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Suggest treatment for pain and anxiety

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Practicing since : 1983
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I have been tested for genetic markers and have come back with a double marker on COMT which explains why I have been in some level of pain sensitivity since I could talk. As time has gone by I'm in my sixtys and have chronic Lyme's ,degenerative musulo-skeletol disease,fibromyalgia and chronic pain syndrome. I have been given many pain med.s and antidepressants. COMT is Catechol-O-methyl transferanse the enzyme primarily responsible for breaking down the neurotransmitters dopamine,epinephrine, and norepinephrine. Have there been any studies on brain enhancement chemical stabilizers that would help my pain level and the receptors of the brain to eliminate anxiety. I have tried many of the antidepressants over many years. I am very sensitve to many, they cause suicidal feelings, weight gain, heart irregularity ,high blood pressure. Most doctors don't even know what this is or are shooting in the dark. What has worked for me was a low dose of dilaudid 4mg,4-5x a day or as needed, ambien 10 mg. at night, and valium 5 mg. 3x a day for severe muscle spasm and anxiety. Doctors in Fl. have taken me off valium and changed to Fentanyl patch 75 mcg. and tramadol that makes my stomach sick. They are even trying to remove my sleep med. Iam in pain and have terrible anxiety. Can you tell me what antidepressants are available for COMT?
Posted Thu, 30 Jan 2014 in Anxiety and Stress
Answered by Dr. Saatiish Jhuntrraa 2 days later
Brief Answer: There are many options for you Detailed Answer: Hello thanks for choosing WWW.WWWW.WW I am sorry to learn that you have so many problems. I shall try to help . As you have described,your pain threshold has been low since childhood, -you have many diseases having pain as main symptom, -you have anxiety as well , -you have been receiving some antidepressants ,some causing side effects including suicidal ideas - you have been on narcotic analgesics and hypnotics 1.One can do nothing about pain threshold as it varies from person to person and in the same person from time to time 2.COMT is an enzyme for metabolism of monoamines . Your genetic makeup doesn't indicate that antidepressants acting by inhibiting the reuptake of serotonin,norepinephrine or dopamine are not suitable for you. It means you will breakdown these chemicals faster than others so may need higher dose to get the same benefit 3.For inhibition of pain pathways and increase pain threshold, we need medicines who can increase levels of norepinephrine in nociceptive pathways so drugs like SNRI (Desvenlafaxine, Duloxetine,milnacepran) may be useful. These could help both in anxiety as well as in pain. 4.The fact that you have been given unsuccessful trials of many antidepressants raise some questions- did you develop stimulation ( antidepressant induced excitement) , or were they tried in adequate doses for adequate period of time) Specially in cases like you, they should be guided by the serum levels of medicines to make sure you are getting adequate dose and adequate time is a period of 8-10 weeks 5.There have been numerous studies and research in this field,esp in last 2-3 years. Now we have moved forward from the era of monoamine theories of depression . There are definite indications and strong data which tells the role of other chemicals like Glutamate , leading to newer molecules in the horizon. I would suggest the following line of action for you a.) Presently you are on medicines which have high risk of dependance. That is perhaps the reason your doctors are trying to take off sleep inducing valium and ambien. Some of your problems may be due to withdrawl effect from narcotic analgesics . Instead I personally would prefer to try baclofen sustained release for a short time to help you wean away from valium and ambien and dilaudid b) I would prefer to try nortriptyline with monitoring by serum levels for at least 8-10 weeks . Other medicines could be desvenlafaxine,duloxetine c.) I would also assess you for the presence or absence of mood disorder .If it is present, I would add a mood stabilizer ,helpful to control pain stimuli as well. d) As for other options, I would try L methyl folate , rTMS, Lithium or thyroid supplementation to augument the effect of medicines I hope this will help you a bit. I shall be glad to answer any more queries DR SAATIISH JHUNTRRAA
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