Chronic Pain Syndrome and SNRI's

Posted , 4 users are following.

Afetr having artritis for over 20 years (I am 42 now) I was told I have Chronic Pain Syndrome..... after trying various medications I would like to add to my gabapentin and co-codamols a SNRI.

I was on fluoxetine, but after reading up on it want to try a SNRI like Milnacipran, Duloxetine or Venlafaxine.

Does anyone have experience of these?

Can anyone in the UK tell me if Milnacipran and Venlafaxine are available on NHS prescription or private?

Thank You for any words of wisdom you can share.​

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  • Posted

    Hi Tartan Tiger. So I did a check on a website here in the US on codeine/acetaminophen, cymbalta/duloxetine, Effexor/Venlafaxine, and Minicipran.

    What I can tell you abou these drugs is that I have tried Cymbalta/Venlafaxine. It worked great for pain, but after 3 months my stomach (I have Gerd) could not handle it and even though it worked great for my pain it wasn't worth the stomach nausea which would last all day.

    When put on Effexor/Venlafaxine, I was also on Gabapentin and Seroquel. I almost had a seizure after 1 week of taking the Venlafaxine. The reason I know this is because my mother is an RN and I was on the phone with here the whole time. I had to be put on Ativan for 2 weeks to get rid of the twitching. After reading up on Effexor I hear Effexor ER has been banned in the USA. I'm glad because friends that have taken it give it a bad review.

    As far as the Milnacipran you cannot use it with alcohol at all. It has a label warning that says it could be extremely dangerous for your liver. The most frequently occurring adverse reactions are nausea, headache, constipation, dizziness, insomnia. Nausea, again, but it does sound like a promising drug because it treats Fibromyalgia which I have. I take Lyrica for my fibromayalgia.. I would go with Cymbalta/Duloxetine and try it in the morning and see how you feel. It definitely elevated my mood. I would not try Venlafaxine. I have not tried Milnacipran. Note that all these drugs together in any combination of the 3 that you have described as well as Nucynta/Tapentadol will cause marked drowsiness.

    If these drugs don't work for you you might want to try Nucynta/Tapentadol which is an NRI. For some reason my main doctor won't prescribe it even though I have severe pain and depression. I may ask my NP about it. Nucynta is a moderately strong NRI, so its like combining Prozac and Vicodin in 1 little pill. 

    Its considered to be 3 times as strong as tramadol as far as pain relief efficiency goes, and to be similiar in potency to percocet. Its moderately potent NRI abilities help to intensify its opioid effects. Its NRI effects also have pain killing properties as it helps to block pain signals before they reach the brain. It is considered to be *roughly* 1/3rd the potency of oral morphine. 

    The only thing is you wouldn't be able to combine it with an SNRI. It could cause seratonin syndrome. I have had bad experiences with SNRI's in combination with any pain killers. If you don't have stomach issues then go ahead and try the safe ones. If you do, I would skip the SNRI's and go with something like Nucynta. 

    I am writing from the US, but I hope this helps. Gabapentin made me want to commit suicide at 1200mg after 1.5 years but maybe that is because my pain was not under control yet. Now I stretch 3 times per day using videos and do core strenghthening and ride my bike. Its really hard to get rid of chronic pain but taking pills alone might not help. I was in two bad car accidents and abused physically. My tailbone is bent. I have a terrible lower back problem I spend about 2 hours per day attending to with medication, vitamins, diet, and exercise/stretching. My neck had problems that seem to be gone. My hands still fall asleep. I have GERD which seems to be going away thanks to Betaine HCL Pepsin. I now have Fibromyalgia, Chronic pain syndrome, Anxiety, PTSD, Osteoarthritis, and have been diagnosed with Bipolar 1. My feet also hurt because of Plantar Fasciatis. I am doing strenth training with a rubber band. I'm using a lont of free stuff I find on videos on the internet as well as my bike, yoga matt and dvd's and it seems to be making me stronger. Just wanted to tell you this because I am a 43 year old female and 3.5 years ago I was a different person. The pain changed me and I was a guinea pig for the doctors. Have you tried pool and hot tub relief? I don't know if you have an injury or what but I'm interested in that because you have to get to the core cause of the problem to treat it. There is nothing wrong with medication, but I am learning that there are other things at play here like genetics, diet, toxins, sleep, relaxation techniques, etc. Try the medicine but give it your best shot. We are too young to let pain take over our lives. Good luck. I hope you get some more responses!  

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  • Posted

    Hi Tartan Tiger; the only litle extra that i can add to Debra's reply is that be careful in taking 2 anti-depressant medications (or those that have similar activiities), for as Debra said, when taking two of same, it can lead to having a seizure.....this was an issue for me back in early 2000's when I still didn't have a Definitive Diagnosis, and grabbing at straws, and drs were trying to "treat my symptoms"....a pharmacist told me, and advised not to take more than one drug that contains "any" anti-depressive combinations.......hope that you can find what works for you...do your research from the web, on what each of your medications are made up of/what their main activities do........I take Gabapentin (but a maximum of 800 mgms) and Amitriptylline, which works on my Fibro pain, and helps me to sleep (a mild anti-depressant as well).....Bron
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    • Posted

      Thank you for your reply.  I was given fluoxetine and tramadol, but only found out about seratonin sydrome when I felt ill and read up on it!  Makes me wary of taking meds at all but needs must.  If it wasn't for Gabapentin and Amitriptylline i would still be in my wheelchair and getting no sleep.   Good to hear you've found what helps you. smile
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