear that you are, with me, a member of the neuropathy club.
> Neurontin does nothing.
Have you tried pregabalin (Lyrica)? Although it was supposed to be "improved Neurontin", at least by some people, I consider it to be different enough that a lack of response on the one does not properly predict responsiveness to the other.
> Tricyclics are the other thing you usually see recommended, but I've tried several tricyclics (for depression) and the only one I was able to get to a therapeutic dose on was nortriptyline and that had terrible side effects too, just not as bad as the others.
I hear you on that. I am absolutely *sick* of prunes right now.
> I've read some places that only small doses of tricyclics are needed for neuropathy and and other places that you need to get up to the full dose to do any good. If the latter is true there's no point in bothering, but if a small dose would work it might be worth trying. Anyone know?
I think it's most important to figure out if you can answer that question for yourself. I was prescribed nortrip at 150 mg/day? (something like that, maybe higher), but I couldn't get past 75. I struggled with those side effects for a number of weeks, and none of them were remitting with the passage of time, so I reluctantly backed down in dose. I now take 25 mg a day. I still think it helps, but I also clearly noted greater pain as I reduced the dose, both from 75 to 50, and during the later reduction to 25.
I can say that I get some benefit from nortrip at 25 mg/day, but that a higher dose would provide stronger relief. That is my personal nortrip dose/response.
> Oh, I've tried Cymbalta too (for deprssion) couldn't tolerate it. I haven't tried Lyrica, but doubt that it would be that different from neurontin. Cecilia
Oh, you mention Lyrica. It might be different. You won't know until you try. From what I understand, responders know that they are responders within days, if not a couple weeks. So, a three week trial would totally answer that question.
I know this may not be an option for you, but my biggest "breakthrough" on the neuropathy front came when I added medical marijuana to my regimen. I get cannabis-butter infused chocolate bars from a clinic in Toronto, and one square of chocolate twice a day does the trick. It hasn't helped with the pain, really. What it did was it increased my ability to cope with the pain. A dramatic increase in my pain threshold. I hurt just as much, but I'm not being dragged down by it, day by day by day.
If I smoke marijuana, I get high. And that's not what I'm after, although it would probably also do something similar with my pain threshold. The cannabis chocolate does not make me high. It's a very different animal.
Lar
Posted by cecilia on March 1, 2006, at 0:07:27
In reply to Re: Peripheral Neuropathy- Tricyclics » cecilia, posted by Larry Hoover on February 28, 2006, at 8:24:20
I guess I'll ask my doctor about Lyrica again, I e-mailed him about it once but he didn't answer my question, just doubled my Neurontin from 900 mg to 1800. I doubt my HMO would cover Lyrica, they're pretty cheap about expensive new drugs. I've been taking the Neurontin for about 9 months and I'm not really sure why except it has no side effects and I think, well maybe I would be worse without it. I briefly went up to 2400 but started back down again after embarrassing moments of not being able to think of the names for a couple of common objects-I thought oh no, I'm getting Alzheimer's and then remembered I'd increased the Neurontin. I'm really reluctant to try a tricyclic again, I don't mind prunes, it's the tachycardia and palpitations that bother me most, along with the numerous other side effects. I'll probably try the long awaited Emsam for depression 1st anyway, so wouldn't be able to use a tricyclic at the same time. What exactly is it about the tricyclics that's supposed to help? It seems the meds that are supposed to help neuropathy are those like tricyclics and Cymbalta that have both serotonin and norephinephrine. But you never hear of MAOI's being used and they have both as well. I just finished a trial of Marplan for depression, it didn't work for depression and certainly had no effect on my neuropathy either. I'm not brave enough to search out the marijuana chocolate, though the chocolate alone sounds like a pleasant remedy. I'm taking tons of supplements-fish oil, flax oil, evening primrose oil, conjugated linoleic acid, alpha lipoic acid, benfotiamine, glucosamine and chondroitin (for my arthritis), multi-vitamins, vitamin C, vitamin E, vitamin B complex, calcium and magnesium, selenium, lutein, coenzyme Q-10, grapeseed extract, bilberry extract. Who knows if any of them do a thing or if I'm just wasting my money. . Have you heard of the Rebuilder device for neuropathy, frankly it looks like pure quackery, but they give you a 90 day guarantee so maybe it's worth a try. Cecilia
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