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Suggest Remedies For Chronic Pain Syndrome
Question: Dr. Naval Mendiratta, this is to inform you that I have just taken my third injection of testosterone and am feeling no better. I know that I must be patient but it's very difficult to suffer like this. Should I keep my chin up?
Brief Answer:
Continous Pain
Detailed Answer:
Good evening there
Sorry for late reply...Was caught up as I had presentation today
Well, if your pain is still going on despite the injections, I feel we need to put on pain modulators. I think the cascade of your pain cycle has become constant and it needs to be broken with some different medications as well. Once broken it will have a better effect on your overall pain and maybe response to these injections as well.
I feel the symptoms go more in favor of Fibromyalgia/Chronic pain syndrome. It may have been due to low testosterone which has triggered the attack and something we need to break in due course of time.
I would suggest you start on the drugs for it, maybe for a short course and see how the improvement happens. Recommended Drug: Duloxetine 20 mg or Amitryptilline 10 mg...Meanwhile continue with the injections as well. I am hoping your pain and fatigue should respond to this.
You can discuss this with your physician and let me know what they say. But yes, i feel we need to step up if there is still not much improvement
Regards
Dr Naval
Continous Pain
Detailed Answer:
Good evening there
Sorry for late reply...Was caught up as I had presentation today
Well, if your pain is still going on despite the injections, I feel we need to put on pain modulators. I think the cascade of your pain cycle has become constant and it needs to be broken with some different medications as well. Once broken it will have a better effect on your overall pain and maybe response to these injections as well.
I feel the symptoms go more in favor of Fibromyalgia/Chronic pain syndrome. It may have been due to low testosterone which has triggered the attack and something we need to break in due course of time.
I would suggest you start on the drugs for it, maybe for a short course and see how the improvement happens. Recommended Drug: Duloxetine 20 mg or Amitryptilline 10 mg...Meanwhile continue with the injections as well. I am hoping your pain and fatigue should respond to this.
You can discuss this with your physician and let me know what they say. But yes, i feel we need to step up if there is still not much improvement
Regards
Dr Naval
Above answer was peer-reviewed by :
Dr. Raju A.T
I always get confused when you use the word pain because I have none. I assume it's synonymous with fatigue and body aches which I have. My primary doctor wrote the prescription for testosterone injections but today I went to my endocrinologist for my diabetes. I showed him my labs and the two meds that you had suggested to break the cycle. He didn't think much of either one or of the injections! I couldn't believe it! Keep in mind that he had no prior knowledge of my severe fatigue and body aches. He even suggested zymbalta! I don't need another psychiatric med but I just listened to him. I need to see my primary care doctor. Do you still think one of these meds wouod break the cycle and bring me some relief? I just wish I could see some improvement.
Brief Answer:
Chronic Fatigue
Detailed Answer:
Good evening there
Well, sorry about the nomenclature. It is mostly the fatigue which is bothersome,,I keep on saying the pain.
Well, I am not sure why he disagreed with the medicine when he prescribed the same one. Zymbalta/Cymbalta is the same I prescribed. It has duloxetine in it. I think you need one of it to break the cycle. I would have expected some benefit from testosterone by now, at least a feel good factor comes. But since after 3 there is hardly any improvement, we should switch to the other alternative.
You can discuss it with your physician. Dont worry, it is not a psychiatric medicine. It has multiple uses and one of it is in this disease as well..
Discuss it and let me know
Regards
Dr Naval
Chronic Fatigue
Detailed Answer:
Good evening there
Well, sorry about the nomenclature. It is mostly the fatigue which is bothersome,,I keep on saying the pain.
Well, I am not sure why he disagreed with the medicine when he prescribed the same one. Zymbalta/Cymbalta is the same I prescribed. It has duloxetine in it. I think you need one of it to break the cycle. I would have expected some benefit from testosterone by now, at least a feel good factor comes. But since after 3 there is hardly any improvement, we should switch to the other alternative.
You can discuss it with your physician. Dont worry, it is not a psychiatric medicine. It has multiple uses and one of it is in this disease as well..
