nortriptyline

[pianogal]

does it constipate you? all the meds did, so I am on no meds currently.

[calluna]

I did get constipation to start with, but that has gone now. For me, the side effects all settled down and went away over the weeks/months.

With regard to the palpitations/racing heartbeat, what I have been experiencing is different, I think. It is not all the time - usually it wakes me at night, sometimes more than once a night - sometimes I do get it in the daytime as well. My heart rate goes up to around 100 - counting my pulse at 2am is not my forte, turns out! - and the heartbeat feels so loud and strong. It doesn't last too long though, maybe 15 or 20 minutes from when it wakes me, I can go back to sleep again.

I shall take myself off to the GP this week and see what he says.

[Faith]

I took desipramine and amitriptyline which are both in the same drug class as Nortriptyline (tricyclic antidepressant). Amitriptyline made me way to drowsy throughout the day (even at 12.5mg) and while I got up to 50mg of desipramine it did nothing for my pain (even in conjunction with Neurontin). Desipramine just caused me constipation (at 50mg) and a fast heart rate. My heart rate stayed between 100-115 bpm. While I didn't have any palpitations I felt it wasn't really good for my heart or my pudendal nerve (with the constipation) so I weaned off. Neurontin has seemed to help my pain more than the TCA's but everyone is different. Glad it's helping you HerMajesty!

[HerMajesty]

I was at work today, busy, and all of a sudden I realized it was noon and I was late taking my meds and hadn't noticed my pudendal symptoms at all since 8am! I am up to 45mg a day in divided doses. So far no palpitations. I don't believe it's possible for me to be constipated, never happened in my life probably because I drink a ridiculous amount of water, a habit I got into years ago because it helps my intertitial cystitis.

[Cora]

hope it's okay to make a little turn in this discussion. First of all, i have a hunch there are a few nurses in on this one. I'm one, just wondering how many nurses here have pN. seems like a few anyway. In another post i mentioned some troubles with sorting symptoms out and we discovered they are primarily ms contin withdrawal. when my levels drop, it triggers withdrawal but also central pain. I see a pain specialist finally in a month and i think she will switch me to 3x a day ms contin rather than 2x a day as she says it really doesn't last 12 hours on most people. i get good control of pain from the ms but still have this judgment that i struggle with regarding taking a narcotic pain med. It really helps my pain tremendously - allows me to drive, go out for an occasional dinner, not be in constant buzzing pain, you know.. change my pain from a 5 to a 2. So, i just nag at myself that maybe i should muscle through a taper and then try amytryptiline, but my only reason is then I'd be off the narcotic, and not feeling judgmentally bad that i am taking it. it's so weird, i would never be that way with anyone else, i would totally support another person telling them all we know about pain management... so.. i guess i am still struggling. maybe that should be my new years resolution- to get over that sef-judgment regarding a med that helps so much. any advice, greatly appreciated.
Cora

[calluna]

No advice, Cora, just a comment to say I know how you feel.

I've got a similar situation, just a bit further along. I was managing my pain quite well with tramadol SR, had a comment that I had to be seriously addicted to it and that if I tried to come off it then I would get pain from that, so I couldn't know if the nerve had healed. The nerve healing is something I am very much hoping for. I came off tramadol SR with no problems at all, and am now back to using it on days when the pain spikes.

But I feel very guilty when I take it, I feel as if I am being weak and should just tough it out. I know this is daft, both the pain clinic and my GP have told me that it is entirely appropriate for me to be on it. I think that this is because it has become an emotional issue - addiction is a very emotive label, and things with a strong emotional connection will take root, if you know what I mean. Even though intellectually I know that taking it is fine, emotionally I can't seem to quite get there.

You mention self-judgement, I think you are absolutely spot on with that. We do ask more of ourselves than we would ever ask of another person - I am not sure why this is the case.....

[JeanieC]

Cora, I just wanted to say there is an active thread, started by Faith, about nurses with PN. If I knew how to cite the thread I would but I have not been able to figure this out. I would like to know if you know how to cite a thread! You are right, though, there are at least 4 nurses on this one!

