Question:

Those spacers are good. . .but the neatest thing I have seen is a product called MDI Tutor.  It is tiny [barely adds any size to the inhaler] and helps you use your inhaler properly.

Response:

My Aerochamber makes a whistleing sound when I inhale too fast.  Is that what you’re talking about? – Hide quoted text — Show quoted text – Those spacers are good. . .but the neatest thing I have seen is a product called MDI Tutor.  It is tiny [barely adds any size to the inhaler] and helps you use your inhaler properly.

Response:

Please email your mailing address.  I will send you a complete package of information on what has finally given me drug free relief after thirty years of suffering!!!

Response:

I can’t imagine taking inhalers anymore without the Aerochamber.  It cuts out that hoarse throat, and just all around seems to be more efficient at getting the medicine where its supposed to go.  Before it would land on my upper pallette (sp?) and leave a spot of medicine there.  Now I don’t have to pay so much attention to how I’m taking it except for expelling my breath before. Sue M.

I agree with you … Aerochambers are great. There’s a really good one out there called an OptiHaler, made by Healthscan Products. I don’t know if you’ve tried it but I personally like to use it a little better than those clear AeroChamber ones. The OptiHaler is more compact so it’s easier to carry around, and I like how it functions. You can store your medication inside it, too. It’s hard to find though at the pharmacies.                                              http://www.europa.com/~bjknotts/

Response:

I can’t imagine taking inhalers anymore without the Aerochamber.  It cuts out that hoarse throat, and just all around seems to be more efficient at getting the medicine where its supposed to go.  Before it would land on my upper pallette (sp?) and leave a spot of medicine there.  Now I don’t have to pay so much attention to how I’m taking it except for expelling my breath before. Sue M.

Response:

What is an aerochamber? Kathy Anderson fellow-sufferer

Response:

What is an aerochamber? Kathy Anderson fellow-sufferer

See the alt.support.asthma FAQ – I wrote a bit on Aerochambers in the FAQ. Briefly, it is a holding chamber that makes inhalers easier and more efficient to use: you spray your medication into it and then inhale the medication from it, at your own comfortable rate. Certainly worth having, since the inhalation speed required for matching the inhaler’s spray speed is difficult for many to achieve (especially during a flare), and since, without one, those who take inhaled steroids are more likely to get thrush. — Mark Feblowitz,   GTE Laboratories Inc., 40 Sylvan Rd.  Waltham, MA 02254

Response:

 When I posted my first note about a month ago I got a lot of wonderful advice from people and many asked for an update after I saw the doctor. Here it is!  I went to the doctor today and by the time I left I was so elated! What a relief to finally get professional help, I feel so relaxed. He put me on Methylprednisolone tabs for 6 days and I also have Flovent and Serevent that I take two puffs of twice a day. I got Albuterol for when/if I have any problems. He also gave me an AeroChamber and a peak flow meter. Now I’m cooking with gas!  :)  Thanks for all the concern. Tammy

Response:

Question:

I must say that I did not find Simple Green very good as a degreaser.  I sprayed it full strength on the chain rings and several areas of the frame with no luck at cutting the grease even after vigorous rubbing.  I even let it sit for a while.  I went back to the citrus degreaser which works great. Mark

I find Simple Green ($7 for a whole gallon at Sam’s Club — and you can dilute it and use it as a general household cleanser) works great in my Vetta Chain Cleaner, but really is not that effective on heavy degreasing jobs, such as cleaning headset bearings in races.  Still, it’s a relative bargain compared to many bicycle-specific products. Ron

Response:

: Does anyone have some experience which cheap degreasers, which do not : include the mtb premium price, i.e. are not primarily made for cycling use. : Try WD40, works great for me. Try Turpentine (Synthetic sort) Costs about

Question:

- Hide quoted text — Show quoted text – My anxiety/panic attacks are actually a lot better than they use to be.  My depression isn’t as intense as it was say a couple of months ago either.  Right now, my biggest problem seems to be obsessive thoughts that I cannot get out of my mind.  For example, I called a lady friend of mine night before last and she still hasn’t called me back.  She normally calls be back shortly after I call her.  This evening I have gotten myself all worked up about her not calling, thinking that she doesn’t like me anymore or is mad at me about something.  Does anyone else experience this obsessive type of thinking?  Is it part of anxiety or is it possibly a deeper problem?  Take care and happy Easter. Yes. A thought goes through my mind and it circulates and intensifies and it becomes very hard to get rid of. At times the thoughts are very positive obsessions (now that the Zoloft is lifting the depression); other times they are negative obsessions. It could be part of anxiety or depression IMO. The Zoloft has merely transferred them more often to the "positive zone." Of course, you constantly have to work to break those negative cycles. Don’t simmer on anything but positive obsessions.

Hello Marie, Thanks for your reply.  Obsessing about things is a big problem with me.  It seems everyday I am obsessing about some new thought or worry. I have been really bad for this for about six years now.  Sometimes I’ll get so worked up I’ll be just beside myself and don’t know what to do.  When I get like this Seroquel PRN seems to be really helpful. Anyways, thanks again for your reply.  Take care. Chris Hecker

Response:

Hello group, I have been struggling with anxiety pretty much my entire adult life. In addition to anxiety I also suffer from depression, possibly bi-polar.  The meds that I am curently on are Effexor XR- 150 mg Seroquel – 50 mg HS Inderal (to counteract shaking caused by my meds) 40 mg Lithium carbonate – 600 mg HS My anxiety/panic attacks are actually a lot better than they use to be.  My depression isn’t as intense as it was say a couple of months ago either.  Right now, my biggest problem seems to be obsessive thoughts that I cannot get out of my mind.  For example, I called a lady friend of mine night before last and she still hasn’t called me back.  She normally calls be back shortly after I call her.  This evening I have gotten myself all worked up about her not calling, thinking that she doesn’t like me anymore or is mad at me about something.  Does anyone else experience this obsessive type of thinking?  Is it part of anxiety or is it possibly a deeper problem?  Take care and happy Easter. Chris H. Internet Security 101 – http://www.internetsecurity101.net

Response:

My anxiety/panic attacks are actually a lot better than they use to be.  My depression isn’t as intense as it was say a couple of months ago either.  Right now, my biggest problem seems to be obsessive thoughts that I cannot get out of my mind.  For example, I called a lady friend of mine night before last and she still hasn’t called me back.  She normally calls be back shortly after I call her.  This evening I have gotten myself all worked up about her not calling, thinking that she doesn’t like me anymore or is mad at me about something.  Does anyone else experience this obsessive type of thinking?  Is it part of anxiety or is it possibly a deeper problem?  Take care and happy Easter.

Yes. A thought goes through my mind and it circulates and intensifies and it becomes very hard to get rid of. At times the thoughts are very positive obsessions (now that the Zoloft is lifting the depression); other times they are negative obsessions. It could be part of anxiety or depression IMO. The Zoloft has merely transferred them more often to the "positive zone." Of course, you constantly have to work to break those negative cycles. Don’t simmer on anything but positive obsessions.

Response:

Question:

I’m new to this news group. I’ve been diagnoses with severe ocd. I’m just hoping to connect with some others that have this problem. I am a counselor but you know it’s easier for me to help others than it is for me to help myself. I’ve struggled and studied this for a long time so hopefully I will have useful information for y’all as well. Staggy

Response:

"Micky Stagemeyer" <sta…@charter.net

wrote in message

news:v72poo4cj5qv03@corp.supernews.com…

I’m new to this news group. I’ve been diagnoses with severe ocd. I’m just hoping to connect with some others that have this problem. I am a counselor but you know it’s easier for me to help others than it is for me to help myself. I’ve struggled and studied this for a long time so hopefully I will have useful information for y’all as well. Staggy

Hi Staggy, I too find it easier to dish out advise then to "help myself". Anyway, I am looking forward to your posts. Lain — Warning: Be careful of the right side.

Response:

Lain –   My ocd is mostly what they would refer to as a "pure obsessional". I don’t have much of the compulsions that are typical of ocd. "Fear" of future events is really hard for me. It keeps me isolated. I spent a month in a day hospital during october which did help but I have a lot of work left to do. The cure is worse than the disease itself. Staggy

Response:

"Micky Stagemeyer" <sta…@charter.net

wrote in message

news:v72poo4cj5qv03@corp.supernews.com…

I’m new to this news group. I’ve been diagnoses with severe ocd. I’m just hoping to connect with some others that have this problem. I am a counselor but you know it’s easier for me to help others than it is for me to help myself. I’ve struggled and studied this for a long time so hopefully I will have useful information for y’all as well. Staggy

Hello Staggy Welcome to the group! Sounds like you’ve come to the right place. Dr Zorg

Response:

"Staggy" <sta…@charter.net

wrote in message

news:v72r14fctffbc1@corp.supernews.com…

The cure is worse than the disease itself. Staggy

Yes, "seems" like the is no light at the end of this tunnel. Lain — Warning: Be careful of the right side.

Response:

Staggy wrote:

  My ocd is mostly what they would refer

to as a "pure obsessional". I don’t have

much of the compulsions that are typical

of ocd. "Fear" of future events is really

hard for me. It keeps me isolated.

Copied from a post I wrote a few weeks ago –

‘FWIW, most people who claim to be ‘pure obsessionals’ or to have ‘pure o’ OCD, in fact perform mental compulsions. Which is good news, in a way, cos it was previously believed that people with just obsessions (people with ‘pure o’ OCD) were more difficult to treat because there were no compulsions to deal with. Most experts now see the concept of ‘pure o’ OCD as outdated and not useful for proper treatment as more has been learned about mental compulsions. Now, people who were once labelled as ‘pure o’ and thus ‘difficult to treat’ are seen as just as treatable as people with ‘regular’ OCD.’ I would add that it could be that isolating yourself is a form of OCD avoidance, which is very typical OCD behaviour.  

The cure is worse than the disease itself.

In some cases, yes. In many cases it’s the belief that the treatment is worse than the OCD that is the culprit. There are many studies that show that people with OCD devalue their ability to cope with ‘bad’ experiences, much more than people without OCD. Couple that with tendencies for people with OCD to exaggerate risk, catastrophize and to dwell on the negative, it’s no wonder many people with OCD do not do CBT. — ARQ Add a dot on each side of the ‘r’ in my name and a ‘c’ in front of lara to email me.