Discuss it and let me know
Regards
Dr Naval
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Again this endocrinologist has always treated me for diabetes and had no knowledge of my fatigue or of my injections. He didn't prescribe zymbalta; he just suggested it. I understand that it's very similar. Hopefully I can talk with my primary care physician tomorrow and get a prescription. Can we still use the term fibromyalgia even if there's no pain? And how long should I take the prescription? Until I notice a difference?
Brief Answer:
Chronic Fatigue Syndrom
Detailed Answer:
Good evening XXXXXXX
Well, Chronic Fatigue syndrome/Fibromyalgia are more of overlapping terms only. If there is no pain, we label it as chronic fatigue syndrome.
Well, it is hard to say. Once we are sure of the diagnosis we have to try the medicines to see which one suits you and which one has maximum benefit. Normally it takes around 2-3 weeks for the medicine to show the effect. If you dont feel good after that, we will have to switch to alternate one or increase the dose of the medicine...Cause as of now, with all the blood tests normal we dont have any other diagnosis.
So let s give it a shot and see what we achieve at...
Regards
Dr Naval
Chronic Fatigue Syndrom
Detailed Answer:
Good evening XXXXXXX
Well, Chronic Fatigue syndrome/Fibromyalgia are more of overlapping terms only. If there is no pain, we label it as chronic fatigue syndrome.
Well, it is hard to say. Once we are sure of the diagnosis we have to try the medicines to see which one suits you and which one has maximum benefit. Normally it takes around 2-3 weeks for the medicine to show the effect. If you dont feel good after that, we will have to switch to alternate one or increase the dose of the medicine...Cause as of now, with all the blood tests normal we dont have any other diagnosis.
So let s give it a shot and see what we achieve at...
Regards
Dr Naval
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Additional medicine background: I've been on 450 mg lithium a long time for depression and mood stabilization, and 15 mg ritalin for 5 months which has done nothing. Previously I was on on cymbalta and provigil. My primary care doctor said that if I didn't see some improvement after three injections that they probably wouldn't help. He said that the duloxetine or amitryptilline wouldn't help because I'm not depressed. If I were depressed, they would help the depression and thus help the fatigue and energy level. Does that make sense to you? He recommends increasing the ritalin from 15 to 30mg and see what happens. He said we could go up to 60mg a day if needed. What do you think about this strategy? The bottom line is to give me some relief. Unfortunately I have to wait for my psychiatrist to write the prescription for the increase.
Brief Answer:
Management of Chronic Fatigue
Detailed Answer:
Good evening
Sorry for the late reply. Had a long duty..
1. Duloxetine and amitrytilline are not anti depressants as such. They are used for multiple purpose with chronic fatigue and fibromyalgia being one of them. We have used it and seen quite some difference.
2. As for the Lithium, I just would like to confirm if they have checked your lithium levels in the blood. That is something which needs to be checked once 3 monthly...To make sure it is making an impact and to avoid toxicity. So incase it hasnt been done, Would recommend you to do those.
3. As for Ritalin, you can increase it. I really doubt it will work if it is not working at 15 mg. But never the less, we can give it a try....Maybe we can give it a try of this tablet and then switch to duloxetine or amitryptilline if tat doesnt work
Do let me know for more queries. But to my prospective, I will want to try something different to help you improve than stick to the same thing
Regards
Dr Naval
Management of Chronic Fatigue
Detailed Answer:
Good evening
Sorry for the late reply. Had a long duty..
1. Duloxetine and amitrytilline are not anti depressants as such. They are used for multiple purpose with chronic fatigue and fibromyalgia being one of them. We have used it and seen quite some difference.
2. As for the Lithium, I just would like to confirm if they have checked your lithium levels in the blood. That is something which needs to be checked once 3 monthly...To make sure it is making an impact and to avoid toxicity. So incase it hasnt been done, Would recommend you to do those.
