LonguylandPA Posted June 8, 2018 Share Posted June 8, 2018 Sorry if this post does not fit the this forum, feel free to remove if so. I am working in an orthopedic office and we have a large amount of patients on opioids that ive been successfully and actively weening down. Ive also included starts/increases in gabapentin/lyrica and which has allowed me to ween some patients off the opioids further. My question is: I understand that cymbalta is approved for neuropathic pain and I know that amitryptaline also shows good results.. My only concern is having a patient (which most likely has addictive perosnality) start one of these antidepressants while on oxycodone with risks of further synergistic CNS effects. Would I be opening up a further can of worms by trying to incorporate these medications into my practice? Thank you Link to comment Share on other sites More sharing options...
sas5814 Posted June 8, 2018 Share Posted June 8, 2018 It is possible but "back in the day" we used multiple meds in tandem particularly for neuropathic pain which is hard to treat and doesn't respond to opioids much if at all. I just tried to be mindful of the synergistic side effect possibilities and go slow. I have seen pain patients on combinations of meds that made me dizzy...usually given by pain specialists. Link to comment Share on other sites More sharing options...
camoman1234 Posted June 8, 2018 Share Posted June 8, 2018 I have lots of patients on duloxetine, lyrica, gabapentin, sodium valproate, effexor, amitriptyline for neuropathy; all in different combos with the meds I stated as well as with hydro/percs. Other medications you can think of include, but not limited to dextromethorphan 400mg/day, capsicin, isosorbide dinitrate spray and percutaneous electrical stimulation. These are all recommendations from the American Academy of Neurology, for ortho they might not be useful, but for primary they are. Link to comment Share on other sites More sharing options...
Moderator ventana Posted June 8, 2018 Moderator Share Posted June 8, 2018 most recent study on Gaba showed it no better then placebo for neuropatic pain is on my "dirty" drug list - abuse and $$ on street, and you can get high on it lyrica is even worse TCA's are good but OD risk is real - Cymbalta seems to help Try cymbalta and Elavil or nortryp.(less s/e) or even topomax (aka dopamax....) DO NOT USE GABA anymore - to much abuse - Link to comment Share on other sites More sharing options...
HmTwoPA Posted June 8, 2018 Share Posted June 8, 2018 5 hours ago, ventana said: most recent study on Gaba showed it no better then placebo for neuropatic pain is on my "dirty" drug list - abuse and $$ on street, and you can get high on it lyrica is even worse TCA's are good but OD risk is real - Cymbalta seems to help Try cymbalta and Elavil or nortryp.(less s/e) or even topomax (aka dopamax....) DO NOT USE GABA anymore - to much abuse - This is the first I am hearing about Gaba causing problems with abuse. From what I just researched it appears it only makes patients opioid high more exacerbated, but does not actually have a euphoric effect itself. I have seen some patients do well on it. It seems that most patients coming off of opioids never have pain control no matter how many different medications we try. I personally think that most pain is psych related and control of it is limited by the patients expectations and threshold. Link to comment Share on other sites More sharing options...
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