Health Organization for Pudendal Education

Has anyone been helped by Cymbalta? If so, have you experienced any side effects? Also, anyone on Tramadol? It was suggested on another board to control symptoms of hyperarousal. I'm trying to decide on which meds to tide me over until my visit with Dr. Hibner in June. Lyrica was originally suggested, but not good with hypertension. Nortriptylline doesn't seem to be as effective without combining it with something like Neurotonin - and then you get the side effects of both drugs. I still have reservations about Cymbalta - maybe just taking the pain is better than any meds? Maybe I just need to grin and bear it?

Cymbalta is a trade name for duloxetine, I think. I've got no experience with this.

Tramadol, yes I was on this for about 17 months. I came off it for a while and now I am taking it again, it does help with the pain in that it takes the edge off, turns things down a notch or two. It doesn't make it go away, though. I have been taking the slow release form of tramadol (on advice of pain clinic) and I've found this much more effective than the ordinary sort, the idea being that if you have the pain relief running before the pain gets going, then you need a smaller dosage than if you let the pain get started and then try to stop it. The other advantage is that it is much easier to stop taking the slow release tramadol, I had no problems at all in stopping taking it when I wanted to.

With regard to hyperarousal, this is interesting. I have had a few episodes of this, and now that I come to think about it, these have all been whilst I was not taking tramadol. So maybe it does help? Will have to think about this one.

Nortriptyline, I've been taking this for a good while as well. I have had some episodes of palpitations and fast heartbeat, opinions seem to vary as to whether it is the nortriptyline causing this, or the gabapentin - can be a side effect of either drug - or whether it is an underlying condition. Nortriptyline does definitely help with the pain, and I would say that I now have no side effects at all with this drug, other than possibly the palpitations thing. There was a certain amount of dry mouth/dry eyes to start with, but this went away within a couple of weeks.

I would say that the pain relief I get with nortriptyline is not altered by whether I am taking gabapentin or not. (I think you mean Neurontin, this is a trade name for gabapentin.) It does help, definitely. I'd like to be taking it at 50mg really but I'd have to work up to that in steps.

The idea behind combining a TCA with an anticonvulsant is that you can take each drug at a low dose that does not cause any problems with side effects, and that on its own does not give pain relief, when you combine the two drugs then you do get pain relief....

I hope you can get something sorted out. At the moment, I am sticking with nortriptyline and tramadol SR - but YMMV....

I take Cymbalta but only @ 30 mg so it doesn't really help with the pain. It does, however, help me immensely with the depression. I was told I could up the dose if I wanted to, but I'm afraid it would make me drowsy. I take my dose at night along with trazodone to help me sleep so I don't really know if it makes me sleepy or not.

I did have a few slight side effects in the beginning but nothing major. Just muscle twitching and little nausea.

If you are depressed (and being a fellow sufferer I don't know how you couldn't be) you might try it at the low dose and see if it helps. Because pain sucks but being depressed and in pain sucks worse!

Scaredgal, if you have hyperarousal you definitely want to avoid trazadone -- that can be one of the side effects of it. Haven't tried tramadol so I can't say. Cymbalta gave me too many side effects so I didn't take it long enough to know what the benefits were.

Pain is bad for the nerve and bad for you. From what I have read, Lyrica may cause hypotension (lower blood pressure) , not hypertension (high blood pressure). It works well for me along with hyrocodone (daytime) and oxycodone (evening). Addicted to all of it but well worth it to get away from the pain. Alows me to function and survive until I can see Dr. Hibner (a long wait).

Calluna, thanks for the information both on the Tramadol (slow release vs regular) and the Nortriptyline - so I'm wondering if this is a better combo for me than the Cymbalta and Tramadol. I've read some very serious contraindications to taking Tramadol and Cymbalta together - surprised my dr didnt know about them - I'm so SICK of doctors not knowing what they are doing!

