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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 2 of 2. This is the beginning of the thread.
Posted by sgoose on December 5, 2004, at 17:04:09
i've been struggling with chronic pain for well over a year now and have gotten nothing but chiropractic and physical therapy. i wish those non-med solutions had worked but they only made a small dent into my rampant pain. so last week i awoke to another massive headache and called my dr. for an emergency appointment, as i'm at the end of a semester with a heavy workload that is much harder with this pain and the (IMO) undertreated ADHD I am also dealing with. For the ADHD I am on dexedrine 10mg capsure once a day and 10mg tablet once a day. I also take Klonopin 1mg twice a day (anxiety).
So.. i get into the GP's office and start rattling off my problems, get asked the usual pain questions I've answered way too many times now. Out of the blue she says 'narcotics aren't the way to go here' .... strange because I never have requested or spoke of narcotic pain pills. So I walk out 2 scripts. Nortriptyline 25mg before bedtime and 25mg indomethacin at bedtime.
When I picked up the pills my pharmacist says: "do you have GOUT??" which i certainly do not. This is the second time he has been puzzled by my doctor's script writing.
Can anyone put this in perspective and/or help me on how to talk correctly about my pain to the doctor?? Is it unreasonable to think of narcotic pain relievers in this situation? My doctors seem to be going out of their way to avoid the narcotics. I have no past history of any sort of substance abuse, despite having schedule II scripts in my hands for seven years now..
thx in advance!
Posted by zeugma on December 6, 2004, at 16:01:40
In reply to nortriptyline + indomethacin ... need insight!, posted by sgoose on December 5, 2004, at 17:04:09
nortriptyline is a potent analgesic, and is often given for conditions of chronic pain:
Hum Psychopharmacol. 2004 Oct;19 Suppl 1:S15-9. Related Articles, Links
Serotonin and noradrenaline reuptake inhibitors in animal models of pain.Mochizucki D.
Asahi Kasei Pharma, Chiyoda-Ku, Tokyo, Japan. mochizucki.db@om.asahi-kasei.co.jp
Animal models of chronic pain serve as an experimental basis for testing new therapeutic interventions and for mechanistic investigations. In an animal model of chronic pain, based on the injection of formalin into the paw of a rodent, inhibitors of noradrenaline reuptake such as nisoxetine, nortriptyline and maprotiline and dual inhibitors of the noradrenaline and serotonin reuptake such as imipramine and milnacipran produce potent anti-nociceptive effects, whereas selective serotonin reuptake inhibitors, such as fluvoxamine, are much less potent. In another model, neuropathic pain resulting from the chronic constriction injury of the sciatic nerve was prevented by the dual uptake inhibitor, venlafaxine. The experimental model involving ligation of the 5th spinal nerve induces behavioural signs in rats and mice that are similar to the symptoms of human neuropathic pain. In this model amitriptyline, a non-selective serotonin and noradrenaline reuptake blocker, the preferential noradrenaline reuptake inhibitor, desipramine and the selective serotonin and noradrenaline reuptake inhibitors, milnacipran and duloxetine, produce a decrease in pain sensitivity whereas the selective serotonin reuptake inhibitor, fluoxetine, is ineffective. Antidepressants acting on the noradrenergic or both the noradrenergic and serotonergic systems thus appear to be more effective than those working on the serotonin system alone. 2004 John Wiley & Sons, Ltd
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