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I take the following for pain: Neurontin, Ambien, oxycodone,
marijuana, and Cymbalta (an SNRI—selective serotonin and norepinephrine
reuptake inhibitor). These drugs are what’s left of the 25 or 30 I’ve used, a
list that includes every legal narcotic I know of, a half dozen sleeping pills,
various anti-inflammatories, and, for good measure, Elavil. Cymbalta (see photo) has helped
most, but, due to insurance changes, my cost for my next prescription will be $607 for a 90-day supply. While looking online for substitutes, I learned that Effexor (another
SNRI) is equally good for pain and, because it has been around since 1994, comes
in a generic form for $12.32.
The high cost of Cymbalta is
why, if you live in America, you are barraged with Cymbalta commercials, whereas you never see Effexor advertised. Along with price, other disadvantages to the latest “miracle drugs” is that their long-term
downsides are unknown and they are rarely more efficacious than older
drugs. So, why did my doctor prescribe an expensive medication before trying me on a dirt-cheap drug that is likely to be just as effective? Hell if I know,
although I’ve noticed that doctors don’t usually know how much drugs cost. They also used to get kickbacks from pharmaceutical companies, although my understanding is that the government put an end to this.
It’s good to remember that you’re probably in a
better position than your doctor to know which drugs might help you. For
instance, if you suffer from ongoing pain, your medication options are limited,
and with a little effort, you can learn what they are and stay abreast of the
latest research. Of the drugs I’ve tried for chronic pain, I would say that
narcotics are both the most heralded and one of the least effective. I mention
this because some of you have trouble getting narcotics, and, as a consequence,
appear to hold them in higher regard than they deserve. The reason for their relative
ineffectiveness is that you quickly build up a
tolerance, so if your starting dose is 5-10 mgs, you might be taking six times
that amount (and incurring six times the risks) after a few weeks and still not get as good a result as you had
with your initial dose. It is for this reason that I try to limit my narcotic
intake to twice a week, but even then the tolerance problem remains.
No doctor ever told me to take more than 20 mgs of
oxycodone or Dilaudid at a time. This used to leave me in the troubling
situation of thinking that, my god, I’m taking this strong narcotic that people
rob pharmacies at gunpoint for, and I’m still in terrible pain—my condition must be hopeless. When I increasingly turned to the Internet for drug
information, I learned about narcotic tolerance, and realized that my doctors simply weren’t taking tolerance into account, so I started increasing my own
dosage, but no matter how much I took, I soon needed more. (If you should ever
consider increasing drug dosage without your doctor’s consent, bear in mind the following statement from the American Centers for
Disease Control and Prevention: “In 2008, more than 36,000 people died from
drug overdoses, and most of these deaths were caused by prescription drugs.”)
Rather than the prescribed strength being too weak,
I’ve also seen it go the other way. For instance, if I had used that 100-microgram
Fentanyl patch that one doctor gave me, I’m pretty sure I would be dead. After
another doctor started me on a triple dose of Demerol, I could hardly get out
my chair for three days. Such overkill (ha) is another reason that you should do you
own research.
Because of my positive experience with Cymbalta,
I’ve become very interested in anti-depressants for pain relief. Some of you
might know that the old tricyclic antidepressants (Norpramin, Tofranil, and
Elavil, to name a few) have long been given for pain. Then came the SSRIs
(Prozac, Lexapro, and Zoloft are three that I’ve taken), which weren’t good for
pain by themselves but were good in combination with a tricyclic. The next
advance was the SNRIs (Cymbalta, Effexor, Pristiq), which are effective for the
pain of arthritis, fibromyalgia, and neuropathy, along with depression, panic
disorder, social phobia, and obsessive-compulsive disorder.
As you can imagine, any drug that can do all that
can also kick your ass, as I discovered when I stopped taking Cymbalta cold
turkey last November and felt utterly exhausted, experienced excessive scalp
sweating, had symptoms approximating the early stages of a horrendous
cold, and wanted to rage one minute and cry the next, symptoms that continued
for nearly two months. Since I had stopped taking narcotics at the same time, I
assumed I was suffering from narcotic withdrawal and so did my doctor. When I
finally went online, it didn’t take me any time to become convinced that it
wasn’t the narcotics, it was the Cymbalta. Why didn’t my doctor know
this? Maybe he didn’t sleep well the night before, or maybe he was thinking
about his last patient or the fight he had with his wife that morning. I have
no idea, but I do know that one should never go to any doctor with the assumption
that everything that can be done will be done, and that it will be done right. I’ve
experienced situations in which so many mistakes were made by so many people in so short a time
that I imagined myself trapped in a Monty Python skit.
I’ve gone into some detail about anti-depressants for
pain control because Cymbalta has worked fairly well for me without severe side-effects or a tolerance
problem. It’s important to remember that chronic pain causes anxiety and
depression, problems that worsen the pain, and that anti-depressants have the
advantage of treating these along with pain. The worse downside to Cymbalta—so
far, anyway—is that, having been through drug withdrawal a few times by now, I worry more about drugs that cause withdrawal than I do about drugs that I can easily stop. Whenever I start to focus on such concerns,
I remind myself that living with pain and depression pose their own serious
health risks. For example, chronic pain makes a person more prone to accidents;
depression impedes his immune system; and the two of them together make it impossible
to get adequate sleep. I, like so many of you, can no longer imagine a drug-free
life despite the fact that I anticipate dying earlier because of it.
I have found living with pain—and the
resultant disability—to be a major challenge to my desire to live at all. Many
people experience this, and because of it, I have a great deal of sympathy for
other sufferers. We share a problem that can be very hard to treat and that
many people don’t understand (especially if you “look normal”)
and often seem bored by. I do understand what pain sufferers are going through, at least somewhat, and I am far from bored by it. Just as some of you worry about me, so do I worry about you. I am
hardly the worst-off of those in my blogging community, and I can thank many of
you for helping me keep my head above water.