Griff522 - yes, I am severely depressed - some days worse than others. I have seriously considered suicide, but being a Christian, fear the afterlife if I do. I can just imagine Hell being a place where you have PN forever and ever..... at least there will be an end to this life eventually (sooner than later, I hope). You know, from someone who was always a health nut and always did the regular mammograms, blood work, etc. etc. to try to maintain health, now I just really don't care. I have a very strong death wish right now - but not courageous enough to do anything about it. I honestly feel there really is no hope for me. I read all the posters MRI's where they have entrapments in areas that are currently surgically accessible and none of that applies to me - I am a freak.....
My main concern about Cymbalta is one of my most troubling symptoms is hyperarousal - I have read that SSRI's and SNRI's are associated with development of this condition - so I definitely don't need to add fuel to the flame....

Violet - good to know about Trazadone - that will be added to my "definitely do not take" list!

Don - my doctor told me that due to the fluid retention/edema side effects of Lyrica, it was not good if you had hypertension. But not sure who to believe anymore. Also, don't want the horrible weight gain associated with it - I hate myself enough right now as it is...... When is your appt with Hibner?

Scaredgal, have you read my MRI results from Dr Potter? I don't have entrapment at the SS or ST ligaments either. My major problem is scarring in the pelvic floor and a deviated coccyx. Surgery wouldn't help me either and frankly I'm glad about that. I think surgery would cause more scar tissue. So I am currently working with a PT to correct my coccyx alignment and seeing my chiropractor for shockwave/laser therapy. I am feeling less coccyx pain and the pain in my vuvla/perineum is changing. It is not gone I can assure you. I have only had 2 PT treatments and 3 chiro treatments so its still very early, but I do believe there are ways to break up scar tissue so I am pursuing that route.

I know that I've read that you have had some bad experiences with PT but were they trying to break up scar tissue? Did they have the info that you now have from Dr Potter?

scaredgal wrote:My main concern about Cymbalta is one of my most troubling symptoms is hyperarousal - I have read that SSRI's and SNRI's are associated with development of this condition - so I definitely don't need to add fuel to the flame....

Scaredgal, do you have an links you could share that show SNRI's like Cymbalta are associated with the development of hyperarousal? I too am scared of this drug, but my doctor wants me to try it. I am not extremely depressed (I am some of course like any chronic pain patient, but I function well) and I personally don't like messing with the chemicals in my brain.

I think that this is not hyperarousal in the context that we mean, but rather in the context of PTSD where it means hyper-alertness. There are plenty of links talking about how duloxetine can exacerbate PTSD symptoms, including hyperarousal in that context - not a single one that I can find which mentions hyperarousal in the context of pudendal nerve-related symptoms.

Scaredgal - yes, duloxetine and tramadol together is not so good, there is a risk of serotonin syndrome and a risk of seizures. Depends on dosages of course....

Hi Faith,

Here's a link from PubMed - it specifically talks about SSRI's, but if you do some searching, you will find that it is also happening with the SNRI's (ie., Cymbalta, Effexor). Also, if you want to find out more, check out the website, psas-support.com - there is really good info on that site that talks about women developing persistent sexual arousal - especially after discontinuing SSRI's and SNRI's.

http://www.ncbi.nlm.nih.gov/pubmed/18224549

Oddly enough, some doctor's actually use SSRI's or SNRI's to help women with this condition because it is supposed to dampen the sexual urge. Unfortunately, in quite a few women studied, it does not dampen the urge, only makes the ability to have orgasm more difficult - so there is no release at all (not that orgasm really provides relief anyway).

I took Zoloft and Prozac many years ago (about 9 years ago) and said I'd never, ever get on an antidepressant again because of the withdrawal side effects. Even though I gradually stopped using it (over 2 months - reduced dosage), I had these horrific brain zaps that would come out of nowhere - it was like lightening bolts in my head. This lasted for several months and had me terrified. Hence, my strong concern about Cymbalta or any other SSRI/SNRI antidepressant.

My hyperarousal is not "mental", it's the physical, sexual type and at times it borders on unbearable where you can't put it out of your mind. I'd like to chop everything off right now.....

Griff - I'd be interested to find out more about the shockwave treatments, I don't think PT can break up scar tissue - rather I think it just further irritates an already trapped nerve. I just don't think it's aggressive enough (JMHO). Shockwave may be an entirely different story. I would love to go to Canada and check out that group - I don't know of anyone that does it here locally. But of course, same story, different verse - no money to do that.