Response:

I drove an ambulance for 15 years and I’ve worked in a hospital for most of my adult life but I don’t want to delude you into thinking I’m a DOCTOR or anything. I also find it easier to help others than to help myself. I’ve been on this group for over for over 5 years and have gotten a lot of useful information from this group. I also find the moral support encouraging. I’ve was diagnosed with OCD & depression 12 years ago (have had it longer). I’ve taken Pamalor, Prozac, Paxil, Celexa, & some others with varying results. SOme were pretty good (like Pamalor and Paxil) but I didn’t like the side effects. I’m currently on Zoloft and Tegretol and I am going to stop the Zoloft (gives me diarrhea & makes me anxious) and try Luvox starting tomorrow. Welcome. NK PS- I would be careful about using your real name on usenet. Too many psychos. "Micky Stagemeyer" <sta…@charter.net

wrote in message

news:v72poo4cj5qv03@corp.supernews.com… – Hide quoted text — Show quoted text -

I’m new to this news group. I’ve been diagnoses with severe ocd. I’m just hoping to connect with some others that have this problem. I am a counselor but you know it’s easier for me to help others than it is for me to help myself. I’ve struggled and studied this for a long time so hopefully I will have useful information for y’all as well. Staggy

Response:

Hi NK,         It is a known fact that diarrhea is a side effect of Zoloft. However, my experience is that you have less risk of it if you take it with a full stomach.  Also, thank you for letting me pick your brain about my current situation. JP

Response:

Question:

Hello folks– I’ve been prescribed Effexor XR for just over a month for moderate depression. I started at the lower doses of 37.5 and 75 mg. for two weeks, and I’ve been on the 150 mg. dose (once a day) for nearly 3 weeks.  I’ve had very few of the *customary* side effects and I’m tolerating the 150 mg. dose well, and the medication is really working well at alleviating my depression. However, I think the medication is negatively affecting my harder runs–specifically my recent 5K to 5 mile races, and my tempo/interval workout on Wednesday evenings.  For example, I’ve slowed down about 1:30 for my 5K time (29:15 in mid-November to 30:45 on New Year’s Day), and I’m considerably slower running my interval workout when I take my pill the morning of the workout.  Yesterday I experimented by skipping my pill, and ran my workout great–like before I started on the medication.  However, last nite I had very vivid dreams while sleeping (the second time this has happened), and felt groggy when getting up–which passed after I took my pill after eating breakfast this morning. Does anyone here on the newsgroups know specifically about the cardiovascular effects of anti-depressants?  Will my running/training be compromised for as long as I’m on the medication?  I’ll be mentioning this to my psychiatrist when I see her soon, but I thought I’d ask about it here first.  Since she told me that I could expect to be on medication this time for over a year (this is my 3rd recurrence of depression in 16 years), I’d really like to get this little *wrinkle* straightened out sooner instead of later! Thanks in advance– Jean Barto Newport News, VA — "If you are going through hell, keep going." Winston Churchill

Response:

Hi Jean, Here is some info: Side effects registered for Venlafaxine The FDA has forced safety related drug labelling changes regarding Efexor.

Question:

"Edee Roche" <Roche…@AOL.COM

wrote in message

news:39.80b5c24.26b3c117@aol.com…

I’m on prozac, which costs between $140  and $156 for 60 caps. Does anyone out there know if meds would be cheaper in Canada? and if so, what iis the procedure to follow to get my meds from Canada?

1)  You bet your *ass* prozac is cheaper here, Edee.   It would run $90-120CDN ($60-80US) for your scrip. 2)  Other than showing up here to buy ‘em, I have no idea how you’d get ‘em from here.  :-( —      (((((((((((((U))))))))))))) Michael <muirh…@island.net

  -=[ Livin' on Island Time ]=-

Response:

In a message dated 07/27/2000 11:57:35 PM Central Daylight Time, ta…@TNS.NET writes:

<< I just downloaded a huge list of pharmacies in Mexico and that’s my  next step.  

I’m on prozac, which costs between $140  and $156 for 60 caps. I take Miacalcin to rebuild  and  strengthen my bones @ about $66 a month. These are two of the 10 meds I take, and the most expensive.  Tammy mentioned Mexico. Does anyone out there know if meds would be cheaper in Canada? and if so, what iis the procedure to follow to get my meds from Canada? Edee

Response:

Shell, I can increase my neurontin if I want too (more $$$$) – I don’t want to go back on morphine as I do travel – it is very difficult to go out of this country with morphine – I went to Tel Aviv (Israel trip) – found out after that if my meds were inspected I dould have been arrested even with Neuro’s lettters etc. That scared me.  Be well Shell Love Barbxx. "Shell" <smin…@epix.com

wrote in message

news:397B4595.FA1F6D1B@epix.com… – Hide quoted text — Show quoted text -

Barb, Won’t your doc give you both (neruontin and morphine) I know I could never

even

ask for morphine and that is why I put up with the awful neuro I currently

see

because I’m scared I will lose my current pain meds. Anyway….. If you have already used Morphine and it helped, wouldn’t your doc give

you some

for break thru pain? I never sleep thru the night. I hate this nasty pain

and I

feel for all of us that have to put up with it ecspecially when there is something that helps. Our only obstacle are getting the docs to do their

jobs.

Take Care Shell Barb Edmiston wrote: Hi Joanne I still get break through pain at times on Neurontin. At the moment I am in a real mess. I can’t sleep – if I try to exercise

I

get into this ‘overdrive’ like tremors and weakness + pain but fast

heart

and nightmares.(Neurontin relief is reduced by eating high protein =

steak

or lean chicken etc.) BUT I need to try to keep fit. Barb – wondering

what

the ****** is going on in my body. Got my first wheelchair last week –

for > > home – but failing badly at everything else.  Hey –  xx be well on both > > meds!! OK? > > "joannek4" <joann…@email.msn.com

wrote in message

> > news:ePKwXo58$GA.420@cpmsnbbsa08… > > > Barb Edmiston <barbedmis…@dingoblue.net.au

wrote in message

> > > news:3977da87$0$11187$7f31c96c@news01.syd.optusnet.com.au… > > > > Shell – I thought morphine worked really well for me – it changed my > > life! > > > > But the Docs are dead against it now as some folk have discovered ho w to

change the content of the capsule and sell it. Hi Barb & Shell, I take Neurontin and Morphine (MS Contin) for severe pain. My Neuro

sent

me to a Pain Clinic because he tried everything he could and didn’t work.

I

deal with nerve pain which in my opinion only Morphine can help calm

the

pain. I well understand anyone dealing with pain its devastating! Take Care, Joanne

Response:

On 29 Jul 2000 08:14:03 +0300, Roche…@AOL.COM (Edee Roche) wrote: }and if so, }what iis the procedure to follow to get my meds from Canada?

I just did a search for any outlets that sold prescription drugs on-line. The only one I found was Guardian Drugs, but you must have a prescription from a physician licensed to practice in the Province of Ontario.  If you want to search further then I suggest http://www.canada.com — jcarter at superaje dot com The next century and the next millennium begin at midnight on December 31,2000.

Response:

Here are some drug comparisons from an article in the OREGONIAN newspaper.  The U.S. insured price is the cost negotiated & paid by the insurance company. Drug       U.S. insured      Canada         Mexico      U.S. uninsured Prilosec     $58.73            $49.80           $37.50        $117.56 Zoloft        115.70            125.00           133.00          223.61 One of the tv stations did a cost comparison between Portland, OR pharmacies and found some of the best prices at small pharmacies. Carole – Hide quoted text — Show quoted text -Michael Muirhead wrote:

"Edee Roche" <Roche…@AOL.COM wrote in message news:39.80b5c24.26b3c117@aol.com… I’m on prozac, which costs between $140  and $156 for 60 caps. Does anyone out there know if meds would be cheaper in Canada? and if so, what iis the procedure to follow to get my meds from Canada? 1)  You bet your *ass* prozac is cheaper here, Edee.   It would run $90-120CDN ($60-80US) for your scrip. 2)  Other than showing up here to buy ‘em, I have no idea how you’d get ‘em from here.  :-( —      (((((((((((((U))))))))))))) Michael <muirh…@island.net   -=[ Livin' on Island Time ]=-

Response:

In a message dated 07/23/2000 3:34:30 PM Central Daylight Time, ms150…@MINDSPRING.COM writes:

<< He  is aware that I cut the pills in half and on good days, have gone up to 11  hours without one…but still afraid that I will get addicted, though my  actions show otherwise.  Isn’t it frustrating?  Really tough when we have  this pain and can barely function, and to add to it, we have to fight the  doctors to get what we need.

I cut mine in half also. I have been taking oxycodone since 1980, about 20 years. I use less now than ever and have had now problems with it at all. Many in the medical field believe that if a medication is used for its intended purpose, addiction is very rare.and unlikely. I have found that stress increases pain, including stress caused by knowing you are in pain and can’t do anything about it or are running low on pain medication with no refills. I told my GP and my neuro both that the only part of MS I can control is the pain and that was a right I was entitled to. Edee

Response:

Joanne, You SAID it girl!  Power to the patient! Susan E

Response:

John P. Husvar <jhus…@apk.net

wrote in message

news:8lhabj$1rh$1@plonk.apk.net…

While addiction can generate its own set of problems additional to the condition causing the pain; which is better, a happy, productive, self-supporting addict or a miserable dependent, but "clean" victim? Is a puzzlement.

I agree…this has been an ongoing issue for me. With sufficient pain meds, I’m up and around, active, working, eating better, and less tired. Funny how my non-MS friends can take a Vicodin and it wipes them out…for me it’s a few hours of respite on bad days and it gets me up and functioning. My HMO disagrees. MS is officially a "painless" disease. I am hoping the MS Society will come out with some official statement at some point that will allow some of the stricter HMO’s (I have Kaiser) to prescribe adequate pain relief. We’re actually looking into going down to Mexico for meds at this point. I spoke to a therapist about meds – she specializes in illness with chronic pain. The whole addiction question. Her questions were "Have you increased your dosage or frequency?" No. "What do you do when you take a pain reliever?" Laundry, play with my child, cook, work, and sleep restfully. Her response made sense to me….that if we are addicted to anything it’s the relief from pain, and that if monitored carefully, the improvement in quality of life far outweighs the risks.  Unfortunately, she can’t write prescriptions Tammy —–= Posted via Newsfeeds.Com, Uncensored Usenet News =—– http://www.newsfeeds.com – The #1 Newsgroup Service in the World! —–==  Over 80,000 Newsgroups – 16 Different Servers! =—–

Response:

That is such an encouraging attitude, Edee…I so know that horrible feeling of no refills and no help in sight. Or counting out what they do give you to parcel them out over a month’s time to make them last. It’s ridiculous, and does increase stress – something none of us need. It feels like a never-ending battle. Tammy Edee Roche <Roche…@AOL.COM

wrote in message

news:44.5bbe4f0.26ade33a@aol.com… – Hide quoted text — Show quoted text -

I cut mine in half also. I have been taking oxycodone since 1980, about 20 years. I use less now than ever and have had now problems with it at all. Many in the medical field believe that if a medication is used for its intended purpose, addiction is very rare.and unlikely. I have found that stress increases pain, including stress caused by knowing you are in pain

and

can’t do anything about it or are running low on pain medication with no refills. I told my GP and my neuro both that the only part of MS I can control is

the

pain and that was a right I was entitled to. Edee

—–= Posted via Newsfeeds.Com, Uncensored Usenet News =—– http://www.newsfeeds.com – The #1 Newsgroup Service in the World! —–==  Over 80,000 Newsgroups – 16 Different Servers! =—–

Response:

I just spoke with my Kaiser pharmacy and my doc (and he IS a specialist) hasn’t gotten around to this month’s refill approval yet (I have to get a new one every month, and it’s about half of what I actually need). It makes me sick. I just downloaded a huge list of pharmacies in Mexico and that’s my next step. This is a huge waste of energy. I though the National MS Society was considering a statement on pain management and MS? Their stance on the ABC drugs is the one and only reason I got approved for Copaxone after a 3-month fight. (I wasn’t "sick enough". For a prophylactic drug.) Tammy <ms150…@mindspring.com

wrote in message

news:8lopl0$r75$1@slb0.atl.mindspring.net… – Hide quoted text — Show quoted text -

