# Depressed and in Pain



## annelilli80 (Mar 12, 2002)

Hi, I am new to this bulletin board. I was diagnosed with fibro in October last year. Currently I have been off work since Tuesday afternoon because of severe back pain.MRI showed bulged disk. Here it is 3:25am and pain has been a 10 all night.







I am supposed to start back to work Wed. but I am beginning to wonder if working is making me feel worse. I have not felt good enough to clean house since Oct. when I started working. I am on a truckload of meds. including ultracet. Has anyone had good results with other pain meds? How about meds for restless leg syndrome? I am taking Senamet (sp?)














Sorry for the pity party.







I guess I will close now.


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## Susan Purry (Nov 6, 2001)

Hello crazynks, welcome to the bulletin board







Sorry you have so much pain at the moment. Can your doctor do anything other than give you pain medication for the bulging disk? Have you talked to him or her about returning to work? I take CoProxamol and Tramadol (Ultram, Zydol) for pain. They help, but not enough!As for the restless legs, it's a nightmare isn't it - constantly tossing and turning all night. Do you get a sort of pain with it in your legs? My legs and arms feel like they are going to explode, as if they are being squeezed very hard. Here's some info for you on treatment for restless legs, from medscape.You have to register with medscape, but it is entirely free and is a great resource. It has a section on treatment for restless legs which I'll copy below, but the whole article is very informative and worth reading if you have the energy.