I was surprised that you don't already have a pain management doctor since you are on MS Contin. My PCP doctor has written prescriptions for Oxycodone (percocet) since last summer but he has told me this is my last prescription from him (for narcotics) but he is referring me to a pain management specialist. So now I can say I know how you feel too (Cora and Calluna). My PCP doctor's explanation for needing to consult a Pain doctor is that "some people get to liking it (oxycodone) too much"

Needless to say I am a bit upset, here I am labeled a "druggie" too. I really can't figure this out because my general doctor has always been so helpful, and he has all my records from the Houston PN specialists. Do any of you know if there is some reason that a primary care doctor can't continue to write prescriptions for oxycodone 10mg twice a day?

[Faith]

Do any of you know if there is some reason that a primary care doctor can't continue to write prescriptions for oxycodone 10mg twice a day?

I don't know a for sure reason Jeanie, but it may just be that they don't feel comfortable prescribing pain meds for long periods of time since that isn't really their area of specialty. I know my Internal Medicine doc doesn't want to prescribe more than 2400mg of Neurontin a day whereas my urogynocologist who specializes in pelvic pain will go up to 3600mg. I think it's just to kind of protect their license type of thing. I wouldn't take offense to it Jeanie although the doctor could have used his words a little more carefully instead of insinuating that you might be started to "like" oxycodone too much. Maybe he just doesn't feel comfortable helping people wean off narcotics and the pain management docs are more up to date on meds. I think it's good you will be seeing a pain management doc, but I know that it's not fun building repore with a new doc again

Cora,

I am going to respond to you on your post about your latest blog entry.

[HerMajesty]

Cora, As I think you know I had to do a slow wean off tramadol before I started the antidepressant. I'm not sure if it makes any difference in judging oneself, narc or not: As my eventual goal is to get off neurontin, that would mean I would be on an antidepressant plus valium and it did occur to me that anyone taking my history would think I was a psych patient! So it is totally possible to self judge without taking a narc
A better reason to switch out the narc for an antidepressant is the insiduous nature of narcs. I went through this with tramadol which I know is not strictly a narc as it is synthetic, but it has narcotic properties. When I got on it, I believed it was worth it because I felt zero side effects. So even though it did not make a huge difference in my symptoms, it made some difference with no down side I could see, so I stayed on it for something like 6+ months. Well, at some point down the road I stopped being a morning person and starting wanting to die every time the alarm clock rang: I think this was because I was actually starting withdrawl by 6am after taking my last dose at 4pm the evening before. I also started to have some sexual dysfunction which I am too reserved to discuss further...but anyway this all went away when I weaned off the tramadol. I feel like myself again, waking up before the alarm with energy and getting things done in the morning. The withdrawl itself was a 3 week process. Mainly I was able to wean slow enough to have only minimal symptoms but a couple of times I cut my dose too quickly and became really ill.
All in all, I think because of tolerance and physical dependence, long term narcs might be helping you less, and impacting your life more, than you realize. If the narc is all that helps so be it, you need it. But I am doing much better having switched out to an antidepressant, and I do think it is worth taking the time to experiment with med alternatives even though it is a pain in the butt especially when you need to withdraw from something to do it.

[Cora]

the delay in me getting a pain management dr has been due to the fact that the majority out where I live in wisconsin all want to treat spines with procedures/ nerve blocks and don't want to deal with pelvic pain. MY pmd has actually been great and sympathetic, and very non-judgmental. It's me that feels judgmental. but anyway, we need a specialist by now to help treat the subtleties of pain management and for the long-term it's likely that my needs will change and i really want a specialist for all of this. also, a total aside here, on a facebook support group called I have or know someone with pelvic pain, they are talking again about hip labral tears. another person got diagnosed with that, so it seems that some of us at least should have that looked into. with my sports background, i am going to ask my pain dr who is also a physiatrist to evaluate my hip and ask for a rule out labral tear mri if she thinks it might be the case. they say you should have a high suspicion in people who are not responding to PT, as it may be a cause of pelvic pain. so here we go again.. being our own advocates, doing our own research, then telling the doctors what to do. as for finding a specific thread, nope. don't know how to but violet might!

Cora