I am going through the exact same thing myself!  I take hydrocodone and my neuro is afraid of addiction!!! :O  I too cut them in half and wait as

long

as I possibly can between pills.  My husband told the doc, that stress is our worst enemy and there is not stress to compare with what we go through trying to get our pain pills refilled.  He gave me one more and said ‘no more’!  I am switching to a specialist and hoping that he can help with something else that will work as well.  No one can imagine this pain that

we

go through.  NOT the pain of the occasional spasm!  But feels like being

in

labor 24/7! Karlyn Shell wrote in message <397F4EA9.2E732…@epix.com… It is awful having to worry about the next refill. My spouse and I are constantly wondering whether the cessation will occur and what we will do as I cannot take aspirin or ibuprofen and of course the docs think I’m making

it

up like the one episode of ER where the old lady says she has a migraine and aspirin hurts her ‘tummy’. Then of course, you have the actors who go through their little phase and end up at Betty Ford. I’m sorry just having a bad pain day and so tired of playing the game when  no patient should have to

worry

about living with this awful pain. Take Care Shell Tammy wrote: That is such an encouraging attitude, Edee…I so know that horrible feeling of no refills and no help in sight. Or counting out what they do give

you > to > >> parcel them out over a month’s time to make them last. It’s ridiculous, > and > >> does increase stress – something none of us need. It feels like a > >> never-ending battle. > >> Tammy > >> Edee Roche <Roche…@AOL.COM

wrote in message

> >> news:44.5bbe4f0.26ade33a@aol.com… > >> > I cut mine in half also. I have been taking oxycodone since 1980, about

20 years. I use less now than ever and have had now problems with it at all. Many in the medical field believe that if a medication is used for

its

intended purpose, addiction is very rare.and unlikely. I have found that stress increases pain, including stress caused by knowing you are in pain and can’t do anything about it or are running low on pain medication with no refills. I told my GP and my neuro both that the only part of MS I can control is the pain and that was a right I was entitled to. Edee —–= Posted via Newsfeeds.Com, Uncensored Usenet News =—– http://www.newsfeeds.com – The #1 Newsgroup Service in the World! —–==  Over 80,000 Newsgroups – 16 Different Servers! =—–

—–= Posted via Newsfeeds.Com, Uncensored Usenet News =—– http://www.newsfeeds.com – The #1 Newsgroup Service in the World! —–==  Over 80,000 Newsgroups – 16 Different Servers! =—–

Response:

I am going through the exact same thing myself!  I take hydrocodone and my neuro is afraid of addiction!!! :O  I too cut them in half and wait as long as I possibly can between pills.  My husband told the doc, that stress is our worst enemy and there is not stress to compare with what we go through trying to get our pain pills refilled.  He gave me one more and said ‘no more’!  I am switching to a specialist and hoping that he can help with something else that will work as well.  No one can imagine this pain that we go through.  NOT the pain of the occasional spasm!  But feels like being in labor 24/7! Karlyn – Hide quoted text — Show quoted text -Shell wrote in message <397F4EA9.2E732…@epix.com

… It is awful having to worry about the next refill. My spouse and I are constantly wondering whether the cessation will occur and what we will do

as I

cannot take aspirin or ibuprofen and of course the docs think I’m making it

up

like the one episode of ER where the old lady says she has a migraine and aspirin hurts her ‘tummy’. Then of course, you have the actors who go

through

their little phase and end up at Betty Ford. I’m sorry just having a bad

pain

day and so tired of playing the game when  no patient should have to worry

about

living with this awful pain. Take Care Shell Tammy wrote: That is such an encouraging attitude, Edee…I so know that horrible

feeling

of no refills and no help in sight. Or counting out what they do give you

to

parcel them out over a month’s time to make them last. It’s ridiculous,

and

does increase stress – something none of us need. It feels like a never-ending battle. Tammy Edee Roche <Roche…@AOL.COM wrote in message news:44.5bbe4f0.26ade33a@aol.com… I cut mine in half also. I have been taking oxycodone since 1980, about

20

years. I use less now than ever and have had now problems with it at

all.

Many in the medical field believe that if a medication is used for its intended purpose, addiction is very rare.and unlikely. I have found

that

stress increases pain, including stress caused by knowing you are in

pain

and can’t do anything about it or are running low on pain medication with

no

refills. I told my GP and my neuro both that the only part of MS I can control

is

the pain and that was a right I was entitled to. Edee —–= Posted via Newsfeeds.Com, Uncensored Usenet News =—– http://www.newsfeeds.com – The #1 Newsgroup Service in the World! —–==  Over 80,000 Newsgroups – 16 Different Servers! =—–

Response:

It is awful having to worry about the next refill. My spouse and I are constantly wondering whether the cessation will occur and what we will do as I cannot take aspirin or ibuprofen and of course the docs think I’m making it up like the one episode of ER where the old lady says she has a migraine and aspirin hurts her ‘tummy’. Then of course, you have the actors who go through their little phase and end up at Betty Ford. I’m sorry just having a bad pain day and so tired of playing the game when  no patient should have to worry about living with this awful pain. Take Care Shell – Hide quoted text — Show quoted text -Tammy wrote:

That is such an encouraging attitude, Edee…I so know that horrible feeling of no refills and no help in sight. Or counting out what they do give you to parcel them out over a month’s time to make them last. It’s ridiculous, and does increase stress – something none of us need. It feels like a never-ending battle. Tammy Edee Roche <Roche…@AOL.COM wrote in message news:44.5bbe4f0.26ade33a@aol.com… I cut mine in half also. I have been taking oxycodone since 1980, about 20 years. I use less now than ever and have had now problems with it at all. Many in the medical field believe that if a medication is used for its intended purpose, addiction is very rare.and unlikely. I have found that stress increases pain, including stress caused by knowing you are in pain and can’t do anything about it or are running low on pain medication with no refills. I told my GP and my neuro both that the only part of MS I can control is the pain and that was a right I was entitled to. Edee —–= Posted via Newsfeeds.Com, Uncensored Usenet News =—– http://www.newsfeeds.com – The #1 Newsgroup Service in the World! —–==  Over 80,000 Newsgroups – 16 Different Servers! =—–

Response:

Here in NY- this is a problem as well. Drs. here are paranoid about any pain meds. Their fear is addiction. This is insanity-I know so many are suffering with tremendous pain on a daily basis, but Drs. here refuse to Rx. I guess they are more concerned with how they appear to the HMOs than with the welfare of their patients. Its called CYA.!! Dianne-NY – Hide quoted text — Show quoted text -

While addiction can generate its own set of problems additional to the condition causing the pain; which is better, a happy, productive, self-supporting addict or a miserable dependent, but "clean" victim? Is a puzzlement. joannek4 <joann…@email.msn.com wrote in message news:ea5v0lT9$GA.64@cpmsnbbsa07… Hi Michael, I have to agree with you on getting addicted to  whatever a person takes for pain and it works. We are talking about MS and the severe pain that comes with it. What is more important stopping the pain enough to deal with it or becoming addicted. It is ridiculous for a Doctor to even bring this up to a patient but if it’s a must,well I feel it’s our choice to continue to take it not the Doc. We are the ones in pain not him. Take Care, Joanne

Response:

Hi Michael, I have to agree with you on getting addicted to  whatever a person takes for pain and it works. We are talking about MS and the severe pain that comes with it. What is more important stopping the pain enough to deal with it or becoming addicted. It is ridiculous for a Doctor to even bring this up to a patient but if it’s a must,well I feel it’s our choice to continue to take it not the Doc. We are the ones in pain not him. Take Care, Joanne

Response:

While addiction can generate its own set of problems additional to the condition causing the pain; which is better, a happy, productive, self-supporting addict or a miserable dependent, but "clean" victim? Is a puzzlement. joannek4 <joann…@email.msn.com

wrote in message

news:ea5v0lT9$GA.64@cpmsnbbsa07… – Hide quoted text — Show quoted text -

Hi Michael, I have to agree with you on getting addicted to  whatever a person

takes for

pain and it works. We are talking about MS and the severe pain that

comes

with it. What is more important stopping the pain enough to deal with

it or

becoming addicted. It is ridiculous for a Doctor to even bring this up

to a

patient but if it’s a must,well I feel it’s our choice to continue to

take

it not the Doc. We are the ones in pain not him. Take Care, Joanne

Response:

Barb, Won’t your doc give you both (neruontin and morphine) I know I could never even ask for morphine and that is why I put up with the awful neuro I currently see because I’m scared I will lose my current pain meds. Anyway….. If you have already used Morphine and it helped, wouldn’t your doc give you some for break thru pain? I never sleep thru the night. I hate this nasty pain and I feel for all of us that have to put up with it ecspecially when there is something that helps. Our only obstacle are getting the docs to do their jobs. Take Care Shell – Hide quoted text — Show quoted text -Barb Edmiston wrote:

Hi Joanne I still get break through pain at times on Neurontin. At the moment I am in a real mess. I can’t sleep – if I try to exercise I get into this ‘overdrive’ like tremors and weakness + pain but fast heart and nightmares.(Neurontin relief is reduced by eating high protein = steak or lean chicken etc.) BUT I need to try to keep fit. Barb – wondering what the ****** is going on in my body. Got my first wheelchair last week – for home – but failing badly at everything else.  Hey –  xx be well on both meds!! OK? "joannek4" <joann…@email.msn.com wrote in message news:ePKwXo58$GA.420@cpmsnbbsa08… Barb Edmiston <barbedmis…@dingoblue.net.au wrote in message news:3977da87$0$11187$7f31c96c@news01.syd.optusnet.com.au… Shell – I thought morphine worked really well for me – it changed my life! But the Docs are dead against it now as some folk have discovered how to change the content of the capsule and sell it. Hi Barb & Shell, I take Neurontin and Morphine (MS Contin) for severe pain. My Neuro sent me to a Pain Clinic because he tried everything he could and didn’t work. I deal with nerve pain which in my opinion only Morphine can help calm the pain. I well understand anyone dealing with pain its devastating! Take Care, Joanne

Response:

I have this pain and my neuro prescribed Hydrocodone and it works!  Doesn’t take the pain away completely, but leaves you with a feeling of pressure instead of PAIN.  But now he fears that I will become ‘addicted’ and has tried other things that have not worked and made me violently ill on top of not taking away the pain.  I have some of the hydrocodone left and as this exacerbation has started subsiding, I have been cutting my 10mg tablets in half and that seems to be doing the job…at least now.  I have an appointment with a new neurologist Aug. 1st who specializes in MS and we will see what he has to say.  Only problem is that I have pain meds to last only until the 28th and my current neuro, will not prescribe any more.  He is aware that I cut the pills in half and on good days, have gone up to 11 hours without one…but still afraid that I will get addicted, though my actions show otherwise.  Isn’t it frustrating?  Really tough when we have this pain and can barely function, and to add to it, we have to fight the doctors to get what we need. Karlyn "Laura K." wrote in message <8e.7f85b88.26a64…@aol.com

… Hello Group: For all interested, another prospective on MS pain. use of milder medications containing codeine, if tolerated. I then use=20 hydrocodone, long-acting oxycodone, long-acting morphine, methadone,=20 hydromorphone, meperidine, fentanyl patches or oral fentanyl. I warn

patient=

Response:

Karlyn wrote…

I have this pain and my neuro prescribed Hydrocodone and it works!

Doesn’t

take the pain away completely, but leaves you with a feeling of pressure instead of PAIN.  But now he fears that I will become ‘addicted’ and has tried other things that have not worked and made me violently ill on top

of

not taking away the pain.