> quote:*Restless Legs Syndromefrom Journal of the American Board of Family Practice* http://www.medscape.com/viewarticle/405870 *Treatment Approaches*Not all patients with restless legs syndrome need medication. Many patients will benefit from appropriate sleep hygiene practices, including avoiding caffeine, nicotine, and alcohol. Consistent, relaxing bedtime routines are helpful. Vigorous exercise and stimulation, including sexual activity, can worsen symptoms if they occur within 1 or 2 hours of bedtime. Because sleep deprivation can worsen restless legs syndrome symptoms, which can in turn lead to further sleep deprivation, patients should allow themselves adequate opportunity for sleep in their daily schedules.[28] Patients might find it helpful to make adaptive changes, such as working at a high desk with a stool, taking an aisle seat on trips or in meetings, and shifting their sleep cycle to permit a later awakening time.Several potentially important but not rigorously tested nonpharmacologic therapies have been used in restless legs syndrome, including massage, electroencephalographic biofeedback, counterirritants, and acupuncture.[2] Much of the information regarding these and other modalities is disseminated informally, through newsletters, support groups, and the Internet (Table 2). Patients might find it helpful to explore these resources to learn more about this chronic disorder and how to cope with it.Although medications used in restless legs syndrome have been more extensively studied than have nondrug therapies, much of the evidence base that supports current recommendations remains relatively weak. Many published studies describe small case reports or clinical trials that are not randomized, not blinded, or involve few patients. Studies that have involved placebos often show a strong placebo effect in this disorder.[29] Nevertheless, a combination of clinical experience and published studies supports a number of evidence-based recommendations regarding the use of medications to treat restless legs syndrome symptoms. A decision to use medications should take into account the severity of the patient's symptoms and functional impairment and a knowledge of the side effects and difficulties associated with various pharmacologic agents (Table 3).*Dopaminergic Agents*Dopaminergic agents, as a rule, are highly effective in treating the symptoms of restless legs syndrome and periodic limb movement disorder. In fact, a lack of response to a moderate dose of a dopaminergic agent might lead one to question seriously the diagnosis. Unfortunately, these agents frequently cause challenging side effects. Many dopaminergic agents have a rebound phenomenon, with a tendency for symptoms to increase as a dose wears off, so that a patient experiences disruptive symptoms during the night or early morning. A related phenomenon, augmentation, involves an increase in symptom intensity, earlier daily onset of symptoms, decrease in medication efficacy, or expansion of symptoms to other parts of the body.[30] Increasing medication dosage typically leads to further worsening of rebound and augmentation once they occur. These side effects usually disappear once the offending agent is discontinued.Carbidopa-levodopa (Sinemet) has been the most frequently used agent for initial treatment of restless legs syndrome.[2] Therapy may be started with a very low dose, such as one half of a 25/100-mg tablet taken 1 hour before bedtime, and titrated upward until the desired effect is reached. The patient might need to take a second dose during the night. An alternative regimen involves combining the usual bedtime dose with an additional low dose, typically 25/100 mg of the long-acting formulation (Sinemet CR). Patients might need additional doses to control daytime symptoms. Total daily dose of levodopa above 200 mg should be prescribed with caution to avoid augmentation, which has been reported in more than 50% of patients with restless legs syndrome who take this medication.[30]The dopamine agonists bromocriptine (Parlodel) and pergolide (Permax) are also effective in treating restless legs syndrome. Pergolide, the more commonly used of the two drugs, appears to cause less augmentation than is observed with levodopa, particularly when higher doses are required.[31,32]An open-label trial of pergolide in 15 patients with severe restless legs syndrome who had previously experienced augmentation of symptoms while on levodopa found that all patients experienced some degree of improvement while taking an average of 0.4 mg of pergolide per day. None of these patients reported serious augmentation during the 6-month period of observation.[31] A randomized, double-blind, placebo-controlled study of 16 patients with restless legs syndrome who took an average 0.35 mg of pergolide per day found a 61% global improvement in the treatment group compared with 19% in those patients taking placebo.[32] No rebound or augmentation of restless legs syndrome symptoms was reported, but the 3-week duration of the trial limits the importance of this observation. Another study started with patients taking levodopa and successfully switched many patients who experienced augmentation to pergolide.[33] Because of side effects - gastrointestinal distress, hypotension, and nasal stuffiness - pergolide needs to be started at a low dose and slowly adjusted upward.Two newer dopamine agonists, pramipexole (Mirapex) and ropinirole (Requip), have also been found helpful in treating restless legs syndrome,[34,35] although there are less experience and fewer clinical trials involving these medications to date. Although the dopamine agonists are currently considered to be second-line agents after failure of carbidopa-levodopa therapy, as experience with and knowledge of these promising drugs increases, they could become medications of first choice.*Benzodiazepines*The benzodiazepines have nonspecific sleep-promoting properties. Whether they also have a specific effect on restless legs syndrome and periodic limb movement disorder is unclear.[2] Clonazepam (Klonopin) is the best-studied benzodiazepine for this disorder, but other medications in this class have been used as well. Benzodiazepines could be a satisfactory choice in treating restless legs syndrome symptoms that are relatively mild and primarily sleep related.[8] Side effects of daytime drowsiness, confusion, and unsteadiness might be problematic, particularly in elderly patients. Prescribers and patients also need to be aware of the potential for habituation and dependence with all benzodiazepines.*Opioids*Opioid agents have been shown to be helpful in both restless legs syndrome and periodic limb movement disorder.[36,37] In addition to their analgesic and sedative properties, they might work through a specific interaction between the opioid and dopaminergic systems. Direct comparisons between various opioids and between opioids and other medications, are lacking. Because of concerns about their addictive potential, these agents are generally reserved for use in more severely affected patients, in patients who have failed other medications, or in the uncommon patient with pain as a prominent symptom.*Other Medications*Anticonvulsant medications have been used with some success in restless legs syndrome. A 1984 double-blind, placebo-controlled study of carbamazepine (Tegretol) in 174 patients showed significant improvement in both the treatment and placebo groups, although there was a demonstrable treatment effect.[38] Since then, only two very small open-label trials have been undertaken using carbamazepine in restless legs syndrome that have showed modest benefits. More recently, gabapentin (Neurontin) has been found to have some benefit in treating restless legs syndrome. In an open-label study involving only 8 patients, gabapentin was given in doses ranging from 300 to 2,400 mg/d (mean 1,163 mg/d). Three patients had 76% to 100% improvement in restless legs syndrome symptoms, 1 had 0% to 25% improvement, and the remaining 4 patients experienced no benefit.[39] A second open-label series involved 16 consecutive patients who took gabapentin at doses ranging from 300 mg at bedtime to 400 mg given 5 times a day. All patients reported at least a 50% improvement in restless legs syndrome symptoms.[40]Although these anticonvulsants might have a role in treating undifferentiated patients with restless legs syndrome, they might be particularly well-suited for those with neuropathy or considerable pain. Small trials have suggested some improvement of restless legs syndrome symptoms with clonidine (Catapres),[41] which might be appropriately tried in a patient with both restless legs syndrome and hypertension.