3. As for Ritalin, you can increase it. I really doubt it will work if it is not working at 15 mg. But never the less, we can give it a try....Maybe we can give it a try of this tablet and then switch to duloxetine or amitryptilline if tat doesnt work
Do let me know for more queries. But to my prospective, I will want to try something different to help you improve than stick to the same thing
Regards
Dr Naval
Above answer was peer-reviewed by :
Dr. Arnab Banerjee
I understand about trying something different but it looks like I'll have to increase the ritalin first. Why wouldn't it possibly work at a higher dose? Do you not use it in some cases? Are your two medications used frequently for fatigue and fibromyalgia? I will definitely try them after ritalin. He wants me to stay on the injections in case they're doing some good. You have been so helpful to me as I appreciate all of your information.
Brief Answer:
Ritalin
Detailed Answer:
Good evening
Well, Ritalin( methylphenidate) is something I havnt used yet.So I am not too sure how much benefit it will provide
The ones I recommended are the one which we use in our daily practice with good results. The injections you can continue for 3 more doses and see if it provides any benefit. After 6 I wont suggest continuing it.
I hope the best for you and whatever medicines they are gonna try should work out for you. Just remember, to keep meditating and yoga...
Do let me know for more queries
Regards
Dr Naval
Ritalin
Detailed Answer:
Good evening
Well, Ritalin( methylphenidate) is something I havnt used yet.So I am not too sure how much benefit it will provide
The ones I recommended are the one which we use in our daily practice with good results. The injections you can continue for 3 more doses and see if it provides any benefit. After 6 I wont suggest continuing it.
I hope the best for you and whatever medicines they are gonna try should work out for you. Just remember, to keep meditating and yoga...
Do let me know for more queries
Regards
Dr Naval
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thanks for all of your help. What dose of the two recommended meds do you suggest? And do you prefer one over the other? You have had success with them. Does that mean less fatigue and achiness? Or is it used in combination with other meds? Ritalin is a stimulant so why couldn't it help me at a higher dose? Does it not help fatigue? And why do you think the injections haven't worked? Sorry for all of the questions but I'm concerned about the quality of my life!
Brief Answer:
Further queries
Detailed Answer:
Good evening mr XXXXXXX
Well, it s all a pleasure I can be of some help to you
As per your queries:
1. I would suggest Duloxetine over amitryptilline...Personal experience has been better , but both are of equal efficacy. Depends which one suits which patient
2. It can be used along with your lithium, but then we will have to stop Ritalin. I am not sure about the drug interactions between these drugs but we cant overload with so many medications who do come with a small risk of side effects as well.
3. Ritalin , as mentioned I dont have any experience with it. Either you have reached a saturation point with it or it is not working in your case at the current dose. Since you have been on it for a while now without much improvement in your fatigue, I really doubt it will work further on increasing the dose.
4. Injections may not have worked as Low testosterone may not be the only cause for your fatigue. Maybe something else we are looking at and missing. Maybe something which needs more medications to help control the fatigue levels. So, it can be that your diagnosis didnt click here or there is something else which needs to be treated.
i hope the information was useful
REgards
Dr Naval
Further queries
Detailed Answer:
Good evening mr XXXXXXX
Well, it s all a pleasure I can be of some help to you
As per your queries:
1. I would suggest Duloxetine over amitryptilline...Personal experience has been better , but both are of equal efficacy. Depends which one suits which patient
2. It can be used along with your lithium, but then we will have to stop Ritalin. I am not sure about the drug interactions between these drugs but we cant overload with so many medications who do come with a small risk of side effects as well.
3. Ritalin , as mentioned I dont have any experience with it. Either you have reached a saturation point with it or it is not working in your case at the current dose. Since you have been on it for a while now without much improvement in your fatigue, I really doubt it will work further on increasing the dose.
4. Injections may not have worked as Low testosterone may not be the only cause for your fatigue. Maybe something else we are looking at and missing. Maybe something which needs more medications to help control the fatigue levels. So, it can be that your diagnosis didnt click here or there is something else which needs to be treated.
i hope the information was useful
REgards
Dr Naval
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Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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