Gimme a break.  Your doctor is an idiot.   Don’t fault him too harshly for that, most of them are in this regard. Of *course* you’ll become addicted ("tolerant" and "dependant", to name it properly) if you take any opiate for long enough… so WHAT?   It’s not that hard to become UN-addicted when the time comes to stop taking the stuff. What he’s *really* afraid of is that you’ll become the stereotypical poster-campaign drug fiend that the world has come to know and fear. Doctors aren’t granted some special immunity to social pressure, you know.

He is aware that I cut the pills in half and on good days, have gone up to 11 hours without one…but still afraid that I will get addicted, though

my

actions show otherwise.  Isn’t it frustrating?

Yup.   You’ve given him ample evidence that even if you *did* become addicted, you’re prepared to end your addiction as soon as it’s appropriate. Model behaviour, I’d say.   Tell your new neuro about all this, will you? It might be a good litmus test of how commited he/she is to helping you, rahter than merely *treating* you. —      (((((((((((((U))))))))))))) Michael <muirh…@island.net

  -=[ Livin' on Island Time ]=-

Response:

Barb, I found Neurontin exacerbated all my symptoms. I hated it. The only thing that works for me are narcotics. This is one whacky disease, what works for one of us doesn’t work for another. I’m glad you have found relief with the Neurontin but I never ever want to see it again. Take Care Shell – Hide quoted text — Show quoted text -Barb  wrote:

Thank you – I have only one word to say NEURONTIN beats MORPHINE!!!!!!!! AMEN. Works for me thank goodness – even though the dose goes up – (and price)  thank you for your info! Barb. In respite I think  - I hope………. xxx

Response:

Shell – I thought morphine worked really well for me – it changed my life! But the Docs are dead against it now as some folk have discovered how to change the content of the capsule and sell it. :0( So glad it works for you – keep eating the tinned pears beats prunes….(good for the bowel!!)  Barb..(on Neurontin now)…. Be Well x. "Shell" <smin…@epix.com

wrote in message

news:3975F006.9B920A51@epix.com… – Hide quoted text — Show quoted text -

Barb, I found Neurontin exacerbated all my symptoms. I hated it. The only thing

that

works for me are narcotics. This is one whacky disease, what works for one

of us

doesn’t work for another. I’m glad you have found relief with the

Neurontin but

I never ever want to see it again. Take Care Shell

Response:

Barb Edmiston <barbedmis…@dingoblue.net.au

wrote in message

news:3977da87$0$11187$7f31c96c@news01.syd.optusnet.com.au…

Shell – I thought morphine worked really well for me – it changed my life! But the Docs are dead against it now as some folk have discovered how to change the content of the capsule and sell it.

Hi Barb & Shell, I take Neurontin and Morphine (MS Contin) for severe pain. My Neuro sent me to a Pain Clinic because he tried everything he could and didn’t work. I deal with nerve pain which in my opinion only Morphine can help calm the pain. I well understand anyone dealing with pain its devastating! Take Care, Joanne

Response:

Hi Joanne I still get break through pain at times on Neurontin. At the moment I am in a real mess. I can’t sleep – if I try to exercise I get into this ‘overdrive’ like tremors and weakness + pain but fast heart and nightmares.(Neurontin relief is reduced by eating high protein = steak or lean chicken etc.) BUT I need to try to keep fit. Barb – wondering what the ****** is going on in my body. Got my first wheelchair last week – for home – but failing badly at everything else.  Hey –  xx be well on both meds!! OK? "joannek4" <joann…@email.msn.com

wrote in message

news:ePKwXo58$GA.420@cpmsnbbsa08… – Hide quoted text — Show quoted text -> Barb Edmiston <barbedmis…@dingoblue.net.au

wrote in message

> news:3977da87$0$11187$7f31c96c@news01.syd.optusnet.com.au… > > Shell – I thought morphine worked really well for me – it changed my life!

But the Docs are dead against it now as some folk have discovered how to change the content of the capsule and sell it. Hi Barb & Shell, I take Neurontin and Morphine (MS Contin) for severe pain. My Neuro sent

me

to a Pain Clinic because he tried everything he could and didn’t work. I deal with nerve pain which in my opinion only Morphine can help calm the pain. I well understand anyone dealing with pain its devastating! Take Care, Joanne

Response:

Thank you – I have only one word to say NEURONTIN beats MORPHINE!!!!!!!! AMEN. Works for me thank goodness – even though the dose goes up – (and price)  thank you for your info! Barb. In respite I think  - I hope………. xxx "Laura K.""  <Nygab…@AOL.COM

wrote in message

news:8e.7f85b88.26a6439f@aol.com… – Hide quoted text — Show quoted text -

Hello Group: For all interested, another prospective on MS pain. Intelihealth Rational Polypharmacy In The Treatment Of Chronic Neuropathic Pain Robert L. Knobler, M.D., Ph.D., is the director of the Knobler Institute

of=20

Neurologic Disease, PC, and the K.I.N.D. Clinic. He is professor of

neurolog=

y=20 at Thomas Jefferson University. Dr. Knobler has basic science and

clinical=20

research expertise in multiple sclerosis, viral immunology and the

managemen=

t=20 of chronic pain disorders.=20  =20 In my adult neurology practice, I see many referred patients with

multiple=20

sclerosis and chronic pain disorders. About half of the patients I see

with=20

multiple sclerosis are also affected by chronic neuropathic pain.

Therefore,=

=20 I thought I would discuss some of the clinical issues in the day-to-day=20 management of chronic neuropathic pain. The patients I see have various forms of pain, but their pain is almost=20 always severe. The pain is often rated 7-9/10 before treatment and

interrupt=

s=20 the patients’ activities of daily living. The pain may be a result of

trauma=

=20 or the lesions of multiple sclerosis. The most common component of my patients=E2=80=99 complaint is that of a

bur=

ning=20 dysesthetic sensation. Many of the newer anticonvulsants work

particularly=20

well for this symptom, particularly gabapentin (Neurontin), tiagabine=20 (Gabitril) and topiramate (Topamax). It has been my perception, perhaps influenced by the information I am=20 provided in the history I elicit from the patient, that there is an

effort=20

directed at pushing this class of medication to its limit before

considering=

=20 other medications. Typically, a patient will see me who has been given=20 gabapentin at a dose of 800 milligrams four times daily (2400

milligrams=20

total). The patient is still experiencing sensory dysesthesia as well

as=20

having some confusion and dizziness from the high dose of gabapentin.=20 I have found that patients get the best response from gabapentin by

starting=

=20 at a lower dose of 100 milligrams to start, and then titrating upward to

a=20

higher dose. I start the patient on the medication at bedtime initially,

to=20

be certain that the patient gets to sleep, and then add additional

doses=20

during the daytime, as needed, to get maximal relief. Recognizing that

this=20

is an educational process for the patient, I explain that it will take

time=20

to get the maximum benefit from the medicine, and encourage the patient

to=20

work with me to help find the best dose for them.=20 Older drugs, such as the tricyclics, still will work best in some=20 circumstances. I may choose to use 10 milligrams of amitriptyline to

start,=20

and have the patient titrate up to as much as 40 milligrams at bedtime,

if=20

that much is actually needed. The reasons for using tricyclics such as=20 amitriptyline for the treatment of neuropathic pain include its impact

on=20

improving mood, slowing the urgent bladder, reducing burning pain and

helpin=

g=20 patients get to sleep. Caution is advised in patients with a history of=20 palpitations. Dry mouth and urinary retention can present drawbacks for

this=

=20 class of medication, so I tend to use the newer medications with more=20 specific effectiveness. However, tricyclics sometimes still have great=20 utility and have the added benefit of being relatively inexpensive. With all of these medications, the starting dose is always low, and the=20 titration is always slow. The titration can be accelerated as needed. It

is=20

far more difficult to get a patient to continue a medication that they

have=20

had an adverse reaction to caused from taking too much of the drug, than

to=20

have the patient gradually increase the dose and tolerate the side effects

a=

=20 bit longer until they are adequately treated by the drug. For gabapentin, I start patients with 100 milligrams and increase the dose

i=

n=20 100-milligram increments, generally until reaching three tablets at

bedtime.=

=20 I may then begin to spread the medication throughout the day as needed.

For=20

tiagabine, I start patients with 4 milligrams and escalate at

4-milligram=20

increments to reach a dosing schedule of two 4-milligram tablets four

times=20

per day. This can be reduced to twice daily dosing if needed for

convenience=

.=20 For topiramate, I start patients with 25 milligrams at bedtime and

escalate=20

to two 25-milligram tablets or capsules four times per day. I may have some patients taking more than one type of anticonvulsant at

the=20

same time. I have observed that I can continue to use lower doses of

each=20

type of medication effectively and keep the side effects low while

improving=

=20 efficacy since their mechanisms of action are different (which is beyond

the=

=20 scope of the present discussion, but which is the scientific basis for=20 rational polypharmacy). Other symptoms and side effects may occur in patients and these must also

be=

=20 addressed to provide effective care and management. These symptoms

include=20

aching pain, unresponsiveness to these newer anticonvulsants, reactive=20 depression, muscle spasms, difficulty sleeping, confusion and memory

problem=

s. I have noted that medication and lack of sleep can contribute to the

combine=

d=20 symptoms of sleep disruption, confusion, muscle spasms and memory

problems.=20

To address these issues effectively, I have found that a certain degree

of=20

pain relief is needed for quality sleep to take place. Pain is an

alerting=20

response that will effectively prevent sleep, and lack of sleep can lead

to=20

confusion and memory disturbances. To treat pain, I often prescribe opioids as they are needed. I begin with

th=

e=20 use of milder medications containing codeine, if tolerated. I then use=20 hydrocodone, long-acting oxycodone, long-acting morphine, methadone,=20 hydromorphone, meperidine, fentanyl patches or oral fentanyl. I warn

patient=

s=20 of possible side effects such as nausea, vomiting, delayed swallowing

or=20

delayed gastric emptying, and constipation. I have noted a reduction of pain intensity to the 4-5/10 range in

patients=20

treated with opioids. However, some patients indicate higher pain levels

at=20

their follow-up appointments for several reasons: (1) they have not

taken=20

their medication in order to drive to their appointment; (2) they

over-repor=

t=20 pain in an attempt to ensure continuation of their medication; (3) they=20 purposely don=E2=80=99t take their medication before their appointment in

or=

der to=20 look as if they need more pain medication, or to ensure continuation of

thei=

r=20 pain medication. I put patients taking opioids on a stool softener and a fiber supplement

as=20

well. I caution them about the use of magnesium citrate if they are at

risk=20

of developing fecal impaction because of the potential danger of

perforation=

.=20 Patients usually don=E2=80=99t like to hear that, but they have to know.

If=20=

they=20 develop gastrointestinal pain or rectal bleeding, I send them for an=20 appropriate endoscopic or colonoscopic evaluation. If patients have reactive depression develop, I prescribe an

antidepressant.=

=20 I favor the selective serotonin reuptake inhibitors (SSRIs), and note

that=20

they have been of some use in both relief of depression and treatment

of=20

migraine. This is helpful since there is an element of migraine-like

headach=

e=20 in many of the patients that develop upper extremity pain problems.