Best wishes,


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## gfinster (Jan 11, 2001)

I've been on Neurontin (aka Gabapentin) for about three months now and it has helped quite a bit. It's used for lots of things besides epilepsy. It's used for pain, phantom pain, 4th stage sleep, bipolar disporder, depression, just to name a few. I don't have restless leg syndrome but I do have sleep disturbance and FM and I am improving. My mood has improved as well. I take 300 mg before bed. That's really low dosage and it is a very safe med with very few interactions. My constipation became worse though, so I have to work hard at keeping up fibre intake and water. The sleep has been worth it. I also take Xanex on and off for relaxation when muscles get all tied in knots. I understand your depression. I'm newly diagnosed as well. I still have a muscle EEG test to take to rule out other diseases but FM looks like it. I was crying all day yesterday grieving the loss of my vitality and activity level. I'm very athletic - I have two horses, ride dressage and play tennis. Now I can barely walk around the house and put in a load of laundry. I quit work over a year ago due to health - we didn't have any names back then, still not completely sure -- so I know how you feel. It will get better - and some days worse. I used to stay depressed but the meds have helped that a lot. We just have to be thankful for the health that we do have and keep listening to our bodies and trying new things to help us improve. Stay on the board because the support really helps.  Here are some neurontin links fyi: http://www.intelihealth.com/IH/ihtIH/WSIHW...486/334024.html rxlist.com is my favorite site to check out different drugs: http://www.rxlist.com/cgi/generic/gabapent.htm


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## LoriAnn (Jan 31, 2002)

I don't really have much to add to what the others have said except that I hope things improve for you soon.Wishing you health & happiness







Lori


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## squrts (Aug 14, 2000)

welcome crazy,i use neurotin along with trazadone at bedtime.it works for me.as for pain,i take darvasett,clonipin,and baclofin.it aint perfect but it helps.


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## Guest (Mar 24, 2002)

Don't feel badly about venting over your pain... that's what this place is for, I think?







I have FMS, IBS, chronic fatigue, arthritis in my hips and daily pain. The more I move, the better I feel. I even get temporary relief from participating in modern dance which involves a lot of stretching and flexing. But I am never without pain. On those days when it makes me cry, I sometimes have a great deal of difficulty forcing myself to go to dance class.... but I take a warm shower to help relax muscles and I take pain relievers and well as antihistamines/decongestants. Collectively they somehow help me to ignore the pain long enough to get through the dance classes... which I love so much. I also eat things like chocolate.... somehow it helps with the pain.


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## Guest (Mar 24, 2002)

This may not be your typical response to what to do about pain.... but one of the things that helps me the most with pain..... is orgasm. Whether with my husband or alone..... I engage as often as I need to in order to keep myself feeling good and as pain-free as possible. There is a scientific reason why this works.... orgasm releases tons of "feel good" hormones throughout the body. And the effects can last anywhere from a few hours to a few days.


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## Susan Purry (Nov 6, 2001)

Hi Artspirit - are you a new name round here or have I missed you before? If you're new, welcome!Do you find the movement which helps with your pain leaves you more fatigued? I do find movement helpful for pain, but it leaves me more depleted in terms of energy (I have CFS). Of course, the real question, is; is orgasm or chocolate best?!!!














I think it's all to do with endorphins isn't it.


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## Guest (Mar 25, 2002)

New is old and old is new..... I started here a few weeks ago, then left for a while because I was too busy to post.... but I continued to read. Thanx for the welcome.Regarding the stretching and flexing exercises that go along with modern dance..... if I work at it as hard as my technique instructor would like me to, I do run into trouble with the fatigue. In fact, I am often unable to finish the sessions. I've been known to just lie on the floor and fall asleep for a few minutes. But I love dance so much.... and it seems I have a gift for it... so I try to moderate the exercise so that I don't get so tired. In fact, sometimes I even feel energized afterwards when I can keep the exericise moderate. I tend to get carried away at times because I love it so much. I barely eat for 3 days prior to a performance, and the day of the performance, I don't practice except to warm up and maybe "go through the motions" just to recap in my mind what I need to dance.Chocolate, orgasm, wine, song, dance.... whatever it takes.... I do it as best I can. Until the day I can no longer do it.... I'll dance and dance and dance When you love something... there's always a way.Having to sew my most recent costume, however, was an even bigger challenge. I'd never have made it as a seamstress


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