Migraine=

=20 may be the response that any of several stimuli yields when triggered,

but=20

whatever the explanation the depression must be treated. Fluoxetine

(Prozac)=

,=20 sertraline (Zoloft) and venlafaxine (Effexor) all have excellent records

of=20

effectiveness. When an SSRI cannot be used because of a potential

conflict=20

due to simultaneous use with an anti-migraine triptan (Serotonin

Syndrome),=20

bupropion (Wellbutrin) can be used effectively. If memory problems persist, donepezil (Aricept) can be used at a dose of 5

t=

o=20 10 milligrams per day, with some improvement. Confusion should subside

as=20

sleep improves and the dose of anticonvulsant adjuvant is reduced.

Improved=20

pain control will also help improve cognition. Finally, perhaps the most important aspect of neuropathic pain control

is=20

that associated with the control of movement-related muscle spasms.

Muscle=20

spasms are made worse by physical activity of even the mildest variety,

a=20

dependent posture and cold ambient temperature. This is important

because=20

treating movement-related spasms is one of the principal ways by which=20 neuropathic pain may be resolved, particularly early after the onset of

the=20

pain, before it has had a chance to become "centralized" pain due to

changes=

=20 secondary to the release of excitatory neurotransmitters within the

dorsal=20

root entry zone. I most often will use tizanidine (Zanaflex) to treat neuropathic pain=20 associated with movement-related muscle spams, beginning with a dose of

1mg=20

at bedtime. I have the patient titrate up to as much as 8 milligrams at=20 bedtime, if needed, and 1 to 4 milligrams at two-hour intervals if so

needed=

,=20 with a maximum of eight full 4-milligram tablets per day (32

milligrams).=20

Tizanidine reduces the spasm of movement and the pain associated with

that=20

spasm,

… read more »

Response:

I hated Neurontin. It exacerbated all my symptoms and I will never take it again. I know it has helped a lot of patients but not me….yuk. As for Zoloft……To each their own. Take Care Shell – Hide quoted text — Show quoted text -"Laura K." wrote:

Hello Group: For all interested, another prospective on MS pain. Intelihealth Rational Polypharmacy In The Treatment Of Chronic Neuropathic Pain Robert L. Knobler, M.D., Ph.D., is the director of the Knobler Institute of=20 Neurologic Disease, PC, and the K.I.N.D. Clinic. He is professor of neurolog= y=20 at Thomas Jefferson University. Dr. Knobler has basic science and clinical=20 research expertise in multiple sclerosis, viral immunology and the managemen= t=20 of chronic pain disorders.=20  =20 In my adult neurology practice, I see many referred patients with multiple=20 sclerosis and chronic pain disorders. About half of the patients I see with=20 multiple sclerosis are also affected by chronic neuropathic pain. Therefore,= =20 I thought I would discuss some of the clinical issues in the day-to-day=20 management of chronic neuropathic pain. The patients I see have various forms of pain, but their pain is almost=20 always severe. The pain is often rated 7-9/10 before treatment and interrupt= s=20 the patients’ activities of daily living. The pain may be a result of trauma= =20 or the lesions of multiple sclerosis. The most common component of my patients=E2=80=99 complaint is that of a bur= ning=20 dysesthetic sensation. Many of the newer anticonvulsants work particularly=20 well for this symptom, particularly gabapentin (Neurontin), tiagabine=20 (Gabitril) and topiramate (Topamax). It has been my perception, perhaps influenced by the information I am=20 provided in the history I elicit from the patient, that there is an effort=20 directed at pushing this class of medication to its limit before considering= =20 other medications. Typically, a patient will see me who has been given=20 gabapentin at a dose of 800 milligrams four times daily (2400 milligrams=20 total). The patient is still experiencing sensory dysesthesia as well as=20 having some confusion and dizziness from the high dose of gabapentin.=20 I have found that patients get the best response from gabapentin by starting= =20 at a lower dose of 100 milligrams to start, and then titrating upward to a=20 higher dose. I start the patient on the medication at bedtime initially, to=20 be certain that the patient gets to sleep, and then add additional doses=20 during the daytime, as needed, to get maximal relief. Recognizing that this=20 is an educational process for the patient, I explain that it will take time=20 to get the maximum benefit from the medicine, and encourage the patient to=20 work with me to help find the best dose for them.=20 Older drugs, such as the tricyclics, still will work best in some=20 circumstances. I may choose to use 10 milligrams of amitriptyline to start,=20 and have the patient titrate up to as much as 40 milligrams at bedtime, if=20 that much is actually needed. The reasons for using tricyclics such as=20 amitriptyline for the treatment of neuropathic pain include its impact on=20 improving mood, slowing the urgent bladder, reducing burning pain and helpin= g=20 patients get to sleep. Caution is advised in patients with a history of=20 palpitations. Dry mouth and urinary retention can present drawbacks for this= =20 class of medication, so I tend to use the newer medications with more=20 specific effectiveness. However, tricyclics sometimes still have great=20 utility and have the added benefit of being relatively inexpensive. With all of these medications, the starting dose is always low, and the=20 titration is always slow. The titration can be accelerated as needed. It is=20 far more difficult to get a patient to continue a medication that they have=20 had an adverse reaction to caused from taking too much of the drug, than to=20 have the patient gradually increase the dose and tolerate the side effects a= =20 bit longer until they are adequately treated by the drug. For gabapentin, I start patients with 100 milligrams and increase the dose i= n=20 100-milligram increments, generally until reaching three tablets at bedtime.= =20 I may then begin to spread the medication throughout the day as needed. For=20 tiagabine, I start patients with 4 milligrams and escalate at 4-milligram=20 increments to reach a dosing schedule of two 4-milligram tablets four times=20 per day. This can be reduced to twice daily dosing if needed for convenience= .=20 For topiramate, I start patients with 25 milligrams at bedtime and escalate=20 to two 25-milligram tablets or capsules four times per day. I may have some patients taking more than one type of anticonvulsant at the=20 same time. I have observed that I can continue to use lower doses of each=20 type of medication effectively and keep the side effects low while improving= =20 efficacy since their mechanisms of action are different (which is beyond the= =20 scope of the present discussion, but which is the scientific basis for=20 rational polypharmacy). Other symptoms and side effects may occur in patients and these must also be= =20 addressed to provide effective care and management. These symptoms include=20 aching pain, unresponsiveness to these newer anticonvulsants, reactive=20 depression, muscle spasms, difficulty sleeping, confusion and memory problem= s. I have noted that medication and lack of sleep can contribute to the combine= d=20 symptoms of sleep disruption, confusion, muscle spasms and memory problems.=20 To address these issues effectively, I have found that a certain degree of=20 pain relief is needed for quality sleep to take place. Pain is an alerting=20 response that will effectively prevent sleep, and lack of sleep can lead to=20 confusion and memory disturbances. To treat pain, I often prescribe opioids as they are needed. I begin with th= e=20 use of milder medications containing codeine, if tolerated. I then use=20 hydrocodone, long-acting oxycodone, long-acting morphine, methadone,=20 hydromorphone, meperidine, fentanyl patches or oral fentanyl. I warn patient= s=20 of possible side effects such as nausea, vomiting, delayed swallowing or=20 delayed gastric emptying, and constipation. I have noted a reduction of pain intensity to the 4-5/10 range in patients=20 treated with opioids. However, some patients indicate higher pain levels at=20 their follow-up appointments for several reasons: (1) they have not taken=20 their medication in order to drive to their appointment; (2) they over-repor= t=20 pain in an attempt to ensure continuation of their medication; (3) they=20 purposely don=E2=80=99t take their medication before their appointment in or= der to=20 look as if they need more pain medication, or to ensure continuation of thei= r=20 pain medication. I put patients taking opioids on a stool softener and a fiber supplement as=20 well. I caution them about the use of magnesium citrate if they are at risk=20 of developing fecal impaction because of the potential danger of perforation= .=20 Patients usually don=E2=80=99t like to hear that, but they have to know. If=20= they=20 develop gastrointestinal pain or rectal bleeding, I send them for an=20 appropriate endoscopic or colonoscopic evaluation. If patients have reactive depression develop, I prescribe an antidepressant.= =20 I favor the selective serotonin reuptake inhibitors (SSRIs), and note that=20 they have been of some use in both relief of depression and treatment of=20 migraine. This is helpful since there is an element of migraine-like headach= e=20 in many of the patients that develop upper extremity pain problems. Migraine= =20 may be the response that any of several stimuli yields when triggered, but=20 whatever the explanation the depression must be treated. Fluoxetine (Prozac)= ,=20 sertraline (Zoloft) and venlafaxine (Effexor) all have excellent records of=20 effectiveness. When an SSRI cannot be used because of a potential conflict=20 due to simultaneous use with an anti-migraine triptan (Serotonin Syndrome),=20 bupropion (Wellbutrin) can be used effectively. If memory problems persist, donepezil (Aricept) can be used at a dose of 5 t= o=20 10 milligrams per day, with some improvement. Confusion should subside as=20 sleep improves and the dose of anticonvulsant adjuvant is reduced. Improved=20 pain control will also help improve cognition. Finally, perhaps the most important aspect of neuropathic pain control is=20 that associated with the control of movement-related muscle spasms. Muscle=20 spasms are made worse by physical activity of even the mildest variety, a=20 dependent posture and cold ambient temperature. This is important because=20 treating movement-related spasms is one of the principal ways by which=20 neuropathic pain may be resolved, particularly early after the onset of the=20 pain, before it has had a chance to become "centralized" pain due to changes= =20 secondary to the release of excitatory neurotransmitters within the dorsal=20 root entry zone. I most often will use tizanidine (Zanaflex) to treat neuropathic pain=20 associated with movement-related muscle spams, beginning with a dose of 1mg=20 at bedtime. I have the patient titrate up to as much as 8 milligrams at=20 bedtime, if needed, and 1 to 4 milligrams at two-hour intervals if so needed= ,=20 with a maximum of eight full 4-milligram tablets per day (32 milligrams).=20 Tizanidine reduces the spasm of movement and the pain associated with that=20 spasm, thus allowing the patient to move more freely. Tizanidine may be used= =20 strictly on an as

… read more »

Response:

Hello Group: For all interested, another prospective on MS pain. Intelihealth Rational Polypharmacy In The Treatment Of Chronic Neuropathic Pain Robert L. Knobler, M.D., Ph.D., is the director of the Knobler Institute of=20 Neurologic Disease, PC, and the K.I.N.D. Clinic. He is professor of neurolog= y=20 at Thomas Jefferson University. Dr. Knobler has basic science and clinical=20 research expertise in multiple sclerosis, viral immunology and the managemen= t=20 of chronic pain disorders.=20  =20 In my adult neurology practice, I see many referred patients with multiple=20 sclerosis and chronic pain disorders. About half of the patients I see with=20 multiple sclerosis are also affected by chronic neuropathic pain. Therefore,= =20 I thought I would discuss some of the clinical issues in the day-to-day=20 management of chronic neuropathic pain. The patients I see have various forms of pain, but their pain is almost=20 always severe. The pain is often rated 7-9/10 before treatment and interrupt= s=20 the patients’ activities of daily living. The pain may be a result of trauma= =20 or the lesions of multiple sclerosis. The most common component of my patients=E2=80=99 complaint is that of a bur= ning=20 dysesthetic sensation. Many of the newer anticonvulsants work particularly=20 well for this symptom, particularly gabapentin (Neurontin), tiagabine=20 (Gabitril) and topiramate (Topamax). It has been my perception, perhaps influenced by the information I am=20 provided in the history I elicit from the patient, that there is an effort=20 directed at pushing this class of medication to its limit before considering= =20 other medications. Typically, a patient will see me who has been given=20 gabapentin at a dose of 800 milligrams four times daily (2400 milligrams=20 total). The patient is still experiencing sensory dysesthesia as well as=20 having some confusion and dizziness from the high dose of gabapentin.=20 I have found that patients get the best response from gabapentin by starting= =20 at a lower dose of 100 milligrams to start, and then titrating upward to a=20 higher dose. I start the patient on the medication at bedtime initially, to=20 be certain that the patient gets to sleep, and then add additional doses=20 during the daytime, as needed, to get maximal relief. Recognizing that this=20 is an educational process for the patient, I explain that it will take time=20 to get the maximum benefit from the medicine, and encourage the patient to=20 work with me to help find the best dose for them.=20 Older drugs, such as the tricyclics, still will work best in some=20 circumstances. I may choose to use 10 milligrams of amitriptyline to start,=20 and have the patient titrate up to as much as 40 milligrams at bedtime, if=20 that much is actually needed. The reasons for using tricyclics such as=20 amitriptyline for the treatment of neuropathic pain include its impact on=20 improving mood, slowing the urgent bladder, reducing burning pain and helpin= g=20 patients get to sleep. Caution is advised in patients with a history of=20 palpitations. Dry mouth and urinary retention can present drawbacks for this= =20 class of medication, so I tend to use the newer medications with more=20 specific effectiveness. However, tricyclics sometimes still have great=20 utility and have the added benefit of being relatively inexpensive. With all of these medications, the starting dose is always low, and the=20 titration is always slow. The titration can be accelerated as needed. It is=20 far more difficult to get a patient to continue a medication that they have=20 had an adverse reaction to caused from taking too much of the drug, than to=20 have the patient gradually increase the dose and tolerate the side effects a= =20 bit longer until they are adequately treated by the drug. For gabapentin, I start patients with 100 milligrams and increase the dose i= n=20 100-milligram increments, generally until reaching three tablets at bedtime.= =20 I may then begin to spread the medication throughout the day as needed. For=20 tiagabine, I start patients with 4 milligrams and escalate at 4-milligram=20 increments to reach a dosing schedule of two 4-milligram tablets four times=20 per day. This can be reduced to twice daily dosing if needed for convenience= .=20 For topiramate, I start patients with 25 milligrams at bedtime and escalate=20 to two 25-milligram tablets or capsules four times per day. I may have some patients taking more than one type of anticonvulsant at the=20 same time. I have observed that I can continue to use lower doses of each=20 type of medication effectively and keep the side effects low while improving= =20 efficacy since their mechanisms of action are different (which is beyond the= =20 scope of the present discussion, but which is the scientific basis for=20 rational polypharmacy). Other symptoms and side effects may occur in patients and these must also be= =20 addressed to provide effective care and management. These symptoms include=20 aching pain, unresponsiveness to these newer anticonvulsants, reactive=20 depression, muscle spasms, difficulty sleeping, confusion and memory problem= s. I have noted that medication and lack of sleep can contribute to the combine= d=20 symptoms of sleep disruption, confusion, muscle spasms and memory problems.=20 To address these issues effectively, I have found that a certain degree of=20 pain relief is needed for quality sleep to take place. Pain is an alerting=20 response that will effectively prevent sleep, and lack of sleep can lead to=20 confusion and memory disturbances. To treat pain, I often prescribe opioids as they are needed. I begin with th= e=20 use of milder medications containing codeine, if tolerated. I then use=20 hydrocodone, long-acting oxycodone, long-acting morphine, methadone,=20 hydromorphone, meperidine, fentanyl patches or oral fentanyl. I warn patient= s=20 of possible side effects such as nausea, vomiting, delayed swallowing or=20 delayed gastric emptying, and constipation. I have noted a reduction of pain intensity to the 4-5/10 range in patients=20 treated with opioids. However, some patients indicate higher pain levels at=20 their follow-up appointments for several reasons: (1) they have not taken=20 their medication in order to drive to their appointment; (2) they over-repor= t=20 pain in an attempt to ensure continuation of their medication; (3) they=20 purposely don=E2=80=99t take their medication before their appointment in or= der to=20 look as if they need more pain medication, or to ensure continuation of thei= r=20 pain medication. I put patients taking opioids on a stool softener and a fiber supplement as=20 well. I caution them about the use of magnesium citrate if they are at risk=20 of developing fecal impaction because of the potential danger of perforation= .=20 Patients usually don=E2=80=99t like to hear that, but they have to know. If=20= they=20 develop gastrointestinal pain or rectal bleeding, I send them for an=20 appropriate endoscopic or colonoscopic evaluation. If patients have reactive depression develop, I prescribe an antidepressant.= =20 I favor the selective serotonin reuptake inhibitors (SSRIs), and note that=20 they have been of some use in both relief of depression and treatment of=20 migraine. This is helpful since there is an element of migraine-like headach= e=20 in many of the patients that develop upper extremity pain problems. Migraine= =20 may be the response that any of several stimuli yields when triggered, but=20 whatever the explanation the depression must be treated. Fluoxetine (Prozac)= ,=20 sertraline (Zoloft) and venlafaxine (Effexor) all have excellent records of=20 effectiveness. When an SSRI cannot be used because of a potential conflict=20 due to simultaneous use with an anti-migraine triptan (Serotonin Syndrome),=20 bupropion (Wellbutrin) can be used effectively. If memory problems persist, donepezil (Aricept) can be used at a dose of 5 t= o=20 10 milligrams per day, with some improvement. Confusion should subside as=20 sleep improves and the dose of anticonvulsant adjuvant is reduced. Improved=20 pain control will also help improve cognition. Finally, perhaps the most important aspect of neuropathic pain control is=20 that associated with the control of movement-related muscle spasms. Muscle=20 spasms are made worse by physical activity of even the mildest variety, a=20 dependent posture and cold ambient temperature. This is important because=20 treating movement-related spasms is one of the principal ways by which=20 neuropathic pain may be resolved, particularly early after the onset of the=20 pain, before it has had a chance to become "centralized" pain due to changes= =20 secondary to the release of excitatory neurotransmitters within the dorsal=20 root entry zone. I most often will use tizanidine (Zanaflex) to treat neuropathic pain=20 associated with movement-related muscle spams, beginning with a dose of 1mg=20 at bedtime. I have the patient titrate up to as much as 8 milligrams at=20 bedtime, if needed, and 1 to 4 milligrams at two-hour intervals if so needed= ,=20 with a maximum of eight full 4-milligram tablets per day (32 milligrams).=20 Tizanidine reduces the spasm of movement and the pain associated with that=20 spasm, thus allowing the patient to move more freely. Tizanidine may be used= =20 strictly on an as needed basis during the day or night. Taken together, the use of medications for the burning pain/allodynia=20 (anticonvulsants); aching pain (analgesic/narcotics); bowel regimen (stool=20 softener/fiber); reactive depression (antidepressants); disturbed memory=20 (memory enhancer); muscle spasm (antispasticity agents) provides the basis=20 for a plan of rational polypharmacy in the clinical management of the patien= t=20 with chronic neuropathic pain. Nygabnet

Response:

Question:

Thanks to everyone for the replies….. I’ve had lots of dizziness as part of my anxiety, but it’s just since the first Zoloft that I noticed this tendency to get dizzy when I watch something moving fast. It’s very concerning to me in that I always thought of dizziness to be ear-related, but this appears to be caused by some connection with my eyes. My other dizziness that I had before this is also strange, it seems that as long as I keep moving, I’m OK, but the minute I stop moving, I get dizzy. It’s almost as if all of the energy from my nervous system being used to move me around as I walk or run suddenly smashes into my balance system the minute I stop moving (I know thats ridiculous but I’m just using it as an analogy) The other amazing thing is that both my doctor and my therapist told me that zoloft would most likely make it hard to sleep, but the opposite has occured, since taking my first zoloft a few days ago I am increidbly tired (and dizzy). So part of me wants to run and have more medical tests, but then again I’ve been through that whole routine many times before. Thanks again to everyone for the replies. It really helps knowing there are other people out there that are going through this.

Response:

. That is very good. Most doctors start their patients on 25 or 50 mgs and it is really better to *start low and go slow* in order to avoid or minimize initial Zoloft side effects.

Hi, I was given 50mgs for two weeks then on to 100. I believe I have a bite problem from clenching my teeth during this time. I see an endodontist next week to see if it’s a major crack way down in at least two teeth or the nerves that have been damaged as a result of this horrible clenching. I also had the *worst* nightmares. Can’t say for sure if it was the med (and yes I was really dizzy too) but it gradually went away after stopping it. I am, however, left with problem with my teeth, my dentist says to hope for a root canal as that would be the most simple repair of the possible ones. Great littlebear

Response:

Hi Steve, I had dry eyes real bad..kind of like dry mouth and yawns. My eye sight changed while taking zoloft and ive talked to another person that that happened with too…you no your body best and if you think it is a side effect then bring it up with your doctor…it does sound like it will get better if that’s the case. once again best wishes charla

– Hide quoted text — Show quoted text – Thanks to everyone for the replies….. I’ve had lots of dizziness as part of my anxiety, but it’s just since the first Zoloft that I noticed this tendency to get dizzy when I watch something moving fast. It’s very concerning to me in that I always thought of dizziness to be ear-related, but this appears to be caused by some connection with my eyes. My other dizziness that I had before this is also strange, it seems that as long as I keep moving, I’m OK, but the minute I stop moving, I get dizzy. It’s almost as if all of the energy from my nervous system being used to move me around as I walk or run suddenly smashes into my balance system the minute I stop moving (I know thats ridiculous but I’m just using it as an analogy) The other amazing thing is that both my doctor and my therapist told me that zoloft would most likely make it hard to sleep, but the opposite has occured, since taking my first zoloft a few days ago I am increidbly tired (and dizzy). So part of me wants to run and have more medical tests, but then again I’ve been through that whole routine many times before. Thanks again to everyone for the replies. It really helps knowing there are other people out there that are going through this.

Response:

Thanks to everyone for the replies….. I’ve had lots of dizziness as part of my anxiety, but it’s just since the first Zoloft that I noticed this tendency to get dizzy when I watch something moving fast. It’s very concerning to me in that I always thought of dizziness to be ear-related, but this appears to be caused by some connection with my eyes.

There are nerve tract connections between the eyes and the inner ear, and both tell your brain about the orientation of your body in relation to the environment. Ever watch a movie of a roller-coaster and get dizzy and nauseous? The Zoloft may be temporarily accentuating this reaction. It will pass. My other dizziness that I had before this is also strange, it seems that as long as I keep moving, I’m OK, but the minute I stop moving, I get dizzy.

As long as you’re walking you know where your feet are. If you stand still, your anxiety can over-ride the sensory input from your legs that tells your brain you are upright. This results in a sensation of dizziness, and more specically the feeling that you will fall down. I have been so anxious at times that I was unable to just stand. I had to lean against a table or wall. It’s almost as if all of the energy from my nervous system being used to move me around as I walk or run suddenly smashes into my balance system the minute I stop moving (I know thats ridiculous but I’m just using it as an analogy) The other amazing thing is that both my doctor and my therapist told me that zoloft would most likely make it hard to sleep, but the opposite has occured, since taking my first zoloft a few days ago I am increidbly tired (and dizzy).

I was told to take Zoloft in he AM since it can be stimulating and lead to insomnia for the first several days. It can also cause fatigue, although I have never experienced this side effect. So part of me wants to run and have more medical tests, but then again I’ve been through that whole routine many times before.

I think there are physiological explanations for our symptoms of dizziness, but they are not due to organic disease, only anxiety. Thanks again to everyone for the replies. It really helps knowing there are other people out there that are going through this.

Various types of "dizziness" are very common in people with anxiety disorders. Chip Before you buy.

Response:

- Hide quoted text — Show quoted text – Thanks to everyone for the replies….. I’ve had lots of dizziness as part of my anxiety, but it’s just since the first Zoloft that I noticed this tendency to get dizzy when I watch something moving fast. It’s very concerning to me in that I always thought of dizziness to be ear-related, but this appears to be caused by some connection with my eyes. My other dizziness that I had before this is also strange, it seems that as long as I keep moving, I’m OK, but the minute I stop moving, I get dizzy. It’s almost as if all of the energy from my nervous system being used to move me around as I walk or run suddenly smashes into my balance system the minute I stop moving (I know thats ridiculous but I’m just using it as an analogy) The other amazing thing is that both my doctor and my therapist told me that zoloft would most likely make it hard to sleep, but the opposite has occured, since taking my first zoloft a few days ago I am increidbly tired (and dizzy). So part of me wants to run and have more medical tests, but then again I’ve been through that whole routine many times before. Thanks again to everyone for the replies. It really helps knowing there are other people out there that are going through this.

Hi Steve, Dizziness is my main anxiety symptom too. I also get dizzy sometimes when I am on the computer and I am scrolling through web pages very quickly. It seems to happen when I am very tired. So I try to scroll slowly and take frequent breaks from the computer. Do you experience dizziness when you lay down at night, it feels like you are on a boat on rough seas? When my anxiety was bad this happened everynight, I hated it. There is no quarantee that your sleep will be messed up while on zoloft. Some people do have problems sleeping while others claim their sleep has improved. Your incredible fatigue and dizziness should subside with time. It sounds like you are doing pretty good though. Take care Jackie

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I started on the same dose and felt dizzy too some of the time.  I am up too 100mg without any more sid effects.  i use too be sooooo scared of it but i am actually doing very well. The side effects do go awaya after a few days . I was always scared when they would increase it but then found that it was no big deal.  I am usually very sensitive to meds.  I am really glad to be on it.  My anxiety has really lifted.  I am doing so much more now and can actually enjoy some things now. Good Luck!

Response:

My doctor told me to start Zoloft for anxiety/panic by cutting a 25mg pill in half and taking a half a pill for a week and then start on a whole pill a day. The day of the first half-pill dosage I felt fine (and the doctor said I wouldn’t have any side effects for a few days), but that evening, while watching some animation on my computer screen, I started to get very dizzy as I watched the screen. It seems everytime my eyes are exposed to something in fast motion, I get dizzy. Is this a possible side effect of zoloft on such a low dose, or do I have yet another thing to worry about?

Response:

My doctor told me to start Zoloft for anxiety/panic by cutting a 25mg pill in half and taking a half a pill for a week and then start on a whole pill a day. The day of the first half-pill dosage I felt fine (and the doctor said I wouldn’t have any side effects for a few days), but that evening, while watching some animation on my computer screen, I started to get very dizzy as I watched the screen. It seems everytime my eyes are exposed to something in fast motion, I get dizzy. Is this a possible side effect of zoloft on such a low dose, or do I have yet another thing to worry about?

Hi Steve, Dizziness is a fairly common side-effect of Zoloft.  While it is an uncomfortable side-effect, it is not dangerous and should pass with time. Of course if it is concerning you don`t hesitate to talk to your doctor. Take care. Jackie

Response:

My doctor told me to start Zoloft for anxiety/panic by cutting a 25mg pill in half and taking a half a pill for a week and then start on a whole pill a day.

That is very good. Most doctors start their patients on 25 or 50 mgs and it is really better to *start low and go slow* in order to avoid or minimize initial Zoloft side effects. The day of the first half-pill dosage I felt fine (and the doctor said I wouldn’t have any side effects for a few days), but that evening, while watching some animation on my computer screen, I started to get very dizzy as I watched the screen. It seems everytime my eyes are exposed to something in fast motion, I get dizzy. Is this a possible side effect of zoloft on such a low dose, or do I have yet another thing to worry about?

The way I see it there are three possibilities: – It’s just the old anxiety (did you experience dizziness as an anziety symprom?) – It’s a Zoloft side effect which is very well possible. Some people are more sensitive to these meds than others. In this case you might consider asking for a benzo like Xanax on the side (not a bad idea anyway while weaning on an AD). – Maybe you are so focused on possible side effects that it has becomne a self-fulfilling prophecy IMO you should ask for a benzo on the side and then wait for a few weeks if possible and see how it goes. This is much too early to have any idea about Zoloft being a good med for you or not. I hope it will be. Philip

Response:

HI Steve, I didn’t know they came in 25mgs..I split my 50 in half…It would be cheaper the pharmacist says to buy the 100 and split that in fourths.But I’m so sensitive to change that I stick with what I know. I experienced dizziness the first day starting Zoloft at 12.5 mgs and the doc told me that it was not enough med in my system to have side effects. It was anxiety..I was looking for the side effects.I had increased symptoms of anxiety for the first month starting on Zoloft and it was because I was so anxious about taking it. I told myself everyday I can stop taking this anytime I choose and the dosage I’m taking is so little that these things I’m feeling are the result of my fear of meds and yesterday I was fine and today I will be to…I’m going to give this med time to see if it will help. You can check with your doctor anytime day or night…or call your pharmacist for reassurance..and try to be honest with yourself..Is this anxiety from taking a medicine. Charla

– Hide quoted text — Show quoted text – My doctor told me to start Zoloft for anxiety/panic by cutting a 25mg pill in half and taking a half a pill for a week and then start on a whole pill a day. The day of the first half-pill dosage I felt fine (and the doctor said I wouldn’t have any side effects for a few days), but that evening, while watching some animation on my computer screen, I started to get very dizzy as I watched the screen. It seems everytime my eyes are exposed to something in fast motion, I get dizzy. Is this a possible side effect of zoloft on such a low dose, or do I have yet another thing to worry about?

Response:

Question:

Has anybody experienced anti-depressants making back pain worse? Or knocking out the narcotic? Regards, Dave

Response:

I have noticed the pain being repressed and then causing an emotional breakdown from the repressed pain reappearing and causing an emotional overload.                                                                 Terry

– Hide quoted text — Show quoted text – Has anybody experienced anti-depressants making back pain worse? Or knocking out the narcotic? Regards, Dave

Response:

I’ve taken Elavil, an old tricyclic (amitryptaline –sp?), which helped me sleep through the night when taken at bedtime, as drowsiness is one of its side effects and the sole purpose for which I took it.  I also took Zyban (Wellbutrin) for about 2 months to help me quit smoking, and it had no perceptible effect on my pain or pain meds (I DID quit smoking though, September 1, 1998, 4pm, WAY more easily than prior failed quitting efforts, but I digress).  I’ve HEARD that some of the selective seratonin reuptake inhibitors, like Prozac, Zoloft, etc., can have such a stimulating effect with some people that it could be considered to "negate" the narcotic (to me, a major function of narcotic painkillers is to instill a "what the fuck" attitude toward the pain rather than actually reducing the pain per se, so anything messing with that WTF effect would make my perception of the pain worse.)   I DO know that antidepressant prescribing is a far-from-exact science (one could use the term "buckshot" were one cranky), so I suggest you discuss this with your doc and try a different sort of antidepressant.  Hell, worsened pain is enough to depress anyone, so I can’t imagine your doc not being willing to experiment with a different sort.  May I indulge my prurient curiosity and ask which AD is having this effect on you?  Inquiring minds want to know . . . Hope you get the relief you’re entitled to, and soon ATB Louise

Response:

Greetings all, I take 50 mg of Zoloft once a day, but not for my back pain. I was originally put on it when I had some depression over my medical condition(s), and although it doesn’t seem to make a diffference with the amount of relief I get from my narcotic medications, I feel better able to cope with my situation, and it has helped my appetite. I went off of it for a few weeks, and became more irritable {i.e. bursting into tears and feeling "why me?"}  and did not want to eat. Maybe this is just a psychological reaction on my part…but others that I know using Zoloft and other SSRI’s report the same "better able to cope" benefit.   A side note however, taking it when I get up in the morning seems to work best. If it is taken at night, it can interfere with sleep…I had trouble staying asleep and when I did get to sleep, I had *very* strange dreams.   I have tried Elavil, but could not tolerate it. I had severe neck spasms and a very "disjointed" feeling {think of the Sudafed "medicine head" effect in the commercials}. Wishing everyone a tolerable pain day. All the best, Lily Human (n): domestic animal popular with cats *remove the editorial comment on AOL service from the address to send me e-mail*

Response:

Has anybody experienced anti-depressants making back pain worse? Or knocking out the narcotic? Regards, Dave

Zoloft (sertraline) made my pain worse.  I believe that SSRI antidepressants like Zoloft are less effective for this purpose than the older TCAs (Elavil, etc.).  These can be of SOME help but must be taken on a continuous basis and the side effects can be pretty bad (I took doxepin for some years and discontinued it because of these).  As you suggest, it also seemed to negate the effect of codeine.

Response:

I have been on many differant anti-deppressants along w/ my pain meds w/ varying results.  The docs always told me that the combinations would "help" my headaches.  The only real help I get is the ms contin or sleep (much benedryl) I belive I still need the anti depressants tho because the view over the railings on 10th flr + sure look inviting. Walk Gently Upon Mother Earth Peter **** Posted from RemarQ – http://www.remarq.com – Discussions Start Here ™ ****

Response:

Hi Peter, My mother took Elavil for a very long time for her migraines and it made a huge difference for her.  Instead of having to go to the ER twice a month for injections of Demerol or Dilaudid, it went down to maybe once every six months to a year!!!!!  Due to the Elavil causing weight gain, she was switched to Prozac, which has also done a great job at controlling her headaches.   I belive I still need the anti depressants tho because the view over the railings on 10th flr + sure look inviting.

PLEASE, don’t go over there anymore!!  We want you here!!!! Robin I have been on many differant anti-deppressants along w/ my pain meds w/ varying results.  The docs always told me that the combinations would "help" my headaches.  The only real help I get is the ms contin or sleep (much benedryl) I belive I still need the anti depressants tho because the view over the railings on 10th flr + sure look inviting.

I am in no way a physician or any other type of medical professional.  I am just speaking from personal experience or information gained during my treatment or research ;o). Remove NOSPAM from the above email address to contact me.

Response:

Has anybody experienced anti-depressants making back pain worse? Or knocking out the narcotic? Regards, Dave

    I have. I’m taking 2 antidepressants, Respiridol, and Dyseril.  They really put me to sleep, but the pain is intense when I wake up every 30 minutes.  Before the Dr. prescribed that combo (along with Zoloft), my pain med seemed to last a hell of a lot longer. Alex

Response:

Question:

Any anxious/depressed nurses out there? I recently graduated nursing school and started my first ever LPN job. Although I’ve been on various SSRIs (currently Zoloft) the old anxiety and depression which I thought had subsided several years ago are coming back with a vengeance!  I’m afraid I’m going to screw up, get a bad review, or even get fired or lose my license! Diana B.

Hi Diana, welcome to ASAP, If every nurse with a anxiety disorder was fired, then most hospitals would need to close. For some reason(s) the medical profession generally, and nurses in particular, seem to have more than their fair share of anxiety and depression sufferers. Probably, all  due to those difficult to please patients, although I am of course an exception!    :-^) Take care Ian

Response:

If every nurse with a anxiety disorder was fired, then most hospitals would need to close. For some reason(s) the medical profession generally, and nurses in particular, seem to have more than their fair share of anxiety and depression sufferers. Probably, all  due to those difficult to please patients, although I am of course an exception!    :-^) Take care Ian

In my experience the worst patients, are male patients. Especially in the 45 to 50 age bracket. <G They are demanding, obnoxious and can not handle any pain. I would give up peroxide just to see what kind of patient you are, Ian. ~~ When I was in the hospital having surgery, this one night there was this person screaming all night, it was the most blood-curdling screams I had ever heard. I couldn`t take it any more, and asked one of the nurses what was wrong. With a "giggle", she said it was the man down the hall passing a tiny ole kidney baby…….You guys are such babies<VBG. *Her*

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Any anxious/depressed nurses out there? I recently graduated nursing school and started my first ever LPN job. Although I’ve been on various SSRIs (currently Zoloft) the old anxiety and depression which I thought had subsided several years ago are coming back with a vengeance!  I’m afraid I’m going to screw up, get a bad review, or even get fired or lose my license! Diana B. The JerZ Fox Money doesn’t buy happiness. Poverty doesn’t buy anything.

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Any anxious/depressed nurses out there? I recently graduated nursing school and started my first ever LPN job. Although I’ve been on various SSRIs (currently Zoloft) the old anxiety and depression which I thought had subsided several years ago are coming back with a vengeance!  I’m afraid I’m going to screw up, get a bad review, or even get fired or lose my license! Diana B.

Hi Diana, Welcome to ASAP! I am a LPN also, but I am not working due to PD.  I do understand how difficult it is to do your job while being very anxious and panicky. When I was working in a nursing home, I was the medication and treatment nurse. Medications were quite difficult to dispense while in a anxiety state. My worse fear was I would make a medication error and hurt someone. I had no idea what was wrong with me, but you do know what you are dealing with. Seek help immediately, before this gets out of control. I would first go to your MD and get a good checkup just to make sure nothing physical is causing it. If everything checks out, get to a psych doctor ASAP. It is time to either up the Zoloft dose, or think about a med change. A script for a benzo would also help. I would also suggest Cognitive Behavioral therapy, if you haven`t done this before. You need to be taught some coping tools for those anxious moments at work. And CBT can do that. You can`t get fired or lose your license because you suffer from a anxiety disorder. Making errors while really anxious is always a possibility, that is why you need to deal with this now, and aggressively, this will not go away on its own. I really do sympathize with you, I do know what you are going through. Hope things work out, and keep in touch<g Jackie ~~Optimism is the faith that leads to achievement. Nothing can be done without hope and confidence~~

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~~<snipping throughout~~ Hi Beth i did quit my job and quit driving and just ran away from all the things that i thought were making me nervous. not healthy, eh?

Know what you mean – I did exactly the same. Wish I’d quit driving though coz instead I just took to crashing the car! a lot of things on my mind right now. and , i’m REALLY suffering for it in the panic/anxiety department. my stomach has been a mess for months..and has been ESPECIALLY bad over the past month. my nerves are rather frayed. i am starting to be more afraid of the fear than ofwhat’s causing the fear..and i’m trying to find a single cause of this anxiety so i can just kick it out of my life and get on..but it ISN’T just one thing. i’m jus scared in general. i’m afraid of not being able to cope w/ life.

Beth, if there’s no obvious cause then don’t waste any more time looking. Try to accept the way you feel right now and work on that. Don’t get angry about it coz that won’t help. I know you’re scared but it’ll get better and you’ll get through. Be kind to yourself. so, that’s kind of a synopsis of what’s going on and some histry. i just wanted to give that before i start participating in this group. i just wantt  o talk w/ people who are in a similar boat as i am..because as much as some of my friends care and want to help ,they just don’t know how bad it feels to be so nervous that you’re gagging and your mind is spinning at 24000 RPM. ya know?

Only 24000 RPM? How do you get it to go that slow? Just think of all the extra thinking you can do in that time which your friends can’t. One day you might find that speed-thinking is an asset! As you probably know the gastric problems are caused by your body preparing you to fight a sabre-toothed tiger. Part of the blood flow is re-routed from your digestive system to your muscles (for running/fighting) and your brain (for quick thinking/staying alive). That’s why you feel nauseous, jumpy and your head spins. Personally I’d suggest that you look into relaxation exercises or biofeedback to reduce the level of background anxiety. This will also help reduce all that *noise* going on in your head. Through periods of proper relaxation you can convince your body that the *danger* has passed and give it the opportunity to settle down. well, thanks for the open ear/eye. i’m goign to check this group out some more and i hope i can offer something good for it and get somethign good out of it. okay? -Beth

Nice to hear from you and wishing you all the best. Sounds like you’ve got a lot going on in your life right now but things will settle down in time. Good luck — ROB…  "high mileage but reliable!"

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Hi Gary, I wondered if you have read or even heard of Lucinda Bassett’s new book "From panic to power", I’ve just started reading it and so far it seems pretty good! Any comments, thanks Rocco Rocco

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: Sounds like you’re definitely "one of us", which is rotten luck : for you, but good in as much as you’ve found the right place. : I hope you get as much support and encouragement from ASAP : as I have yup, i guess i am. = / this has been an ongoing problem since iwas younger. i’m goign through a rather rough spot right now. i was pretty much off all of my meds and feelign pretty damn good until about 2 months ago. then , shit just went downhill. i’m just in need of support wherever i can get it..and, from some of the email i’ve been getting, i am finding that my strange phobias and paranoias aren’t unique. that’s encouraging as hell. at least i’m not hte only one. thanks again. i think i’m going to stick around here for a while. -Beth   ** some esoteric quote from some pretentious band or writer pasted here **   (check out beffie’s homepage: http://www.aracnet.com/~martine/bethie.html)

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Hi Gary, I wondered if you have read or even heard of Lucinda Bassett’s new book "From panic to power", I’ve just started reading it and so far it seems pretty good!

Can I just remind people to *please* not post *and* e-mail? I replied to Rocco’s message earlier, as I received it via e-mail, not realising he’d also posted it here as well. This isn’t a flame – just a plea to avoid duplication of effort — Gary Cooper

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i have lurked in this group and commented a tad a while back…but i was on a good upswing w/ my anxiety problems at the time and didn’t feel that i needed to be adding my $.02 at that time. ya know? anyhow, i’m back because i’ve been feeling a tremendous amount of anxiety about some major changes in my life.

Hi, welcome to ASAP <words deleted to save space so, that’s kind of a synopsis of what’s going on and some histry. i just wanted to give that before i start participating in this group. i just wantt  o talk w/ people who are in a similar boat as i am..because as much as some of my friends care and want to help ,they just don’t know how bad it feels to be so nervous that you’re gagging and your mind is spinning at 24000 RPM. ya know? well, thanks for the open ear/eye. i’m goign to check this group out some more and i hope i can offer something good for it and get somethign good out of it. okay?

Sounds like you’re definitely "one of us", which is rotten luck for you, but good in as much as you’ve found the right place. I hope you get as much support and encouragement from ASAP as I have — Gary Cooper

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hi there, i have lurked in this group and commented a tad a while back…but i was on a good upswing w/ my anxiety problems at the time and didn’t feel that i needed to be adding my $.02 at that time. ya know? anyhow, i’m back because i’ve been feeling a tremendous amount of anxiety about some major changes in my life. let me give a little background: i’m 23. i’ve been suffering from general anxiety and panic stuff since i was a littler kid (say, about 8 years old or so). i had my first hardcore panic attacks when iwas about 16..and then a really bad episode when iwas 18 and ended up shutting myself inside forabout 3 months so iwas basically agoraphobic(sp?). i got a good case about a year ago too, when my parents moved out of state. i’ve been off and on medication for all of this: norpramine (for depression and anxiety), xanax and, more recently, zoloft. xanax and zoloft work wonders for me but i don’t like the side effects of zoloft thati feel. so, i quit zoloft last march or so. my anxiety hits me in the bowels and stomach. i start gagging and can’t stand the smell of food. my body either wants to puke or shit or both. pretty icky, if you must know. = b i’ve been seeing a good therapist and a good doctor lately to help w/ this all. the doctor has me taking a lot of stomach/intestine meds which help that end..and xanax for when the panic or the nerves get overwhelming. so, i’m on my way to recovery..it’s just taking a while. i’m having trouble eating still..and if i don’t keep myself busy, my brain just tries to eat itself and runs in circles, causing more and more anxiety. i ususally start having a good bout of what i call the "heebie jeebies" in my life when i’m going through a lot of change. when iwas 16, there was about 5 new things going on in my life: moving away from my hometown, coming out, my dad remarrying, new job, newly licensed to drive. so, i got overwhelmed and started having anxiety attacks. i got stabilized but was not really ever formally treated for these attacks because i was functioning okay and at least gong to school. i did quit my job and quit driving and just ran away from all the things that i thought were making me nervous. not healthy, eh? then, when i was 18, well, i graduated from highschool and i just totally freaked. it took a long time to get over that one. i was a mess and a half over that summer, didn’t barely leave the house, was having paraniod thoughts, the works. my family deicded that it was probaly a good idea to send me to a psychiatrist, who put me on xanax and norpramine. it really worked. i went to commnity college and did well and slowly learned to face my fears. it took a lot of time, though. the episode of major anxiety i felt a year ago was over my paretns moving to texas and my grades slipping here at UCD. i promply went to see a shrink and worked it out…as usual, it took a while. and then there’s now: i’m goign to be graduating from college in 2 quarters. my parents are out of state. i have a new relationship that started out very intense becuase of distance factors (she’s up in oregon and i’m down here). i have to figure out what i’m goin to do after graduation..a lot of things on my mind right now. and , i’m REALLY suffering for it in the panic/anxiety department. my stomach has been a mess for months..and has been ESPECIALLY bad over the past month. my nerves are rather frayed. i am starting to be more afraid of the fear than ofwhat’s causing the fear..and i’m trying to find a single cause of this anxiety so i can just kick it out of my life and get on..but it ISN’T just one thing. i’m jus scared in general. i’m afraid of not being able to cope w/ life. so, that’s kind of a synopsis of what’s going on and some histry. i just wanted to give that before i start participating in this group. i just wantt  o talk w/ people who are in a similar boat as i am..because as much as some of my friends care and want to help ,they just don’t know how bad it feels to be so nervous that you’re gagging and your mind is spinning at 24000 RPM. ya know? well, thanks for the open ear/eye. i’m goign to check this group out some more and i hope i can offer something good for it and get somethign good out of it. okay? -Beth   ** some esoteric quote from some pretentious band or writer pasted here **   (check out beffie’s homepage: http://www.aracnet.com/~martine/bethie.html)

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